Meaning
For the purposes of this assignment, Dorothea Orem’s self-care deficit nursing theory is chosen. It is based on several principal assumptions, which are the following: a “theory created for a practical science such as nursing encompasses not only the What and Why, but also the Who and How;” nurses and patients should have active and dynamic relationships; care for oneself “must be learned and be deliberately performed for life, human functioning, and well-being” (Hartweg, 2015, p. 107). The main concepts of the theory include six elements. Four of them are related to patients (self-care/dependent care, self-care agency/dependent-care agency, therapeutic self-care demand/dependent-care demand, and self-care deficit/dependent-care deficit), and other two are related to nursing professionals (nursing agency and nursing system) (Hartweg, 2015).
The relationships between the mentioned concepts are comprehensive and complicated due to the theory’s elaboration (Bender, 2016). Primarily, the connections between the theory’s concepts are presented by the interaction between “the self-care agent (person receiving care)/dependent-care agent (family member/friend providing care)” and “the nurse (nurse agent)” (Hartweg, 2015, p. 109). The impact of different concepts on each other is largely determined by various conditioning factors, which include the following: age, gender, developmental and health state, socio-cultural orientation, healthcare system factors, family system factors, patterns of living, environmental factors, as well as resource availability and adequacy (Hartweg, 2015).
Origins of the Theory
It is possible to observe that the historical context, which influenced the scientist’s decision to develop her theory, was her working experience in the Indiana State Board of Health between 1949 and 1957 (Hartweg, 2015). As it is stated by Hartweg (2015), in the process of her practice, Orem noticed that nurses are able to “do nursing,” but they cannot “describe nursing.” Thus, it was her primary motivation to combine a solid theoretical approach with practical experience (Gordon, 2015). Orem’s personal values, her formal education as well as familiarity with works of such philosophers as Aristotle, Aquinas, Harre, and many other, contributed significantly to the development of her theory (Hartweg, 2015).
Orem used the scientific approach in developing her theoretical approach as she was well-acquainted with academic standards of theorization (Hartweg, 2015). In 1956, she published a report, which was entitled “The Art of Nursing in Hospital Service: An Analysis,” and in this report, the early provisions of self-care terminology in the form of “patient doing-for-self or the nurse helping to-do-for-self” had first appeared (Hartweg, 2015, p. 106). Further, she worked both independently and collaboratively in order to improve her theory.
Usefulness
It is possible to state the immense importance of the theory under discussion for nursing science as a whole and, particularly, for nursing practice. As it is mentioned by Hartweg (2015), the implementation of Orem’s theory or its particular provision in various clinical environments could hardly be overlooked, as it influenced significantly the development of contemporary nursing. Since the theory represents a very comprehensive and elaborated framework, it could be efficiently used to predict patient outcomes and also to guide the nurse’s work.
However, it is of high importance to exemplify the practical case, which is described by Hartweg (2015). The case is provided by Laureen M. Fleck, and the following situation is described: Marion W. is presented to a primary care office, and her nurse decides to implement three principal steps of Orem’s process of nursing. They include the following: diagnosis and prescription (first step), design and plan of the nursing system (second step), treatment, regulation, case management, control/evaluation (third step) (Hartweg, 2015).
Testability
The testability of the theory under discussion is highly significant. The theory’s propositions have generated immensely large research since its establishment. Propositions are defined by Hartweg (2015) as “statements about the concepts and their interrelationships” (p. 107). Hartweg (2015) mentions the literature review conducted by Biggs in 2008, which covered nursing literature from 1999 to 2007. As the result of this literature research, more than 400 articles, mentioning, applying, or elaborating on Orem’s theoretical provisions, were found (Hartweg, 2015). Hartweg (2015) also cites one particular example of the study, which was done by using the theory. This study was conducted by Casida and colleagues in 2009 (Hartweg, 2015). They used the theory to “formulate and develop the health-deviation self-care requisites of patients with left ventricular assist devices” (Hartweg, 2015, p. 106). They were also able to include study-specific aspects within the framework.
