Abstract
Dorothea Orem was one of the most influential people in the history of nursing. By creating the self-care deficit theory of healthcare, she enabled nurses to promote the concept of healthy attitudes and habits among patients, thus, reducing mortality rates significantly. Orem’s theory, which is ranked as grand and comprises three tenets encouraging patient independence, allows for significant improvements in the area of a Nurse Educator’s work. Dorothea Orem’s theory in practice sheds light on the relationships between a nurse and a patient. It is bound to become a groundbreaking tool in the domains such as nursing quality management and patient education, thus contributing to positive change. This article explores examples of Orem’s theory in nursing practice and provides a thorough evaluation of the framework. In particular, it reviews major concepts of Orem’s theory and its metaparadigm and evaluates the self-care deficit theory’s strengths and weaknesses.
What is Orem’s Theory?
Dorothea Orem: Biography
Dorothea Elizabeth Orem was born in 1914 in Baltimore, MD, into a family of a construction worker and a homemaker in 1914. Orem was not a single child; her older sister would, later on, become a member of the Medical Mission Sisters (John Hopkins Medicine, n.d.b). Orem, while following in her sister’s footsteps in becoming a nurse, decided to focus on the theoretical aspects of the subject matter and enrolled in the Providence Hospital School of Nursing, from where she graduated with a Master’s Degree in Nursing. She also became the Bachelor of Science in Nursing Education after studying at the Catholic University of America (John Hopkins Medicine, n.d.a). At this point in her education, Orem started developing her own concept of nursing, which led to her publishing the theory of self-care deficit in 1971 (Grove, Gray, & Burns, 2014). Afterward, Orem explored opportunities in the nursing diagnosis area, as well as providing consultations and writing on the subject of nursing. In 2007, Orem died in Savannah, GA (John Hopkins Medicine, n.d.a).
Theoretical Level
In retrospect, Orem’s theory can be viewed as a grand one. It was admittedly groundbreaking at the time, even though it still focused on the practical use of the essential ideas of self-care. Therefore, it can be deemed as a grand theory rather than the one that concerns solely practice.
Orem’s theory embraced three crucial theoretical frameworks that existed at the time, which made it grand. Even though Orem’s philosophy was inseparable from practice does not allow placing it in the middle between huge theoretical foundations and minor ideas. Therefore, the Self-Care deficit framework deserves the title of grand theory.
Support Theory: What Made the Foundation for Orem’s Framework
When reviewing Orem’s philosophy, one often brings up the fact that the theory of self-care was built from scratch. Indeed, very few studies advocated the need for promoting self-care among patients, assuming that caring was the responsibility of a nurse. However, diving deeper into the history of the theory creation, one must mention the fact that the approach was largely grounded in the tenets of the philosophy promoted by Vincent de Paul (1581-1660) and Louise de Marillac (1591-1660), who were the founders of the Daughters of Charity (DOC) organization (Libster, 2008). Although the philosophy of the organization placed the emphasis primarily on the introduction of Christian values, it also encouraged the participants to convince patients to learn how to take care of themselves appropriately. For instance, DOC made nurses extensively engage in active communication with the patients, educating them about the essential means of caring about themselves (Libster, 2008).
Major Concepts of Orem’s Theory
Major Components and Their Definitions
The philosophy created by Orem includes three crucial components, i.e., the Theory of Self-Care, the Theory of Nursing Systems, and the Theory of Self-Care Deficit. The Theory of Self-Care can be defined as the set of principles that need to be practiced to teach patients about the actions and habits that will help them maintain well-being. Although it might seem rather simple, encouraging patients to follow the essential guidelines often requires persuading them to change their behavior styles and habits. As a result, patients may be reluctant to change. The Theory of Self-Care includes three main categories, i.e., the universal self-care requisites (e.g., breathing), the developmental (specialized items), and the health-deviation-related ones (e.g., caused by trauma) (Queirós, Vidinha, & Filho, 2014).
The Theory of Self-Care Deficit implies that self-care levels need to be measured. After a qualitative and a quantitative assessment thereof, a nursing strategy must be shaped. The results (e.g., the lack of self-care or complete absence thereof) inform and define the nursing strategy (Queirós et al., 2014).
