The Self-care deficit theory is a grand nursing theory which is encompassed in Orem’s general theory of nursing. It was developed by Dorothea E. Orem, a nursing theorist. Being a grand theory, it can, therefore, be useful to many instances of nursing. The key foundation of the theory is that all patients desire to provide care for themselves (Berbiglia & Banfield, 2013). Through self-care, they can be able to recover more quickly and holistically. The theory employs concepts such as nursing, humans, environment, health, and self-care. The general theory of nursing entails three interconnected theories.
Theorist Dorothea Orem was born in Baltimore in 1914 in Maryland, in the United States and lived up to the year 2007. Her education background includes receiving a nursing diploma from the Providence Hospital School of Nursing. She earned a BSN Ed in 1939 from the Catholic University of America and in 1945; she earned an MSN Ed from that university. Since then, she worked as a nurse in various capacities and administrator, private duty nurse, and nurse consultant. Orem also received an honorary Doctor of Science degree from several institutions including from Georgetown University. Orem’s theory was first published in 1971, then 1980, 1995, and 2001 in nursing concepts of practice.
She held significant nursing positions including the directorship of the nursing school at the Providence Hospital. She had earlier taught nursing and biological sciences in that institution between 1939 and 1941. Furthermore, at the Catholic University of America, she functioned as an Assistant Professor up to 1964, and as a Dean of the School of Nursing from. She also worked in the Indiana State Board of Health, and in the John Hopkins Hospital. Therefore, she had a lot of experience in the nursing profession that prepared her for the development of the Self-care theory. During her work at the state board of health, she stumbled upon issues concerning the absence of an organized and substantive framework of nursing knowledge which could have possibly inspired her to work on her theory. She also questioned the certainty of nursing and was driven by the capability to accomplish duties yet not communicating treatment services. Some of her major questions included, what is nursing? What is the human circumstance that necessitates nursing? (Hartweg, 1991).
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Areas of Concern
The phenomenon of concern in Orem’s theory is the quick and holistic recovery of patients upon caring for themselves. The self-care deficit theory bases itself on the totality paradigm which views a person as an integration of biological, social-cultural, psychological, and spiritual dimensions. The totality theory further states that a person adapts to changes in their external environment. The state of health or lack thereof is, therefore, a continuum of health states. The theory, therefore, assumes that people should be independent and in charge of their care and that of dependent family members. The theory is mainly aimed at improving the nursing practice (Denyes, Orem, & Bekel, 2001).
Type of Reasoning
The theory uses both inductive and deductive reason. Inductive reasoning is evidenced by Orem’s description of how she employed her experiences to ascertain what precisely drives persons or persons to seek nursing care upon which the theory was built. The fact that the theory is still practiced today is also evidence of the inductive reasoning. Deductive reasoning, on the other hand, is demonstrated by how Orem collected information from different academics and disciplines to outline what led nursing and the nursing actions dissimilar from associated fields such as the clear difference between a nurse and a doctor (Orem, 1983).
Self-care is well-defined as a human supervisory role which is a measured action to supply required materials necessary for continuous life, development, and the conservation of human uprightness. Self-care requisites consist of the requirements needed to bring optimal functioning. Self-care agency is the capability to involve in and accomplish satisfying self-care actions. An agent is charged with providing care while a dependent agent is one who receives care. Self-care agency is inclined to various acclimatizing elements such as development, sociocultural, age, and well-being as well as education. Therapeutic self-care demand includes the joint actions that are essential to achieving the set self-care undertakings in a certain time. In the case of self-care requisites, there are three types (Hartweg & Pickens, 2016). Universal self-care requisites are concerned with life practices and the integrity of persons’ structure and functioning. They include the delivery of care linked with the eradication process, upholding enough intakes of water, air, and food, striking a balance among activity and relaxation as well as privacy and social relations, avoidance of hazards to the welfare of a person, and elevation of human activities. Developmental self-care constitutes the progressive processes linked to an event such as adjusting to body alterations. Health deviation self-care requisites are the requirements in situations of ailment or disease comprising safeguarding suitable medical assistance and effectively carrying out medically prescribed measures.
Upon the examination of the concepts and their definitions, it is clear that they are defined both theoretically and practically. The theory uses a limited number of terms which gives it simplicity. Furthermore, the required complexity of the theory has been attained by developing the concepts with sufficient depth. This allows for the deep understanding of nursing as a human practice discipline (Orem, 1989). Orem also showed consistency and precision in the definition of the terms of the theory. The concepts have been defined explicitly with precision with the intention of ensuring clarity.
There are several propositions among the major concepts such as human beings, or persons have the capabilities which are learned and recalled, to effect their self-care or that of the dependent relatives to attain the developmental, universal, and health deviation self-care requisites. Nurses involve themselves in the choice of valid and reliable procedures, technologies, or actions of achieving the self-care needs (Orem, Taylor & Renpenning, 1995). Nurses are also charged with assessing the capacities of patients to attain both their self-care needs and the prospect of not executing their self-care. Therapeutic self-care incorporates the actions of nurses, patients, among several others. The ability of self-care depends on age, experiences, and social-cultural issues. Finally, there should be equality between self-care demands and capabilities in self-care deficits.