Overall Evaluation
In overall, the conducted overview of principal aspects of the theory under discussion has revealed its comprehensive character. As it was identified in the previous section, the theory is specific enough to be used in considerably narrow fields of study, but it is also universal enough to be used in ordinary caregiving practice. The primary strengths of Orem’s theory are the following: it is significantly elaborated, it includes various patient and nurse-related components and factors, and it is also based on solid theoretical and practical provisions. Among its weaknesses, one could mention that the theory is not easily comprehended, and it is necessary to study it thoroughly to use efficiently. However, I would use this theory in advanced nursing practice because it is applicable to various specific clinical situations.
References
Bender, M. (2016). Conceptualizing clinical nurse leader practice: An interpretive synthesis. Journal of nursing management, 24(1), 1-16.
Gordon, S. C. (2015). Early conceptualizations about nursing. In M. C. Smith & M. E. Parker (editors), Nursing theories and nursing practice (4th ed.) (pp. 55-66). F. A. Davis Company.
Hartweg, D. L. (2015). Dorothea Orem’s self-care deficit nursing theory. In M. C. Smith & M. E. Parker (editors), Nursing theories and nursing practice (4th ed.) (pp. 76-81). F. A. Davis Company.
The Concept Of Orem’s Theory Of Self-Care Deficit
Meaning
The main idea behind Orem’s theory is that the vast majority of the patients desire to be able to care for oneself and the individual members of one’s family. Some of the major assumptions behind the theory are as follows (Alligood, 2017):
- Every patient is a distinct individual with a unique cultural, educational, spiritual, and socio-economic background.
- Nursing is an action-interaction process with the end goal of promoting healthcare and improving quality of life.
- The effectiveness of an intervention is largely dependent on the patient’s understanding of his or her own health situation and their willingness to proactively participate in the healing process.
Orem’s theory of self-care deficit revolves around four major concepts, which are Patient, Health, Environment, and Nursing (Alligood, 2017). A patient is described as a being capable of interaction on a biological, symbolical, and social level, with universal development needs and capable of performing self-care. The concept of nursing is stated to be an array of interventions and actions with the ultimate goal of making the patients and their family members capable of taking care of their own and each other’s’ healthcare needs. The concept of health is defined as a state of homeostasis between physiological integrity, psychological balance, and social standing. Lastly, the environment is described as a broad array of enthronement factors, elements, and conditions that surround the patient and the nurse.
The relationship between these concepts is complicated, as all of the factors mentioned above are connected to one another. The patient is the centerpiece of this theory, as Orem suggests that it is within the capability of every individual to influence his or her health and the surrounding environment (Alligood, 2017). Nursing influences all three other concepts by enabling the patient to cope with their health deficiencies through an action-interaction process. The environment, in turn, affects a patient’s capabilities to do so. The concept of health serves as a binding element between concepts, becoming a common medium for them to interact with one another.
Origins of the Theory
Orem’s theory of self-care deficit was first published in 1971. During that time, American nursing did not have an outlined sense of direction, purpose, or focus. It was considered a part of healthcare as a whole, with no clear boundaries or definitions that differed it from other healthcare practices (Alligood, 2017). Orem’s primary goal in developing her theory was to provide the definition of nursing as a practice.
Orem’s work was based on the totality paradigm, which suggested that humans were capable of learning new skills to adapt to the surrounding environment and make up for their physical and psychological deficiencies (Alligood, 2017). Her prerequisites for facilitating medical care were heavily borrowed from Florence Nightingale. In the development and subsequent improvement of her theory, Orem worked with many fellow scientists and researchers, while maintaining a leadership. She also used a number of non-nursing philosophies, as the theoretical material in regards to nursing was lacking, at the time. This rooted her theory in scientific and academic concepts, but at the same time made it difficult for some nurses to accept and criticize.
