This paper examines Dorothea Orem's theory of self-care, self-care agency, and therapeutic self-care as a framework for professional nursing practice and health policy development. The paper begins by defining nursing theory and its role in guiding clinical judgment, then traces Orem's foundational contributions since 1956. It discusses the broader importance of nursing theory in education, communication, and differentiation of the nursing profession. A summary of Orem's conceptual model is provided, followed by an exploration of its practical application — including a personal clinical example demonstrating how self-care education reduced hospital readmissions by 50%. The paper concludes that Orem's theory is an indispensable educational and professional platform for nursing practice.
A theory consists of related concepts and propositions used to guide professional practice. Nursing theory in particular serves as a set of interrelated, predictive, and explanatory concepts and statements that assist in understanding nursing phenomena, helping practitioners explain and predict nursing outcomes. Nursing theory is an organized body of knowledge used to explain phenomena and support nursing practice. It is defined as a set of definitions, concepts, assumptions, and relational propositions derived from a nursing model. Nursing theories consist of both grand theories and middle-range theories. Middle-range theory is testable, limited in scope and variables, and used primarily for clinical research. Most importantly, nursing theory serves as the body of knowledge that supports the conduct of nursing research.
The objective of this paper is to apply Dorothea Orem's theory to the development of health policy advocacy. The paper argues that Orem's theory will help people achieve a higher level of well-being while encouraging healthcare professionals to deliver quality care that assists patients in improving their health.
The self-care theory is identified here as an essential nursing theory. Orem was the first theorist to pioneer the concept of self-care, beginning in 1956. Before its formulation, the nurse's role was largely premised on patients' social dependence. Starting in 1956, nursing professionals began integrating self-care into nursing practice, and by the 1980s the self-care theory had been more fully articulated within the profession (Maria, 2014). Orem's self-care requisites are influenced by the healthcare system, developmental state, gender, and age. These requisites assert that therapeutic intervention can help an individual satisfy a therapeutic self-care demand within the healthcare environment.
The major importance of nursing theory is its connection to health promotion. Nurses play a central role in preventing disease and encouraging patients to adopt positive health behaviors. They are also responsible for identifying symptoms and undertaking patient care. In this context, nursing theory serves as a platform that helps nurses identify symptoms and strengthen their professional practice. It also enables nurses to make sound clinical judgments that enhance professional performance (Roussel, 2013). Additionally, nursing theory provides common terminology that facilitates communication among nursing professionals regarding their practice.
Nursing theories are grounded in both inductive and deductive reasoning, both of which assist in enhancing patient care. In contemporary healthcare environments, nursing theory guides nurses in their professional practice and helps them identify and understand patients' symptoms as well as undertake appropriate patient care.
Nursing theory is essential to the profession because it guides professional conduct: the nurse's role is to help patients change their behaviors positively toward better health outcomes (Maria, 2014). Nursing theories are therefore effective tools that guide professional conduct and assist nurses in implementing ethical professionalism when dealing with patients. Theory helps nurses understand how to identify patient symptoms and determine appropriate care strategies based on professional knowledge. Since nursing is professionally built on theory, nursing theories help strengthen nursing practice and assist in organizing, analyzing, and interpreting patient data. Professional nurses also rely on nursing theories to make sound clinical decisions that enhance overall practice.
Nursing theory should be included in master's-level programs because it provides a major framework for planning curricula and clinical training. For example, nursing theory assists colleges and universities offering nursing programs in designing curricula that develop the skills and concepts nurses need in practice. At the master's level, nursing theories allow students to understand that self-care is central and critical to the profession.
Aliakbari et al. (2015) argue that nursing theories influence the emotional responses of learners and assist in developing their problem-solving skills. Theories assist in predicting, controlling, and explaining phenomena, and nursing learning theories prepare the foundation for understanding concepts and their applications. Theories can therefore help master's students organize, acquire, and deploy knowledge and skills. The professional roles of master's-prepared nurses after graduation include managing healthcare organizations, implementing employee training, and leading health promotion programs. Theories support nurses in designing and implementing health promotion initiatives, and health communication is an essential tool that enhances patient education toward positive health behaviors.
