Orem\'s Theory of Self-Care Deficit

Orem's Theory of Self-Care Deficit

WHEN HELP DOES NOT COME or ISN'T ENOUGH'

Orem's Theory of Self-Care Deficit

Theory Description

Nursing theorist Dorothea Orem believed that every normal functioning person has the ability or power to care for himself or herself (Weir 2007, Bruce et al. 2008). It keeps the entire person functional and contributes to his total development. The overall purpose of Orem's theory is to view the person as a whole entity and to use nursing knowledge to restore or maintain his optimal health (Weir). In a word, it aims at achieving or maintaining health of mind, body and spirit (Bruce et al.).

Scope

Self-care is a learned behavior, in turn influenced by the meta-paradigm of person, environment, health and nursing (Weir 2007). Its components are universal self-care needs, developmental self-care needs, and health deviation (Weir). A person's ability for self-care depends on age, gender, developmental state, health state, socio-cultural orientation, family system, adequacy and availability of needed resource (Bruce et al. 2008, Weir). These basic conditions, however, are not fully or optimally operational at all times. Orem believes that these affect the person's ability to care for himself. When one of these is lacking or malfunctions, a self-care deficit develops. External help or nursing becomes necessary in achieving or maintaining optimal health for another person. Nursing identifies the limitation or deficit and performs interventions aimed at meeting the person's needs (Bruce et al., Weir).

C. Origins

Dorothea F. Orem was born in Baltimore, Maryland in 1914 (Weir 2007). She studied at the Providence Hospital School of Nursing in Washington DC and the Catholic University of America. Her original idea evolved when she worked as a nurse-consultant at the Indiana State Board of Health between 1949 and 1957. During her travels, she observed nurses' ability to do nursing as well as their inability to talk about nursing (Weir).

While Orem worked on the initial ideas of her theory, the mass media introduced nursing as a respected profession but only in a limited scale (Bruce et al. 2008). At a larger scale, it destroyed the respectable image. In the early 60s, nurses were viewed as mere subordinates of physicians in movies and on television. Physicians dealt with them condescendingly. It was only in 1962 that a revolutionary TV show depicted nurses in a more positive way. The show was a series of medical drama presentations, which focused more on the nurse than the physician. She was portrayed as objective, articulate, disciplined, professional and observing nursing standards. Her image changed. She no longer had to wait for the physician to arrive and give her orders. She right away determined the problem of the patient and sought and applied the solution. It did a great deal in modifying and propagating a positive image of the nurse (Bruce et al.).

From continued observation and inquiries, she formed her first ideas about nursing and further developed her concepts in 1959. She sought for a pragmatic structure of the knowledge of nursing (Weir 2007). The knowledge focused on what nursing is and when it is needed. On these two basic points, Orem drew her concept that a person needs nursing care when he is not able to care for himself. This was the central idea of her Self-Care Deficit Theory of Nursing, which she presented in a book, entitled "Nursing Concepts of Practice," in 1971 but which she continued to revise and update (Weir).

D. Major Concepts

Orem's grand Self-Care Deficit Theory of Nursing consists of three interrelated theories (Weir 2007). These are the theory of self-care, the self-care deficit theory, and the theory of nursing systems. Six central concepts are embodied among these three sub-theories, which are essential in understanding the grand or general theory. These central concepts are self-care, self-care agency, therapeutic self-care demand, self-care deficit, nursing agency, and nursing system (Weir).

From her theory of self-care, Orem derived the three categories of self-care requisites, namely universal self-care, developmental self-care, and health deviation (weir 2007). Universal self-care is inherent in all persons, such as in eating and drinking and balancing all the areas of one's life. Developmental self-care refers care needed for the growth and development of the person. It also covers his response to specific life events, such as job loss, loss of a loved one or the birth of a new child. And health deviation self-care pertains to needs on account of disease, illness or injury (Weir).