Usefulness
Orem’s theory redefined the way most nursing professionals saw the purpose of their craft and introduced a scientific and evidence-based way of thinking into the nursing process. In addition, it offered many tools to enhance the standards and outcomes of healthcare by incorporating the patient as a proactive element. The theory is valuable from a practical standpoint, as it reduced the amount of workload on nurses while simultaneously enabling patients and families to take care of their own needs. Orem’s theory serves as a basis for many preemptive and educational interventions.
In terms of understanding and prediction of outcomes, Orem made an important discovery, stating the correlation between the ability of the patient to understand and implement self-care and overall success rate of the treatment. According to Orem, higher rates of participation and understanding are connected with positive patient outcomes (Alligood, 2017). A study by Dabbs et al. (2016) uses Orem’s theory in practice by examining the application of self-management after lung transplantation. As evidenced in that research, self-care is a very important aspect of post-operational and post-discharge healthcare management.
Testability
Orem’s theory is highly testable due to its intrinsic proposition of including self-care procedures into the daily routine of both patients and healthcare providers. It generated a great number of studies in order to examine the feasibility, efficiency, and economic sustainability of various self-care and healthcare promotion practice (Alligood, 2017). Although the majority of the studies took the form of randomized control trials, meta-analyses, and qualitative studies have also been performed to evaluate the applicability of Orem’s theory in clinical settings (Alligood, 2017). An example of a study done using Orem’s theory of self-care can be found in research performed by Shang, Zheng, and Xiao (2016), which evaluated the applicability of self-care in elderly patients undergoing artificial hip replacement.
Overall Evaluation
Orem’s theory can be used as a comprehensive framework for the understanding of nursing principles, evaluation of practice, and foundation of research. It provides an overarching blanket theory (Theory of nursing systems) as well as specific and more narrow instances of the application (partially-compensatory, wholly compensatory, and supportive-educative systems) (Alligood, 2017). The theory’s strengths include providing a comprehensive base for nursing practice, specifying when nursing is needed, and generating utility for nursing practitioners. Some of its limitations include dynamic views on health and orientation towards illnesses. I would use Orem’s theory in the scope of my practice as a solid framework to base research on as well as a tool in educational and self-care interventions.
References
Alligood, M. R. (2017). Nursing theorists and their work (9th ed.). New York, NY: Elsevier.
Dabbs, A. D., Song, M. K., Myers, B. A., Li, R., Hawkins, R. P., Pilewski, J. M., … Dew, M. A. (2016). A randomized controlled trial of a mobile health intervention to promote self‐management after lung transplantation. American Journal of Transplantation, 16(7), 2172-2180.
Shang, S., Zheng, Y., & Xiao, Z. (2016). Application of Orem self-care mode on hip function recovery of elderly patients with artificial hip replacement. Modern Clinical Nursing, 15(7), 19-22.
What Is Orem’s Self-Care Theory?
Meaning of the Theory
In the process of care delivery, there are multiple instances when patients are advised to put in their most beneficial qualities despite dealing with an illness for long periods of time. In environments where health care relies on patients being independent, Dorothea Orem’s self-care nursing theory comes into play. Developed by Orem between 1959 and 2011, the theory implies that “people have a natural ability for self-care, and nursing should focus on affecting that ability” (Simmons, 2009, p. 419). Most of the main assumptions revolve around the idea that patients should depend on themselves. For instance, Orem assumed that in care provision, patients should be self-reliant and have knowledge of possible health issues. The theory is divided into such subordinate directions as the theory of self-care, the theory of self-care deficits, and the theory of nursing systems (Simmons, 2009, p. 420). Dominant concepts include nursing (as art, technology, and services), health (as integrity and wholeness), environment (as conditions and enthronement elements), human beings (as a biological unity), nursing clients, nursing problems, nursing processes, and nursing therapeutics.
