In 1959, Dorothea Orem created the Self-Care Deficit Theory which encompasses three interrelated theories such as the Theory of Nursing Systems, the Theory of Self-Care, and the Theory of Self-Care Deficit. She explains that in normalcy a normal person can provide self-care while healthy. She also explains that once a person falls ill or has a disease process that has been compromised they will have self-care deficits.
When patients are hospitalized, we as nurse assess the patient ability to provide their own activity of daily living. Activities of daily living consists of being able to feed, bathe, groom, dress, ambulate, brush their teeth, and be able to use the bathroom independently for themselves. When these patients are admitted into an impatient setting, it is important in the nurse-patient relationship to assess the needs, their ability to provide or assist in their own ADL’s, and to provide assistance in those areas they are deficient in until they complete treatment and get stronger (Younas 2017). Level of Theory Orem’s Self Care Deficit Theory is considered a grand theory because it based on the nurse-patient relationship. This theory is a very broad, complex, and abstract. It is not a theory in which you can predict, and easily test, as it involves very many different clinical perspectives, assessment and limitations of the patient, the disease process or illness involved, and the environment.
Origins The origins of this theory was developed starting in 1949 and continued to be redefined up until the early years of 2000 (McEwen ; Willis, pg. 142-145). As part of the totality paragram it describes human beings being able to adapt to their own environment while providing self-care. Orem framework was brought to fruition through her experience a nurse, director of nursing, university dean and personal observation of the nurse and patient relationship in the rehabilitation healthcare setting (Younas 2017).
Major Concepts “Nursing is seen as an art through which the practitioner of nursing gives specialized assistance to persons with disabilities which makes more than ordinary assistance necessary to meet needs for self-care (McEwen & Willis, pg.144).” The other concepts in Orem’s theory were environment, health, self-care, basic conditioning factors, and therapeutic self-care demand, the nursing system, nursing agency, and self-care deficit. Selfcare is described as a “deliberate action to supply or ensure supply of necessary materials needed for continued life, growth, development, and maintenance of human integrity (McEwen & Willis, pg. 144). Selfcare is described as a “deliberate action to supply or ensure supply of necessary materials needed for continued life, growth, development, and maintenance of human integrity (McEwen & Willis, pg. 144). Those maintenance are described as the sufficient intake of air, water, food, balance between rest and activity, social interaction, normal elimination of waste and excretions, and prevention of any unsafe hazards (Smith & Parker 2015).
Other sub-concepts included universal self-care requisites, development self-care requisites, and health deviation self-care requisites. The self-care requisites describe that self-care was common to all humans. Development self-care requisites states that it is necessary for growth and development through all ages of life. Health deviation self-care requisites is congruent to health deficits related to illness or a disease process.
Major Theoretical Propositions “Human agency is exercised in discovering, developing, and transmitting others ways and means to identify needs for, and make inputs into self and other (McEwen & Willis, pg. 145)”. In order to provide care to any patient the nurse must assess the patient, their condition, limitations, and needs to develop a plan of care surrounding what the patient can do for themselves, the needs that will need to be covered with assistance from the nursing staff, and set goals for the patient to regain all responsibility in providing self-care. Depending on a patient’s functional ability, Orem categorize self-care in three categories which are wholly compensatory, partly compensatory, and supportive educative system. Wholly compensatory is described as when the patient is completely dependent on the nurse or others to provide all of their care. Partly is described as when the patient is involved in their care to a certain measure, but still needs partial help from the nurse or others.
The Supportive educative system is when the patient can provide their own care but may have the need to be taught or given extra resources. Major Assumptions The major assumptions made with Orem’s self-care theory is that humans are able to maintain good health, and promote wellness when self-care is given. Although she describes how humans have the ability to provide such care themselves, when humans are impacted by illnesses, disease, or injury that it is the nurse that who must provide care to help aid human improve health and sustain life (Younas, 2017). She also makes the assumption that humans can learn how to provide self-care through education and additional resources. This is an example of when the nurses do patient teaching prior to discharge.
For instance, a patient with a new colostomy would be taught how to keep the surrounding area clean and intact to prevent skin breakdown, and how and to when to empty the bag. The strength of Orem’s theory is that over years it has been heavily utilized and practiced amongst nurse in the care that is delivered to our patients. The context of her theory can be used in different situations, environment, and all individuals across the human lifespan. We assess our patients to see what they can do independently and assist with the other care they can’t effectively do on their own that can be related to weakness, functional limitation, or developmental limitation.
As the patient get stronger we encourage them to resume the task they previously were able to do independently or with assistance from staff. The weakness of Orem’s theory is that the message is simple, the application, testing has proven difficult for researchers. There is a lack of research studies and analysis from other theorist on her work. It also limits the age of humans as these theories would be difficult to apply the aging population and infants. Although, she expanded and defined several concepts in her theory she did not expand on how illness and what the relationship was in relations to the patient’s environment. Over the last thirty years, the basics of her theory has stayed the same, but several revisions have been made on the theorist part to reduce the complexity of this theory and to keep put with the technology and forever evolving practices of nursing.
REFERENCES
1. McEwen, M., & Wills, E. M. (2014). Theoretical basis for nursing (4th ed.).
Philadelphia, PA: Lippincott Williams & Wilkins
2. Smith, M., & Parker, M. (2015). Nursing theories and nursing practice. Retrieved from https://ebookcentral.proquest.com on August 27th, 2018.
3.Younas, Ahtisham,M.N.(c), B.S.N. (2017). A foundational analysis of Dorothea Orem’s Self-Care Theory and evaluation of its significance for nursing practice and research. Creative Nursing, 23(1), 13-23. doi:http://dx.doi.org.ezproxy.uta.edu/10.1891/1078-4535.23.1.13 Retrieved on August 27th, 2018.
