Nursing theory shapes and frames the distinctions of nursing as a unique discipline. Nursing is shaped by practices and concepts which have evolved over the years. To clearly define a nursing theory and place it in its rightful context in nursing practice it is important understanding how knowledge-based concepts have emerged and started being applied in nursing practice. Nursing theories in simple terms are knowledge-based concepts which define nursing as a profession, its scope and place in healthcare delivery. Nursing theories rely on evidence-based approaches. Evidence based practice ensures that nursing fits in the broad concept on offering patient-centered healthcare services to the community. According to Salifu, Gross, Salifu & Ninnoni (2019) nursing theory should be translated into practice to ensure that patients benefit from research advances conducted over the years. Presence of a theory-practice gap should be the main focus to ensure that different theories are applied in nursing practice Dorothea Orem’s self-care deficit nursing theory focuses on the ability of each individual to perform self-care to maintain optimal health, life and overall well-being. This discussion shall provide a solid background to nursing theory and further explore application of Dorothea Orem’s self-care deficit nursing theory in nursing practice. In her theory, Orem posited that nurses should only provide assistance to patients when they (patients) are not in a position to do so on their own.
History of Nursing
Florence Nightingale is hailed as the founder of modern nursing practice. Although many things have changed in the definition and application of nursing practice, the original idea remains with nursing being described as a profession that assumes responsibility for the continuous care of those in need. In Nightingale’s case, people in need may include the injured, sick, or those in palliative care. Nursing takes care of delicate processes including antenatal and post natal care. The scope of nursing continues extending. For instance, nurses also educate communities on healthy lifestyles and approaches to achieve optimal levels of health. Currently, nurses are also involved in research and policy development. The new scope of nursing include new developments which show how nursing as a profession has evolved since its inception. Florence Nightingale was a well-educated daughter of a wealthy British couple. At that time, nursing was not viewed as a prestigious profession, especially for children coming from rich families. However, Nightingale believed that nursing could find its position in the healthcare delivery system by using the best approaches to take care of sick and the injured. Nightingale also considered nursing a noble profession for women who had limited chances of finding their way in other professions.
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Nursing theory and practice have dramatically changed since the time of Florence Nightingale in the 19 th century. According to Stolley, Buckwalter & Garand (2000) nursing theory in the early days was only used to guide teaching and not to be applied in practice. The challenges presented are addressed in today’s nursing practice. To understand how nursing has changed and transformed from a non-clear profession to its current status today, one can explore the environment it was practiced then and the environment today. During the British Crimean War, Florence Nightingale had the chance to test her beliefs and practice nursing in a needy environment. There were many soldiers who were injured and hence requiring the services of a nurse. Nightingale was requested by the British government to take a small pack of nurses to the war front and aid in nursing activities. The nurses improved sanitary conditions in the environment the wounded soldiers were nursed. Deaths plummeted and many soldiers recovered to participate again in the war. The discovery would set a perfect precedence to improve the profession and offer a wider scope of services.
Nursing philosophy has equally evolved just like nursing theory. According to Kristofeersen (2019) “ philosophical inquiry has been one important contributor to understanding fundamentals or philosophical premises underlying the nursing discipline and the pursuit of excellence in nursing care. ” Nursing theory and intervention since Nightingale’s time has relied on philosophical inquiry. Nightingale’s nursing philosophy quickly spread in the western world. By the end of the 19 th century, many countries had started focusing on nursing as a serious profession that could revolutionize healthcare delivery. However, total transformation would take more than a century. In the 20 th century, nursing started as a weak profession. Nurses were viewed as physician-assistants and not as independent players in the healthcare delivery system. Their services were not well defined as they are today. Nursing evolved as a profession in the 20 th century. Many training centers emerged and relied on nursing theory to teach nurses. However, a huge gap existed between training of nursing theory and application in nursing practice. Furthermore, policy formulators lacked goodwill to develop nursing as a profession and give it the autonomy it needed to grow as an independent profession. Many nursing training schools were owned by hospitals in the 20 th century. Although the trend continues, independent institutions have started offering nursing courses to bridge the gap between theory and practice. Nursing theory informs current practice in nursing. Theory is implemented to practice through evidence-based strategies. These strategies involve identifying challenges in nursing practice and identifying the best approaches to address them. Furthermore, nursing research has come up as a major boost to nursing practice. More theories are being developed through nursing research and their application guided by the goals and principles of nursing. Nursing as a profession continues evolving. Unlike in early 20 th century when it was lowly rated in the society, today it commands much respect as the backbone of the healthcare system.