Origins of the Theory
At the time of the theory’s development, the nursing profession of the United States has been undergoing some significant changes and developments in terms of theoretical exploration. There has been a dramatic leap in nursing education and the emerging ideas of developing the profession systematically, similar to the way engineers or surgeons were trained. Because nursing started to rely more on interactions between patients and their care providers, the creation of the self-care model is understandable. Orem’s theory heavily relies on a specific system of values that include the following:
- Establishing the optimal level of health for all people;
- Helping patients reach independence when managing their personal health care needs;
- Valuing nursing as practice makes it possible for people to achieve the conditions mentioned above.
In supporting her theory, Orem appeals to the importance of relations between people rather than individual needs. The components of the theory focus on different dimensions of care. For instance, the self-care aspect relies on the self of a person, the component of self-care deficits focuses on relations between people, while the aspect of nursing systems relies on people in communities. Thus, the key motivation behind the theory is the idea of improving patients’ abilities to care for themselves by collaborating with healthcare providers. In the development of the theory, Orem uses the causal process approach to formulate connections between dependent and independent variables.
Usefulness
Dorothea Orem’s self-care theory is useful because it allows professionals to understand whether their patients have enough resources to administer self-care. It can show whether self-neglect is an issue and provide a framework for overcoming it. By exploring the relationships between nurses and their patients, the theory facilitates the development of practical insights into what should be done to strengthen those connections or create those that do not exist. By doing so, nurses can predict the likely outcomes.
For instance, when dealing with multiple sclerosis (MS) patients that suffer from constant fatigue, the self-care theory can be applied to a sample group, with health outcomes being evaluated before and after the intervention. The study conducted by Afrasiabifar, Mehri, Sadat, and Ghaffarian Shirazi (2016), revealed that before the implementation of an educational intervention on Orem’s model, only 11% of patients with MS had a solid knowledge of self-care. After the one-month intervention was implemented, researchers observed a significant difference in fatigue outcomes between the intervention and the control groups (Afrasiabifar et al., 2016). This means that the self-care theory is effective at not only strengthening patients’ personal awareness about their health but also produce effective results within reasonable timeframes.
Testability
The theory is highly testable because it is easy to measure patients’ health outcomes in relation to their knowledge and self-care abilities. It has generated multiple studies on a variety of topics. For example, Hasanpour-Dehkordi, Mohammadi, and Nikbakht-Nasrabadi (2016) studied the applicability of the self-care theory for chronic hepatitis patients, while Afrasiabifar et al. (2016) tested its effectiveness for caring for patients with multiple sclerosis. In general, research on the theory implied how well patients could care for themselves in the context of dealing with different health conditions.
Overall Evaluation
In general terms, it can be concluded that the theory was developed for encouraging people to overcome their limitations and become independent in caring for themselves and managing their health conditions. Dorothea Orem’s theory provides a comprehensive look at how nursing practice should benefit patients. On the one hand, the theory is useful for implementation in different settings and multiple areas as well as aligns with the changing nature of the profession, which means that it is highly generic. On the other hand, it is illness-oriented, with health being viewed as a process that does not end. In the advanced nursing practice, the theory can be used for the purpose of supporting patients’ abilities to take control of their health.
References
Afrasiabifar, A., Mehri, Z., Javad Sadat, S., & Ghaffarian Shirazi, H. R. (2016). The effect of Orem’s self-care model on fatigue in patients with multiple sclerosis: A single blind randomized clinical trial study. Iranian Red Crescent Medical Journal, 18(8), 31955.
Hasanpour-Dehkordi, A., Mohammadi, N., & Nikbakht-Nasrabadi, A. (2016). Re-designing Orem’s self-care theory for patients with chronic hepatitis. Indian Journal of Palliative Care, 22(4), 395-401.
Simmons, L. (2009). Dorothea Orem’s self-care theory as related to nursing practice in hemodyalysis. Nephrology Nursing Journal, 36(4), 419-421.