E. How Nursing Uses the Theory

The core of the grand or general theory is the Theory of Self-Care Deficit, because it signals the need for nursing (Weir 2007). Nursing becomes necessary when the person's normal self-care becomes limited for some reason. Deficit results from that demand for limited self-care. The nursing system bases its intervention on the person's self-care needs. What the person can do and what he cannot but needs to be done constitute the deficit. Nursing comes into the picture to fill the gap. That gap will be filled by the nurse, the client with the help of the nurse, or both of them together (Weir).

Orem classified nursing systems into wholly compensatory, partly compensatory and the supportive-educative (Weir 2007). A nursing system is wholly compensatory when the nurse provides the complete universal and health function of the person whose ability is impaired. An example is a person or patient in a coma. In providing substitute self-care, the nurse must exercise critical judgment in anticipating and meeting the patient's needs. In a partly compensatory nursing system, the nurse and the patient provide and contribute to meeting the self-care needs. An example is a patient who suffers a stroke or is half-paralyzed. He or she is unable to perform all normal functions. And in a supportive-educative nursing system, the patient retains the ability or cannot and able to perform self-care only with assistance. The role of the nurse is to teach and provide education and support to the patient. An example is a diabetic who needs to know what foods to avoid in order to reduce or to maintain the desired blood glucose level. Or if the patient receives insulin injections, the nurse should teach him or her how to perform self-injection, the amount of blood to draw into the syringe, where to inuect and how to dispose of used needles correctly (Weir).

Orem emphasized on diffusing her theory into various nursing settings (Weir 2007). The comprehensive development of her concepts will make her Self-Care Deficit nursing theory more useful as a guide to practice situations with patients with health problems across the entire life span. It will also boost nurse-client situations in promoting, restoring or maintaining health (Weir).

The ultimate goal of Orem's Self-Care Theory is to enable the patient to achieve optimal health for himself through normal self-care (Weir 2007). When this is achieved, the goal transforms into the maintenance of normal self-care. The nurse needs to understand Orem's various concepts and how to infuse these into the nursing process. All of Orem's concepts are interrelated. The concerted world view is to see the patient as whole and not as a separate entity in his environment. The theory considers the ability of the patient or the combined abilities of the patient and the nurse to promote, achieve, restore or maintain the patient's physical and physiological wholeness (Weir).

The meta-paradigm concept consists of the person, his environment, his health and nursing (Bruce et al. 2008). The person is the patient who experiences self-care deficit. The environment consists of his surroundings, which affect his ability to exercise self-care. Health refers to his structural and functional soundness or the lack of it. And nursing consists of acts of an especially trained and capable person in helping the patient deal with his actual or potential self-care deficit (Bruce et al.). Whatever the patient's medical condition, basic nursing knowledge and careful observation will have considerable impact on the patient's improvement (Weir 2007). The use of this theory in nursing enhances nursing as a discipline and an intrinsically rewarding profession (Weir).

II Theory Analysis

Not all practicing nurses have openly recognized the relevance of nursing theory to clinical practice (Graham 2006). Nevertheless, nursing theories have proved relevant to the practice. Orem's Self-Care Deficit Theory and similar ones have demonstrated their value. All human practices seem to draw from some theoretical premise. Theories are models of reality, which is not always directly observable. Not all nursing models or theories may be suitable to every clinical area of nursing but one may be selected in improving patient care. Orem's theory has shown its value in a number of cases (Graham).

Chronic Diabetes

One drawback of an extended lifespan in the present time is an increase in the incidence of chronic illnesses, such as diabetes (Kumar 2007). Statistics show that more 20 million people in the United States alone have been diagnosed with this illness. The American Diabetes Association predicted that a million more every year will have the same diagnosis. Long-term complications will remain costly to both the person and the healthcare system. In reaction, diabetes research looks into pharmacological options and changes in lifestyle to contain the trend. Recent findings point to the need for healthcare professionals to empower diabetes sufferers to take recourse in self-management as the best option at the moment (Kumar).