Assumptions Underlying the Theory
Assumptions in the Orem’s self-care deficit nursing theory are explicit and also implicit. Explicit aspects include that people are willing and capable of performing self-care for themselves. The same care should be extended to all dependent family members. Nursing is a measured and focused helping service that is executed by nurses. Education and culture are assumed to influence individuals. Orem’s theory also assumes that self-care is knowledgeable through communication and human interactions. It also assumes that the promotion of self-care behaviors requires a being’s awareness of possible health complications. One of the chief components of primary care hindrance and ill-health includes effectively attaining universal and development self-care requisites. The theory also assumes that self-care and dependent care are habits that are attained in a social-cultural context. Self-care includes deliberate as well as systematic actions that are driven towards meeting a given need for care. Every person is assumed to possess capabilities, interests, individual outlooks, and values (Hartweg, 1991). Implicit assumptions of the Orem’s theory include that the people ought to be responsible and self-sufficient for their care and that of the family. Finally is the assumption that people are entities who are distinct from others and their environment (Berbiglia & Banfield, 2013).
Description of the Concepts of the Nursing Metaparadigm
The metaparadigm concepts are well defined in the theory. Nursing is defined as an art, a service of helping, and also as a technology. Nursing constitutes activities that are intentionally chosen and undertaken by the nurses with the intention of helping those placed under their care (Denyes et al., 2001). Three perspectives are taken into considerations when it comes to nursing, and these are the patient’s, physician’s, and nursing perspectives. The objective of nursing, according to this theory should be to enable the patient to meet self-care needs, achieve healthy conditions, and to control, and reduce the effects of long-lasting poor health. Health is another metaparadigm concept which Orem defines as a state that demonstrates the wholeness of improved mental operation (Orem, 1983). The physical, biological, and social environments are interpreted as important aspects of health due to a close relationship between health and environment. According to Orem, a person is considered biologically, socially, and symbolically or rather holistically. A person is also considered as being capable of self-care. Another metaparadigm concept is the Environment which is viewed as a subcomponent of the person. The environment is considered as consisting of the physical, social, and biological context within which persons exist (Hartweg & Pickens 2016). Aspects taken into consideration, therefore, are environmental elements, factors, conditions, and the developmental aspects of the environment (Hartweg & Pickens 2016). The person and the environment are related in that they make up an integrated system by which Orem meant that nurses could modify the environmental factors to effect changes in the patient.
Clarity of the Theory
The theory consists of the characteristics of both empirical precision and generality. Orem on her part addresses generality issue by making it clear that the self-care deficit theory of nursing does not have the intention of being a description of the uniqueness of a certain nursing practice situation, but instead, it is a manifestation of an outstanding grouping of hypothesized properties (Orem, 1989). This translates to the understanding that the theory can be practiced in a wide variety of nursing practices. The theory is widely recognized for its clarity on the difference between the objective of nursing and that of different fields hence providing an exclusive concentration in nursing.
Application in Nursing (General)
Orem’s self-care deficit theory can be utilized in any of the three levels including primary, secondary, or tertiary. Universal and developmental self-care requisites represent the primary level, when therapeutic, while a health-deviation self-care requisite, when therapeutic, represents the secondary or tertiary level of prevention. Orem designed a practical methodology for the framework of self-care consisting of four operations. They are diagnostic, prescriptive, control operations, and regulatory operations. Diagnostic operations involve the identification of self-care requirements while other factors are assessed, resulting in a diagnosis. Prescriptive operations consist deciding on the ideal self-care demand. Regulatory operations involve the self-care agency development. Control operations call for a review of the patient outcome relating to change and the adaptations to the changes in self-care. If the assessment is not satisfactory, then regulatory operations are revisited (Orem et al., 1995).
Application in my Area of Nursing (Family Nurse Practitioner)
A family nurse practitioner can find Orem’s theory very useful in their practice. Both universal and developmental self-care requisites can be applied to primary care. During diagnosis, the practitioner should: determine why nursing is necessary, come up with a nursing system and also plan for the provision of care, and oversee the systems. The nurse practitioner should collect data regarding the patient’s health status (from both the person’s and physician’s perspective), the patient’s essential need for self-care and his or her capability to conduct self-care. The nurse then develops a system that is compensatory. This includes having an arrangement of the constituents of a person’s self-care demands and choosing ways of ensuring the effectiveness of compensation for self-care deficits. The nurse then assists the patient to attain the desired results. Achieved results are compared against specification in the nursing system design to monitor improvement (Orem et al., 1995).
Orem’s self-care deficit theory is a remarkable and one of the most applied theories in the nursing profession due to its practicability and evidence to improve quality of care. It has a great professional background with terms that are defined precisely and consistently throughout the theory. The terms are also limited hence simplicity while the concepts are developed sufficiently to ensure the adequate description and understanding nursing as a human practice discipline. The self-care deficit theory is classified as a grand theory, and therefore it can be applied to many fields of nursing to improve care. Through this theory, Orem was able to make a clear distinction between nursing and other related fields.
Berbiglia, V. A., & Banfield, B. (2013). Self-care deficit theory of nursing. Nursing Theorists and Their Work-E-Book, 240.
Denyes, M. J., Orem, D. E., & Bekel, G. (2001). Self-care: a foundational science. Nursing Science Quarterly, 14(1), 48-54.
Hartweg, D. (1991). Dorothea Orem: Self-care deficit theory(Vol. 4). Sage Publications.
Hartweg, D. L., & Pickens, J. (2016). A concept analysis of normalcy within Orem’s self-care Deficit Nursing Theory. Self-Care, Dependent-Care & Nursing, 22(1), 4-13.
Orem, D. E. (1983). The self-care deficit theory of nursing: A general theory. Family health: A theoretical approach to nursing care. New York: Willey Medical Publications.
Orem, D. E., Taylor, S. G., & Renpenning, K. M. (1995). Nursing concepts of practice.
Orem, D. E. (1989). Self-care deficit theory of nursing. Nursing theorists and their work.. St. Louis: CV Mosby.
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