Nursing Theorists The objective of this study is to identify, describe, research and apply the concepts of a specific nursing theorist and compare and contrast it to other nursing theorists. As well, this work in writing will provide examples of clinical situations from personal nursing practice that illustrates the concepts and application of the framework and will describe these in ways that serve to illustrate and clarify the use of the conceptual material.

The nursing theorist chosen in this study is Dorothea Orem. Dorothea Orem was born in 1914 in Baltimore, Maryland in the U.S. And earned her diploma at Providence Hospital in Washington DC. Orem worked as a staff nurse as well as a private duty nurse, nurse educator, and administrator and finally as a nursing consultant. Orem received her honorary Doctor of Science degree in 1976. Orem's theory was first published in 'Nursing: Concepts of Practice in 1974, 1980, 1995, and 2001.

Dorothea Orem's Theory

The primary assumptions of Orem's theory are that the individual should be self-reliant and responsible for their own care and that the person is a distinct individual. Nursing is assumed a "form of action -- interaction between two or more persons." (Nursing Theories, 2012, p.1) Also an assumption of Orem's theory is that the successful meeting of universal and development of self-care makes a requirement of primary care prevention and ill health. (Nursing Theories, 2012, paraphrased) Orem's theory also includes the assumption that the individual's knowledge of possible health problems is a requirement for promoting self-care behaviors and that self-care and dependent care are behaviors "learned within a socio-cultural context." (Nursing Theories, 2012, p.1)

II. Domain Concepts Defined

Orem's theory contains several domain concepts including those stated and defined as follows:

(1) Nursing is described as "art, a helping service, and a technology and stated is the following:

(a) 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;

(b) Encompasses the patient's perspective of health condition, the physician's perspective, and the nursing perspective;

(c) Goal of nursing -- to render the patient or members of his family capable of meeting the patient's self-care needs;

(d) To maintain a state of health

(e) To regain normal or near normal state of health in the event of disease or injury;

(f) To stabilize, control, or minimize the effects of chronic poor health or disability. (Nursing Theories, 2012)

(2) Health -- this is a term that is used in providing a description for living things and when these living things are "structurally and functionally whole then that person is human and is operating "in conjunction with physiological and psycho physiological mechanisms and a material structure and in relation to and interacting with other human beings." (Nursing Theories, 2012, p.1)

(3) The third state element in the conceptual domain is that of environment. Environment is defined as components that "are enthronement factor, enthronement elements, conditions and developed environment. (Nursing Theories, 2012, p.1)

(4) The fourth stated element in the conceptual domain is that of the human being and that they have the "capacity to reflect, symbolize, and use symbols." (Nursing Theories, 2012 p.1) The human being is conceptualized as "a total being with universal, developmental needs and capable of continuous self-care. It is reported that Orem held that the human being is a unity that can function biologically, symbolically and socially. (Nursing Theories, 2012, p.1)

(5) Reported as the fifth element of the conceptual domain is that of the nursing client and it is reported that a human that 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." (Nursing Theories, 2012, p.1) In addition, a human being is reported as the "focus of nursing only when a self-care requisite exceeds self-care capabilities." (Nursing Theories, 2012, p.1)

The final three conceptual domains are those of nursing problems, process, and therapeutics. The nursing problem is stated as deficits in "universal, developmental and health derived or health related conditions." (Nursing Theories, 2012) The nursing process is a system used for making a determination of why the person is under care in addition to a plan for care and implementation of care. (Nursing Theories, 2012, paraphrased) Nursing therapeutics is described as "deliberate, systematic and purposeful action." (Nursing Theories, 2012, p.1)

III. Three Related Part of Orem's Theory of Nursing

There are three aspects of Orem's general theory of nursing and those include:

(1) theory of self-care;

(2) theory of self-care deficit; and (3) theory of nursing system. (Nursing Theories, 2012, p.1)

The theory of self-care is inclusive of the following principles:

(1) Self-care -- practice of activities that individual initiates...

3 categories of self-care requisites are- (a) Universal self-care requisites; (b) Developmental self-care requisites; and (c) Health deviation self-care requisites. (Nursing Theories, 2012, p.1)
Universal self-care requisites are noted as being "Associated with life processes and the maintenance of the integrity of human structure and functioning" as well as being common to all. The requisites are identified as the following:

(1) Maintenance of sufficient intake of air, water, food

(2) Provision of care associated with elimination process

(3) Balance between activity and rest, between solitude and social interaction

(4) Prevention of hazards to human life well being and (5) Promotion of human functioning (Nursing Theories, 2012)

Developmental self-care requisites are stated as being closely associated with developmental processes "derived from a condition or associated with an event." (Nursing Theories, 2012) Health deviation of self-care is reported to be such that is:

(1) Required in conditions of illness, injury, or disease .these include: (a) Seeking and securing appropriate medical assistance; (b) Being aware of and attending to the effects and results of pathologic conditions; (c) Effectively carrying out medically prescribed measures; (d) Modifying self-concepts in accepting oneself as being in a particular state of health and in specific forms of health care; and (e) Learning to live with effects of pathologic conditions. (Nursing Theories, 2012, paraphrased)

The theory of self-care deficit specifies when there is a need for nursing and specifically that there is a requirement for nursing "when an adult is incapable or limited in the provision of continuous effective self-care." (Nursing Theories, 2012)

Five methods of helping are identified in the work of Orem as follows:

(1) Acting for and doing for others

(2) Guiding others

(3) Supporting another

(4) Providing an environment promoting personal development in relation to meet future demands; and (5) Teaching another (Nursing Theories, 2012)

Dorothea Orem's Self-Care Deficit Theory is illustrated as follows:

Figure 1

Orem's Theory and Nursing Process is inclusive of data collection regarding the following six types of data:

(1) Assessment -- diagnosis and prescription and the determination of why nursing care is needed and making a judgment in regards to care. Inclusive as well of the design of a nursing system and a delivery care plan.

(2) Collection of data including:

(a) health status;

(b) physicians view of the patient's health status;

(c) The patient's view of self-health;

(d) health goals in regards to the life history, lifestyle and health status of the patient;

(e) the patients requirement for providing self-care and (f) the capacity of the patient to perform self-care. (Nursing Theories, 2012)

The next step is that or nursing diagnosis and health care plans based on rational scientific evidence. The step, which next follows, involves implementation and evaluation and includes the patient and their family being assisted by the nurse in self-care matters.

The strengths of Orem's theory include that it make provision of a comprehensive basis for the practice of the nurse and serves in utilization of the professional nursing including curricula, education, administration and research. Orem's theory is specific about when nursing care is needed and the approach of Orem is aligned with contemporary concepts of health prevention and promotion.

III. Case Study

The work of Iglesias et al. (nd) reports a case study involving home care nurse visiting an elderly patient who resides alone and who is bedridden due to osteoarthritis joint pain. The client relates feeling sad and due to his diaiblity feeling inadequate. Examination of this patient from Orem's theory of Self-care it is understood that this individual is limited in the human ability to engage in self-care. Of the three categories of self-care this patient falls into the category of 'Health Deviation of Self-Care' due to an illness, injury or disease and which is inclusive of seeking out medical assistance and learning how to live with the condition and its effects. Orem's theory of 'Self-Care Deficit' specifies when intervention from nursing is a requirement due to the limitations of the patient to participate in self-care that is effective in nature. The priorities in this case study are those of: (1) pain reduction; (2) developmental self-requisites;…