An overview of nursing theories shows that they facilitate communication about concepts and terminology while also serving as a means of measuring quality in healthcare professions. Nursing theories provide the platform through which professionals communicate about patient symptoms and care. They also serve as a solid foundation for patient diagnosis and intervention, and as frameworks that solidify professional teamwork by providing valuable inputs to guide quality treatment and patient safety.
One way nursing theory differentiates the nursing profession from other healthcare professions is by creating a distinct professional environment. While all healthcare professionals share the goal of facilitating patient safety and enhancing quality care delivery, theory defines what is unique to nursing practice. Roussel (2013) argues that theory separates the nursing profession from other healthcare professions through its articulation of nursing clinical skills, job descriptions, competencies, and educational curriculum.
A notable concern regarding the use of nursing theory within the profession is that many different theories exist, and none is universal enough to satisfy all nursing practices.
Dorothea Orem formulated the theory of self-care, self-care agency, and therapeutic self-care. Orem's self-care theory was introduced in her book Nursing: Concepts of Practice (Maria, 2014, p. 495), first published in 1971 and subsequently revised in 1980, 1995, and most recently in 2001. The theory holds that individuals perform and initiate their own well-being and health maintenance (Wong et al., 2015). Self-care agency refers to a human being's ability to engage in self-care, conditioned by life experience, age, developmental state, and available resources. Therapeutic self-care, in turn, refers to the totality of self-care actions performed over a period of time to achieve a specified set of goals and operations.
Orem also articulates the self-care deficit model, which provides a common-sense approach to self-care development in nursing. This model provides a framework for nursing practice and knowledge formation. Orem argues that nursing encompasses health, environment, and person. A patient is defined as a person under a nurse's care who has developmental needs and the capacity for self-care. The environment in which care is provided consists of the physical, biological, and social contexts in which human beings exist. Health is understood to encompass both mental and bodily functioning. Nursing's role is to provide therapeutic care through supportive education. In this framework, the care environment must be warm and conducive to patient recovery, with appropriate ventilation and physical comfort provided during care delivery. The theory holds that it is nursing professionals who have the ability to manage and alter the environment in which natural health promotion is carried out.
Orem's theory is effective in formulating healthcare policy because it assists in providing a communicating platform to people through self-care education about the methods they can employ in caring for themselves. The theory can also assist healthcare providers in formulating policies that enhance the skills of nursing professionals in delivering quality healthcare for patients who are unable to carry out self-care independently. Self-care agency — the ability to nurture a person in regulating their own human development and functioning — is central to this process. By formulating policy through health communication, nursing professionals will be better equipped to assist patients in caring for themselves. Maria (2014) argues that Orem's theory is particularly effective in enhancing care for elderly patients with peritoneal dialysis needs. In the United States, there has been an ongoing call to improve care for such patients and to increase life expectancy. A substantial number of elderly individuals suffer from renal disease and require renal replacement therapy.
"Dorothea Orem's Theory of Self-Care is an appropriate model to guide healthcare providers addressing the unique capabilities of this generation. The utilization and promotion of peritoneal dialysis as a therapy option offers the elderly an improved quality of life with a greater sense of self-worth." (Maria, 2014, p. 495)
"Applying Orem's framework to policy and clinical settings"
Maria, O. (2015). Application of Dorothea Orem's Theory of Self-Care to the elderly patient on peritoneal dialysis. Nephrology Nursing Journal, 41(5), 495–498.
Roussel, L. (2013). Management and leadership for nurse administrators (6th ed.). Jones & Bartlett Learning.
Wong, C. L., Ip, W. Y., Choi, K. C., & Lam, L. W. (2015). Examining self-care behaviors and their associated factors among adolescent girls with dysmenorrhea: An application of Orem's Self-Care Deficit Nursing Theory. Journal of Nursing Scholarship, 47(3), 219–227. doi:10.1111/jnu.12134
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