The Theory of Nursing Systems invites nurses to consider the existing nursing frameworks as a whole. Furthermore, it suggests that nurses should use the system in question to identify and manage the patients’ needs. To be more exact, patients must be educated and provided with the necessary information about both general health principles and the issues related to their condition (Queirós et al., 2014).
Orem’s Theory: Philosophical Underpinnings
The philosophy of Orem’s theory can be summarized as the need to encourage patients to care for themselves as the foundation for promoting well-being in the community. Therefore, Orem’s idea can be viewed from the tenets of the Self-Care Theory as a more general idea of cognizing one’s self. From a philosophical perspective, it may also imply reinforcing the processes related to meta-cognition in patients (Webber, Guo, & Mann, 2015).
Goals of Nursing Viewed through the Lens of Self-Care
As stressed above, the general Theory of Self-Care is focused on enabling patients to take care of themselves and acquire healthy habits. Therefore, when viewed through the prism of Orem’s philosophy, the goals of nursing turn out to be educational. Specifically, the proponents of the theory suggest that nurses should raise awareness among the target population and provide them with relevant information and resources.
Theory and the Nursing Process: EBP as the Tool for Testing
Using the EBP approach as the foundation for research, one may evaluate the efficacy of Orem’s model as applied to the environment of a certain community. The process will imply using the available information management tools to reach out to every single member of the target population. Afterward, nurses will have to encourage patients to use the available tools to gain a deeper insight into the crucial behaviors that lead to well-being.
Dorothea Orem: Self-Care Deficit Theory Metaparadigm
As a rule, the nursing metaparadigm is viewed as a combination of four essential elements, i.e., the human, the environment, nursing, and health. In the context of Orem’s framework, a human is viewed as the system that comprises physiological, psychical, and social elements. The environment is interpreted as a combination of factors that encourage the patients’ ability to care for themselves, inhibit it, or does not have any impact on it. Health is the main indicator of a living creature, whereas nursing in the form of specialized assistance provided to patients in case more than self-care is required.
Examples of Orem’s Theory in Nursing Practice
Practice
Because of the recent technological breakthrough and the availability of an array of tools for spreading awareness among patient and managing information successfully, the prerequisites for a successful application of the theory to actual cases becomes a possibility. The implementation of the theoretical framework in the contemporary nursing setting implies using the available tools (including IT and traditional media) as the means of increasing awareness among patients and opening access to the relevant information for the target population.
Education
The significance of self-care in the educational context is not to be underrated, either. Nurses must be taught to encourage patients to engage in self-care-related activities. Therefore, the introduction of the principles suggested by Orem has shaped the landscape of nursing education to a considerable extent. The present-day nursing curriculum includes the activities linked directly to explore the options for creating a stronger connection between a patient and a nurse. Furthermore, a range of initiatives was started to help students and practicing nurses understand the importance of promoting self-care (Blum, 2014).
Administration
The Self-Care Theory has also added new elements to the process of administration in nursing. Now that the principles of self-care are included in the framework, a Nurse Administrator must make sure that the members of the personnel are capable of providing the patients with the necessary information and making sure that the target audience should acquire the appropriate habits. The budgeting process may also have to be changed given the need to incorporate the latest technological advances into the process of self-care promotion. Therefore, the Nurse Administrator will also have to supervise the information management processes in a more careful manner, which will require the redesign of the current data management approaches, with a focus on information sharing as the guiding principle.
Research
With the introduction of Orem’s philosophy into the realm of academic research, studies will have to embrace the effects that the use of the Self-Care Theory has on the patients and their well-being. Moreover, there is a need to consider the opportunities that one will have when combining the EBP approach and Orem’s nursing framework. It is suggested that the issues related to the application of the theory in a multicultural environment will have to be considered.
Related Article
Gilbert, C., Haggerty, D., & Taggert, H. M. (2012). Exploring factors related to healthy aging. Self-Care, Dependent-Care & Nursing, 19(1), 20-25.
Gilbert, Haggerty, and Taggert (2012) evaluate the efficacy of the theory applied to the issue of patient aging. Particularly, the authors shed light on the way in which the target audience can be educated about aging and the health implications that aging entails. Insightful and well put together, their argument suggests that changes should be made to the current framework of addressing aging issues.