Evolution of Nursing Theory
Nursing theory is the rigorous structuring of concepts and ideas that provide a systematic and purposeful approach to nursing as a profession. Nursing theory should inform ideas applied in nursing practice to ensure that such decisions are always reached from an informed point. In the book “Nursing Theories and Nursing Practice”, Parker (2005) argued that, “ a theory, as a general term, is a notion or an ideathat explains experience, interprets observation, describes relationships, and projects outcomes” (p. 4). Therefore, theories in nursing practice emerged to address ideas, and/or provide new approaches that should be applied to improve nursing as a profession. Florence Nightingale is hailed as the first nursing theorist. Although her approach was simple and straightforward, other theorists have anchored their arguments on her views to provide the current complex nature of nursing theory. Parker (2005) explored nursing theory in the context of nursing knowledge. Nursing theory tries to advance knowledge in nursing profession. Paradigm is described as general framework made of various assumptions made in a given discipline. In nursing, the concept is used to understand nursing knowledge and its purpose. It is impossible to think about nursing theory without exploring nursing philosophy. According to Parker (2005) nursing philosophy comprises statements of enduring beliefs and values that shape nursing and guide members in the profession as they provide their services. Nursing philosophy is the heart of nursing practice. Any nursing theory must be anchored on nursing philosophy. Therefore, as the debate expands on nursing theory, there are several ideas which are common in every theory. For instance, every theorist must shape their idea to the concept of patient-centered service delivery.
Florence Nightingale came up as the first nursing theorist in 1860s. In the environmental theory of nursing, she described nursing as the act of utilizing the immediate patient environment to assist in their recovery. In her work, she focused on issues like sanitation and cleanliness to ensure that patients recovered in a healthy environment. Little effort was made in nursing theory until mid-20 th century. The theory of interpersonal relations was introduced by Hildegard Peplau in 1950s. As the name of the theory states, the theory focused on healthy patient-nurse relationships. This theory would be used as the bedrock to advance studies in nurse-patient relationship. The nursing need theory was also developed during this period by Virginia Henderson. In 1960s, nursing theory was taking shape. Theorists like Ida Orlando, Faye Abdellah and Dorothy Johnson came up with more theories of nursing. The behavioral system theory by Dorothy Johnson is among the most impeccable works during this period. Dorothea Orem developed the nursing care theory in 1971. During this period, other theorists like Callista Roy developed the theory of interrelated systems. The theories shaped the current state of nursing. All the nursing theories describe a given aspect of the nursing metaparadigm. The nursing metaparadigm has four components including the person, environment, nursing and health. An interaction of these components determines whether nursing outcomes will be achieved.
Theorist Choice
Dorothea Orem made significant contribution to nursing theory in 1970s (Haas, 1990). Her choice in this paper was informed by her contribution and the ability of her theory to integrate easily with other theories and the nursing metaparadigm. Dorothea Orem was the pioneer of the self-care deficit theory. The theory positioned her among the leading theorists and hence her choice in this project. Orem’s nursing theory is tripartite in nature. It includes the theory of self-care, the theory of self-care deficit and the theory of nursing system. The three theories are closely related and focus on provision of all needs to a patient to enhance their recovery. Furthermore, the theories emphasize on a healthy relationship between the nurse and patient to create a supportive-educative system that enhances trust between the two parties. The self-care deficit theory of nursing which will be the main focus in the next section will be explored in the context of her general nursing theory to make more sense.
