Dorothea Elizabeth Orem is one of the most celebrated nurse theorists. She developed the Self-Care Deficit nursing theory, a theory which focused on assisting patients to develop self-care agency necessary for maintaining life, health and wellbeing on their own.
Biographical Information:
Orem was born in July 15, 1914 in Baltimore, Maryland. She earned her nursing diploma in the early 1930s from the Providence Hospital School of Nursing in Washington, D.C (Wayne, 2014). She then enrolled in the Catholic University of America in Washington, D.C. for a Bachelors and Masters of Science in Nursing, which she attained in 1939 and 1945 respectively. Orem focused primarily on teaching, research and administration throughout her career. She was appointed the director of the Providence Hospital School of Nursing in Detroit, Michigan from 1945 to 1948, and she held other numerous administrative positions in educational institutions.
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Orem developed her theory in the early 1960s, and she has revised it on numerous counts in the course of her career (Wayne, 2014). The socioeconomic aspects of the 1960s influenced her theory tremendously. There were a number of social challenges that increased the demand for nurses, for instance, World War 2 veterans and Vietnam War soldiers needed nursing care. The rising population growth in the 1960s also meant that nurses had to devise better ways of serving the increasing needs of the society. There were positive social and economic developments too, that played a role. The government was funding nursing programs and medical programs like Medicaid; hence the demand for nurses was on the rise. Orem figured that it was important to teach self-care among patients to reduce the demand for nurses.
Main Concepts of the Theory Model
Orem’s theory is made up of three interrelated theories: theory of self-care, self-care deficit theory and theory of nursing systems (Orem, 1990). Orem believed that each individual has the ability to take care of his/her health needs as well as the needs of the dependents. Orem summed up her theory when she said, “the three-part theory focuses not on individuals, but on persons in relations. Each of the three theories has as its focus a specific dimension of the person: the theory of self-care focuses on the self, the I; the theory of self-care deficit focuses on you and me; and the theory of nursing system focuses on we, persons in community" (1990, p. 49).
The theory of self care focuses on activities that an individual initiates and performs on his/her own behalf to maintain, life and well being (Orem, 1990). Self-care agency on the other hand, refers to the human ability to engage in self care. An individual’s age, developmental state, socio-cultural orientation, economic resources, state of health can affect one’s self care agency. Therapeutic self-care demand refers to the total self-care actions to be performed over a period of time to meet an individual’s self-care requisites. The self-care requisites can be either universal, development or health deviation self-care requisites (Orem, 1990).
Alternatively, the theory of self care deficit states that nursing is needed when an adult is incapable or has limited ability to provide continuous and effective self-care. According to the self-care deficit theory, nurses can support such individuals by guiding, supporting, providing an environment for personal development regarding meeting one’s future needs and teaching (Orem, 1990).
Lastly, the theory of nursing systems describes how nurses, patients or both can meet the patient’s self-care needs. Orem (1990) classifies nursing system into three: wholly compensatory system, partly compensatory system and supportive-educative system.
Apart from the three theories that make up the self-care deficit theory, the theory is also made up of the following important concepts: person, health, nursing and environment (Orem, 1990). Orem described a person as a self-reliant, integrated whole with the capacity to reflect and communicate. Human beings are biologically, symbolically and socially functional beings. However, they have health-related limitations that can render them incapable of providing self-care or care for the dependents. Thus, people will need nursing service when their self-care requisites exceed self-care capabilities (Younas, 2017).
The second concept of the theory is health. Orem described health as a state of wholeness; it entails physiological and psychophysiological mechanisms. Orem (1990) believed that nurses should adopt a holistic approach of care to address all the self-care needs of the patients.
Orem (1990) defined the concept of nursing as an art, a community service and a technology. Nursing entails deliberately selected and performed actions by nurses to improve the conditions of an individual or group of individuals. Nursing is required when the self-care needs of a patient exceed self care agency. Nursing should be provided in a way that it promotes a patient’s future self-care ability. Orem (1990) used the role theory to explain the proper approach to nursing. Nurses and patients play a complementary role as they work together to achieve self-care. As an art, nursing involves designing, providing and managing systems of self-care to improve human functioning. Nurses come up with specific intervention plans to address the unique self-care deficiencies portrayed by an individual. Alternatively, as a technology, nursing is about the application of formalized methods of practice to help nurses achieve certain results (Orem, 1990).
Lastly, the concept of environment refers to external factors that have an effect on the patient’s self-care. The different components of the environment make up an integrated system, which is a source of opportunities that can be taken advantage by nurses. The environment can be either the physical or the social networks. Nurses must recognize the potential for development in the environment, and use it to improve patient care without limiting individual decision and personal pursuits. Nurses can foster a development environment by helping the patient to create appropriate goals and helping them adjust behavior towards attainment of those goals (Orem, 1990).
It is worth noting that Orem did not indicate a particular nursing leader or philosophy that influenced her work directly. However, she cited many other nurses’ work on her theory. She borrows from many nursing authors, and authors from other disciplines.
Impact of Orem’s Theory on Nursing Today
Orem’s self-care deficit theory has been applied to nursing on numerous occasions despite the wide scope. Orem’s theory is based on the promise that nursing care is a way of providing assistance to patients so that they can attain self-care in the end. According to Younas (2017), Orem’s theory describes nursing as a technology and an art to cover all the aspects of nursing in a healthcare environment. However, the theory is more applicable to certain settings, particularly acute care clinics, ambulatory clinics, senior citizens homes, and hospice and rehabilitation centers. The theory is applicable to the management of chronic diseases too, and is often applied by nurses to improve the self-care agency of patients.
Orem’s theory affects other aspects of nursing today. Various nursing articles cite Orem’s theory as their basis for clinical practice. Orem’s theory has been cited heavily by other researchers, and it is recognized as one of the best nursing theories that guide nursing education (Berbiglia, 2011).
Orem’s theory is also applied in specific nursing situations to assess patients for specific self care agency deficiency to establish the best way forward for treating patients. According to Simmons (2009), the theory is quite useful to patients suffering from chronic conditions. Simmons (2009) applied the theory to adult patients receiving hemodialysis for end stage renal disease (ESRD) in an outpatient dialysis setting. Nurses who applied the self-care theory practices in the study by providing educational opportunities and strategies improved self care agency of the patients and made a positive impact on their quality of life.
Future Impact
Orem’s theory has timeless concepts that will be useful in nursing in the future. Orem’s nursing model will continue to promote better patient care in the future. Orem’s theory aims at improving self-care capabilities of patients necessary to maintain life, health and wellbeing. Nursing challenges are bound to increase in the future; hence the theory will be still applicable. Orem’s concept of self-care and holistic approach towards healthcare will be very useful in the future, given the popularity of alternative treatment and holistic practices in today’s society. Nonetheless, nurses must apply the theory based on unique individual and environmental needs.
References
Berbiglia, V. A. (2011). The Self-Care Deficit Nursing Theory as a curriculum conceptual framework in baccalaureate education. Nursing science quarterly , 24 (2), 137-145.
Orem, D. (1990). A nursing practice theory in three parts, 1956-1989. In M. E. Parker (Ed.), Nursing theories in practice (p. 47-60). New York: National league for Nursing.
Simmons, L. (2009). Dorthea Orem's self care theory as related to nursing practice in hemodialysis. Nephrology Nursing Journal , 36 (4), 419.
Wayne, G . (2014). Dorothea Orem’s Self-Care Theory. Nurse Labs. Retrieved from: https://nurseslabs.com/dorothea-orems-self-care-theory/
Younas, A. (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.
