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The Self-Care Deficit Theory developed as a result of Dorothea E. Orem working toward her goal of improving the quality of nursing in general hospitals in her state. The model interrelates concepts in such a way as to create a different way of looking at a particular phenomenon. The theory is relatively simple, but generalizable to apply to a wide variety of patients. It can be used by nurses to guide and improve practice, but it must be consistent with other validated theories, laws and principles.
According to Polit & Henderson, each individual has the ability to perform self-care, and are responsible for their health and the health of their dependents. Self-care is “the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being” (as cited in Cardinal Stritch University Library, 2011). Orem’s initial definition of nursing’s concern included “man’s need for self-care action and the provision and management of it on a continuous basis in order to sustain life and health, recover from disease or injury, and cope with their effects” (Orem, 1959, p. 3). More simply stated, her definition of nursing’s goal was “overcoming human limitations” (Orem, 1959, p. 4) Orem’s general theory of self-care deficit nursing states that a self-care demand exists when the patient of family members are not able to provide care for him/herself and those self-care demands can be met by the nurse (Masters, 2011). According to Sitzman & Eichelberger (2011), “Orem’s Self-Care Model describes a structure wherein the nurse assists the client, where needed, to maintain an adequate level of self-care. The degree of nursing care and intervention depends on the degree to which the client is able (or unable) to meet self-care needs (p. 96).”
The major assumptions of Orem’s Self-Care Deficit Theory are:
- People should be self-reliant, and responsible for their care, as well as others in their family who need care.
- People are distinct individuals.
- Nursing is a form of action. It is an interaction between two or more people.
- Successfully meeting universal and development self-care requisites is an important component of primary care prevention and ill health.
- A person’s knowledge of potential health problems is needed for promoting self-care behaviors.
- Self-care and dependent care are behaviors learned within a socio-cultural context.
Orem’s theory is comprised of three related parts: theory of self-care; theory of self-care deficit; and theory of nursing system.
The theory of self-care includes self-care, which is the practice of activities that an individual initiates and performs on his or her own behalf to maintain life, health, and well-being; self-care agency, which is a human ability that is “the ability for engaging in self-care,” conditioned by age, developmental state, life experience, socio-cultural orientation, health, and available resources; therapeutic self-care demand, which is the total self-care actions to be performed over a specific duration to meet self-care requisites by using valid methods and related sets of operations and actions; and self-care requisites, which include the categories of universal, developmental, and health deviation self-care requisites.
Universal self-care requisites are associated with life processes, as well as the maintenance of the integrity of human structure and functioning. Orem identifies these requisites, also called activities of daily living, or ADLs, as:
- the maintenance of sufficient intake of air, food, and water
- provision of care associated with the elimination process
- a balance between activities and rest, as well as between solitude and social interaction
- the prevention of hazards to human life and well-being
- the promotion of human functioning
DEFINITIONS OF DOMAIN CONCEPTS
Nursing – is art, a helping service, and a technology
- Actions deliberately selected and performed by nurses to help individuals or groups under their care to maintain or change conditions in themselves or their environments
- Encompasses the patient’s perspective of health condition ,the physician’s perspective , and the nursing perspective
- Goal of nursing – to render the patient or members of his family capable of meeting the patient’s self care needs
- To maintain a state of health
- To regain normal or near normal state of health in the event of disease or injury
- To stabilize ,control ,or minimize the effects of chronic poor health or disability
Health – health and healthy are terms used to describe living things …
- It is when they are structurally and functionally whole or sound … wholeness or integrity. .includes that which makes a person human,…operating in conjunction with physiological and psychophysiological mechanisms and a material structure and in relation to and interacting with other human beings
Environment
- environment components are enthronement factors, enthronement elements, conditions, and developed environment
Human being – has the capacity to reflect, symbolize and use symbols
- Conceptualized as a total being with universal, developmental needs and capable of continuous self care
- A unity that can function biologically, symbolically and socially
Nursing client
- A human being who has “health related /health derived limitations that render him incapable of continuous self care or dependent care or limitations that result in ineffective / incomplete care.
- A human being is the focus of nursing only when a self –care requisites exceeds self care capabilities
Nursing problem
- deficits in universal, developmental, and health derived or health related conditions
Nursing process
- a system to determine (1)why a person is under care (2)a plan for care ,(3)the implementation of care
Nursing therapeutics
- deliberate, systematic and purposeful action
Orem’s theory is made up of 3 related theories:
1. Theory of Self-Care
2. Theory of Self-Care Deficit
3. Theory of Nursing Systems
According to Orem, “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).
How are the three theories related?
The theory of self care delineates the demands of self-care requisites that an individual needs to meet in order to stay healthy or get better from illness. When a person cannot meet these self-care demands, or when self-care requisites exceeds self-care capabilites, nursing is needed. Nurses can help patients meet their self-care needs by utilizing the 5 methods in the Theory of Self Care Deficit. However, the nurse must properly assess the level of self-care a patient requires so that the nurse can utilize the nursing system (as stated in the Theory of Nursing System) that best fits the patient’s ability to perform self-care. In the end, the nurse assists the patient in meeting his/her self-care needs so that he/she is healthy and free of illness.
How are the four concepts related?
The person (or patient) is the central focus of nursing care. According to Orem, the person’s health state is mediated by his/her environment. A person, who is healthy, is capable of self-care. When there is illness in the person’s health state, the person is not able to complete all self-care requisites. When this occurs, nursing care is needed to assist the person in completing his/her self-care. Nurses must assess the person’s ability to provide his/her own self care and the environmental context of the person in order to overcome health-associated limitations.
Orem’s Self-Care Deficit Nursing Theory as a THEORETICAL FRAMEWORK for Nursing Practice
- Combining the three sub-theories and major concepts creates the general Self-Care Model, which outlines Orem’s nursing process.
- This process determines the self-care deficits and defines the person or nurse’s roles in meeting the self-care demands
- This nursing process has 3 steps, which is comparable to the currently used and taught nursing process
Application
Orem’s Self-Care Deficit Theory can be used to make appropriate decisions when carrying out nursing process (Orem, 1959). Nursing process entails assessment, nursing diagnosis, planning, implementation, and evaluation. Assessment involves determination of a person’s health status as well as his or her immediate health needs. This is followed by diagnosis where the nurse determines the person’s requirements for self-care. The capacity level of the client to perform self-care will be used as the basis of devising a plan for assistance with a scientific rationale (Tomey and Alligood, 2002).
The nurse therefore designs a plan by incorporating all the components of the client’s therapeutic self-care demands. This should be followed by selection of the best plans that will help the patient to efficiently overcome self-care deficits (Meleis, 1997). After planning session, the nurse will again employ the Self-Care Deficit Theory in implementation and evaluation of the best alternative. The nurse will help his or her client to achieved defined health benefits by putting the identified plan into action. Evaluation will involve analysis of whether the implemented plan is resulting into the expected health outcomes (Masters, 2011).
To date, many nursing institutions have used Orem’s theory as a conceptual framework in achieving primary, secondary, and tertiary levels of prevention (Bekel, Panfil and Scupin, 2005). Specifically, Self-Care Deficit Theory can be used in nursing education to teach patients about personal health issues. For instance, suppose a room contains contaminated air, the therapeutic self-care demand is that, a person will be required to maintain effective respiration in order to stay safe and alive. Considering the situation in the room, it is clear that self-care agency is inadequate. If a nursing diagnosis is conducted, and the nurse discovers that that there is a potential for impaired respiratory status, the nurse will have to teach the client about the importance of staying away from the room in order to prevent further respiratory problems (Tomey and Alligood, 2002)
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