Theory
The self-care deficit theory is one of the pivotal theories that have shaped how nurses approach nursing practice. It should not be confused with the self-care theory by the same theorist. The self-care deficit theory focuses on the concept of autonomy among patients and the way nurses should intervene to achieve it. Orem acknowledged that nursing emerged because of deficits. Patients have certain deficits that nurses should intervene and offer solution. For instance, while working in a home for the elderly, a nurse realizes that most of them require services like dressing, bathing and feeding. The deficits arise from age, mental impairment, accident, illness among many other causes. The underlying principle in Orem’s self-care deficit theory is the same regardless of the source of deficit. According to Haas (1990) Orem (1971, 1979 1980, 1985) explicitly discussed the notion of a dependent-care relationship between care-givers/parents or nurses in her general theory of nursing. The concept of care giving remains the same eve when nurses come into the picture.
Orem’s self-care deficit theory therefore proposed a model or approach where a nurse should always establish the patient’s strengths and weaknesses to understand the level of care that should be provided. Other issues that should be established include the environmental factors and situational needs of the patient. For instance, while dealing with an infant that has been admitted with pneumonia, the nurse should establish the situational needs, strengths and weaknesses of the patient to provide the right regimen of care. By understanding patients’ deficits, nurses stand a better position when offering their services. Furthermore, Orem noted that patients always recover faster and better when they are allowed to retain or maintain some level of independence. The nurse should not overwhelm the patient with care. A nurse should establish whether the patient can maintain proper hygiene, dress oneself, feed oneself or is in a stable psychological position before providing nursing care. Orem therefore promoted patient independence in her theory. Once the patient is fully independent, they are ready to be reinstated back into the community. In an article exploring the application of Orem’s other theory the self-care theory, among patients with rheumatoid arthritis; Saeedifar et al. (2018) noted that as patients are trained to adopt self-care during recovery, they become more independent and recover faster. The self-care theory therefore integrates with the self-care deficit theory to create an environment where patient needs are only provided to the extent needed without overdoing it. In this way, patient autonomy is maintained and chances of quick recuperation enhanced.
Conclusion
Orem’s self-care deficit theory is found in her general nursing theory that describes the role of nurses in any healthcare setting. The theory promotes patient independence and autonomy. The general principle in this theory is that patients recover better when they are supported to become independent. Just like other nursing theorists, Dorothea Orem fitted her argument in the general nursing metaparadigm. She explored how the patient and nursing interact. The other concepts in the nursing metaparadigm come into play when providing the right environment for health recovery to take place. Nursing theory continues to expand. It is the foundation of evidence-based interventions that guide nursing practice today. Once a theory is proposed, it is tested in a clinical setting and qualified for adoption or dismissal. As nursing sa a profession continues evolving, it is important to acknowledge the huge impact made by nursing theorists to shape the profession and provide crucial information when the profession was in infant stages of development.
References
Haas, D. L. (1990). Application of Orem’s Self-Care Deficit Theory to the Pediatric Chronically Ill Population. Issues in Comprehensive Pediatric Nursing, 13 (4), 253–264. Https://doi.org/10.3109/01460869009014488
Kristoffersen M. (2019). Thoughts of creation and the discipline of nursing. Nursing Open , 6 (2), 566–573. https://doi.org/10.1002/nop2.239
Parker, M. E. (2005). Nursing Theories and Nursing Practice, 2 nd Ed. F. A. Davis Company.
Salifu, D. A., Gross, J., Salifu, M. A., & Ninnoni, J. P. (2018). Experiences and perceptions of the theory-practice gap in nursing in a resource-constrained setting: A qualitative description study. Nursing Open , 6 (1), 72–83. https://doi.org/10.1002/nop2.188
Saeedifar, E. S., Memarian, R., Fatahi, S., & Ghelichkhani, F. (2018). Use of the Orem self-care model on pain relief in women with rheumatoid arthritis: a randomized trial. Electronic Physician , 10 (6), 6884–6891. https://doi.org/10.19082/6884
Stolley, J. M., Buckwalter, K. C., & Garand, L. (2000). The Evolution of Nursing Research. Journal of the Neuromusculoskeletal system : JNMS : a journal of the American Chiropractic Association, Inc , 8 (1), 10–15.
