This paper examines Dorothea Orem's Self-Care Deficit Theory as a foundational model of nursing practice. Beginning with Orem's biographical background and the experiences that inspired her theoretical work, the paper explains the four nursing metaparadigms she identified — human beings, environment, health, and nursing — and details the structure of her Self-Care Framework. It further explores key components including the self-care system, self-care agency, therapeutic self-care demand, and nursing agency. The paper concludes by reflecting on the theory's continued relevance in contemporary healthcare, particularly in light of nursing shortages and the emphasis on patient and family self-care capacity.
The model of nursing care examined in this paper is that of Dorothea Orem. Orem's Self-Care Deficit Theory is a general theory of nursing and one of the most widely utilized models in contemporary nursing practice.
Dorothea Orem was born in 1914 in Baltimore, Maryland. She earned her nursing diploma in the early 1930s from Providence Hospital School of Nursing in Washington, D.C. She also received three honorary doctorates and an Alumni Achievement Award for Nursing Theory in 1980 from Catholic University of America (Bridge, Cabell, & Herring, n.d., paraphrased). Orem gained early nursing experience in various hospital clinical settings as a staff nurse.
Bridge, Cabell, and Herring (n.d.) report that Orem recalled from early in her career, while serving as director of nursing service at a hospital in Detroit, Michigan, that "she was asked a substantive question and didn't have an answer because she 'had no conceptualization of nursing'" (p. 2). Orem also related that while working at Indiana University she found that nurses had difficulty articulating their needs to hospital administrators "in the face of demands made upon them regarding such issues as length of stay, scheduling admissions and discharges" (Bridge, Cabell, & Herring, n.d., p. 2).
According to Orem, she recognized a need "to look for the uniqueness of nursing." Specifically, she sought to answer questions such as: "What is nursing?", "What is the domain and what are the boundaries of nursing as a field of practice and a field of knowledge?", and "What condition exists when judgments are made that people need nursing?" (Bridge, Cabell, & Herring, n.d., p. 2). The International Orem Society further posed the questions: "What do nurses encounter in their world as they design and produce nursing for others? What meaning can and should nurses attach to persons, things, events, conditions, and circumstances they encounter?" (Bridge, Cabell, & Herring, n.d., p. 2).
Orem (1978) stated that her task "required identification of the domain and boundaries of nursing as a science and an art" (cited in Bridge, Cabell, & Herring, n.d.). After reflecting on her own nursing experiences, Orem reported that the answer came as a "flash of insight, an understanding that the reason why individuals could benefit from nursing was the existence of self-care limitations" (Orem, 1978, cited in Bridge, Cabell, & Herring, n.d., p. 2).
Orem uses four concepts to explain the nursing metaparadigms: (1) human beings, (2) environment, (3) health, and (4) nursing. Orem described a human being, or "humanity," as "an integrated whole composed of internal physical, psychological, and social nature with varying degrees of self-care ability" (Chinn & Kramer, 2004, cited in Bridge, Cabell, & Herring, n.d., p. 4). A human being is also stated to have the ability to "reflect, symbolize and use symbols" (Bridge, Cabell, & Herring, n.d., p. 2). Orem used the terms "individual, patient, multiperson unit, self-care agent, dependent-care agent" when referring to humans (Fawcett, 2005, cited in Bridge, Cabell, & Herring, n.d., p. 2).
When addressing the concept of health, Orem stated that the terms health and healthy "are terms used to describe living things when they are structurally and functionally whole or sound... includes that which makes a person human, operating in conjunction with physiological and psychophysiological mechanisms and material structure (biologic life) and in relation to and interacting with other human beings (interpersonal and social life)" (Bridge, Cabell, & Herring, n.d., p. 4). Health is further defined by Orem as "a state of physical, mental and social well-being, and not merely by the absence of disease or infirmity" (Foster & Bennett, 2001, cited in Bridge, Cabell, & Herring, n.d., pp. 4–5).
Nursing is viewed by Orem as "an art through which the practitioner of nursing gives specialized assistance to persons with disabilities of such a character that greater than ordinary assistance is necessary to meet daily needs for self-care and to intelligently participate in the medical care they are receiving from the physician" (Bridge, Cabell, & Herring, n.d., p. 5).
According to Orem, the environment "is encompassed by two dimensions — physical, chemical, and biologic features and socioeconomic features. Physical, chemical, and biologic features include things such as atmosphere, pollutants, weather conditions, pets, infectious organisms, and the like. Socioeconomic features of the environment focus on the family and the community and include such things as gender and age roles, cultural roles, and cultural prescriptions of authority" (Bridge, Cabell, & Herring, n.d., p. 5). Orem noted that these two dimensions may interact with one another and emphasized the "potential contribution of environment to a person's development," stating that "it is the total environment, not any single part of it that makes it developmental" (Orem, 2001, p. 58, cited in Fawcett, 2005, cited in Bridge, Cabell, & Herring, n.d., p. 6). From Orem's perspective, the environment represents "prevailing internal and external conditions in some time and place frame of reference" (Fawcett, 2005, cited in Bridge, Cabell, & Herring, n.d., p. 6).
Orem had two purposes in developing the Self-Care Framework: (1) to identify the meaning of nursing, and (2) to develop a body of nursing knowledge grounded in research (Bridge, Cabell, & Herring, n.d., p. 7). Self-care is defined as "actions of individuals directed to self or environment to regulate factors or conditions in the interest of that individual's life, health, and well-being" (Bridge, Cabell, & Herring, n.d., p. 7).
The self-care system is comprised of: (1) actions that are performed over time and, through analysis, organized into coordinated systems of action; (2) the dependent care system, which is a coordinated system of action designed to meet the self-care requirements of dependent individuals; and (3) data that describes self-care and which, through analysis, yields the self-care system (Bridge, Cabell, & Herring, n.d., p. 7).
"Structure of the self-care system and agency"
"Types of self-care limitations and therapeutic demand"
"Three nursing systems and nursing agency defined"
"Theory's relevance to contemporary nursing practice"
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