The purposefulness of a plan and its implementation in assisting a client with diabetes helped fill in her self-care deficit (Kumar 2007). The interpersonal relationship between a nurse and her client minimizes the stress experienced by the latter and her family. This enables the client or patient and her family to act more responsibly in health matters. An assessment and plan of care may use Orem's client-related concepts -- of self-care, self-care agency, therapeutic self-care demand and self-care deficit --, the concepts of nursing agency and nursing system and the basic conditioning factors. Integrating these concepts into other theories on health promotion and family systems may guide effective health assessment, health outcomes and nursing interventions (Kumar).

The particular goal of managing chronic diabetes is self-care (Kumar 2007). Orem's theory provides direction to the diabetes educator in guiding the client in self-management. A recent study found that theory-based nursing care and standardized nursing language reduced a client's self-care deficit and improved his capability to care for himself (Kumar).

Blood Glucose

Monitoring blood glucose by a diabetic is also difficult and frustrating (Aldridge 2005). The specialist nurse must, therefore, exert effort to encourage and empower the patient in the regular performance of this routine process. She needs to explain how skillful monitoring can make him understand that it will help improve quality of life. Self-monitoring of blood glucose is basic to proper diabetes care. Patient education should, therefore, be central to diabetes care. Mere monitoring blood glucose is useful but quality of life will improve only with skillful monitoring (Aldridge).

Kidney Disease

Orem's Self-Care Theory may be integrated into all the aspects of the care of kidney disease (Graham 2006). It is useful from the early detection of renal impairment up to the end stage, which requires renal replacement. Orem's concept can be a basic component in an approach to meet the need for the longest life expectancy and the highest quality of life (Graham).

Stroke

Orem's self-care deficit nursing theory is part of the essential education basic to a successful transition of stroke patients and their caregivers from the hospital to home (Cook et al. 2006). This was the conclusion of a survey recently conducted among therapists of stroke patients at home in eastern United States. Most of them sought information on safe transfer techniques. The therapists or caregivers also gave importance to the acquisition and use of assistive and adaptive devices. Healthcare teams can provide comprehensive information programs needed and sought by stroke patients and their therapists or caregivers (Cook et al.).

Another research found physical assistance and emotional support from family and friends were essential in helping the stroke survivor cope with his condition (Steiner et al. 2008). The survivor's family and friend normally bond with caregivers. As a result, they develop a sense of responsibility to care for the survivor. When the caregiver receives emotional support from the survivor's family and friends, her perception of physical help connects with emotional support (Steiner et al.).

The study surveyed 73 caregivers from the Midwest on their first 12 months after their patients suffered a stroke (Steiner et al. 2008). Results revealed that the caregivers set up a responsive self-care system with their clients. This system provides both physical help and emotional support. The study also disclosed the need for nurses to evaluate the caregivers' health at some later time in the caring process. The connection between their health condition and emotional support provided them should also be investigated. The findings underscored the importance of informal social networks to provide the emotional support needed for caregivers of stroke survivors. The positive relationship between emotional support and the health of caregivers seems to conclude that care-giving is a long-term process. This implies the need for sustained emotional support throughout the draining and challenging provision of care to fill in the survivor's self-care deficit (Steiner).

Heart Failure

Promoting or improving self-care behavior among congestive heart failure patients can cut down on huge costs of hospitalization (Aliha et al. 2006). Assessing their self-care behaviors, needs and abilities is, therefore, paramount. A study conducted on 125 patients, using Orem's self-care theory, said that more than half of the patients had satisfactory self-care behavior. More than half of the respondents had good working knowledge about self-care. At the far end, there were those who said that they had high or very high learning needs about self-care. The study concluded that nurses' knowledge about their patients' self-care behaviors, learning needs, limitations of knowledge and their knowledge about self-care and basic conditioning factors will help them in performing supportive-educative intervention function. This function was derived from Orem's self-care deficit theory (Aliha et al.).