Dorothea Orem’s Theory in Practice
Clinical Area Identification: Where the Focus Should Remain
The critical area under analysis includes the activities related to education and teaching appropriate skills. Students aiming to become nurses can be viewed as the target audience. Providing learners with the tools that will help them cater to the needs of the target audience in a more efficient manner, a Nurse Educator is likely to contribute to a significant improvement of the service quality. For instance, innovative models that will serve as the support for establishing a stronger link between the patient and the therapist can be created with the introduction of Orem’s theory into the clinical practice real. A more elaborate approach toward interpreting nursing instructions can be suggested after the Self-Care framework is included in the set of theories used in the clinical setting.
Appropriateness of Utilizing the Model in Teaching Nursing
Since Orem’s self-Care principle helps create a stronger link between a patient and a therapist, it can be viewed as a legitimate tool. One might argue that the model may cause nurses to focus less on the needs of the patients since the latter will be able to maintain good health on their own. However, the Self-Care concept does not allow for a reduction in the responsibility levels among nurses. Quite on the contrary, it sets the environment for nurses to be more diligent due to the focus on the needs of the patients.
Potential of the Self-Care Concept in the Context of Nursing Education
The potential of the theory is quite big. It will serve as the foil for the promotion of the patient-centered strategy. Furthermore, it may become the tool for improving the quality of services by introducing nurses to the concept of lifelong learning, e. i., acquisition, and training of new skills.
Self-Care Deficit Theory: Impact on Patient Outcomes
The Self-Care theory will affect the patient outcome positively as it will introduce the target audience to the concept of managing the health issues adequately. For instance, with the increase in awareness rates, patients will be able to recognize a health problem at the earliest stage of its development and address health experts before the [problem spins out of control.
Self-Care Deficit Theory Critique: Detecting Strengths and Weakness
Inconsistencies within the Theory: Possibility of a Misinterpretation
One must admit, though, that the theory may have some problems. For instance, it lacks clarity. Designed to embrace the entire area of nursing, it needs adjustments when used in a particular area.
Assessment of the Theory’s Clarity
The model is quite simple and, therefore, rather clear. Its simplicity, however, may become a problem when applying the approach to a nursing problem. Particularly, it lacks the details that could allow applying it to different domains of nursing.
The difficulty of Application in the Hospital Environment
As stressed above, the theory is very vague. Therefore, nurses will have to focus on developing specific approaches to managing patients’ needs. Moreover, the theory needs to be shaped to become applicable in a multicultural environment (Fawcett & DeSanto-Madeya, 2013).
Limitations and from Where They Stem
The fact that the theory may fail to encompass all aspects of nursing care needs to be mentioned. A nurse may fail to locate the problem since the framework does not point to the specific areas in which it should be sought. Therefore, the theory needs to be shaped so that the nurse could manage a specific issue (Grove et al., 2014).
Contributions to the Discipline of Nursing
Orem’s Self-Care Model is bound to become the foil for the enhancement of the patient-centered approach. More importantly, the prerequisites for building awareness among patients can be created. Thus, the philosophy will contribute to an increase in recovery rates.
References
Blum, C. A. (2014). Practicing self-care for nurses: A nursing program initiative. OJIN: The Online Journal of Issues in Nursing, 19(3), n.p. Web.
Fawcett, J., & DeSanto-Madeya, S. (2013). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories. Philadelphia, PA: F.A. Davis.
Gilbert, C., Haggerty, D., & Taggert, H. M. (2012). Exploring factors related to healthy ageing. Self-Care, Dependent-Care & Nursing, 19(1), 20-25.
Grove, S. K., Gray, J. R., & Burns, N. (2014). Understanding nursing research: Building an evidence-based practice. St. Louis, MO: Elsevier Health Sciences.
John Hopkins Medicine. (n.d.a). Dorothea Orem collection. Web.
John Hopkins Medicine. (n.d.b). Monica Orem collection. Web.
Libster, M. (2008). Perspectives on the history of self-care. Self-Care, Dependent-Care & Nursing, 16(2), 8-17.
Queirós, P. J. P., Vidinha, T. S. S., & Filho, A. J. A. (2014). Self-care: Orem’s theoretical contribution to the Nursing discipline and profession. Revista de Enfermagem Referência, 4(3), 157-163. Web.
Webber, D., Guo, Z., & Mann, S. (2015). Self-care in health: We can define it, but should we also measure it? SelfCare, 4(5),101-106.