This paper examines Dorothea Orem's Self-Care Deficit Nursing Theory (SCDNT), tracing its development from Orem's career as a nurse, educator, and administrator through to its widespread application in modern healthcare. The paper outlines the theory's three interrelated concepts — self-care, self-care deficit, and nursing systems — and explores how they inform nursing practice across several clinical settings. Drawing on peer-reviewed studies, the paper reviews the theory's application with adolescents in school health contexts, burn care patients, and coronary care patients, illustrating how Orem's model guides nurses in identifying self-care deficits and designing appropriate interventions to promote patient independence and well-being.
Born in Baltimore, Maryland in 1914, Dorothea Orem went on to become a much-revered nursing leader in the United States, developing and teaching her self-care model until her death in 2007. Orem received her nursing diploma in 1939 from Providence Hospital, and in 1945 she received her M.S. in nursing education (Sitzman et al., 2010, p. 93). During her career, Orem worked as a staff nurse, a private duty nurse, a faculty member in a nursing college, a consultant, and an administrator (Sitzman et al., 2010, p. 93).
"Communication is the key to positive health results, particularly for patients with low literacy skills, yet few studies have examined patients' ability to converse about health information taught to them by providers" (Wilson et al., 2008).
Vitally interested in effective communication between nurses and patients, Orem published her self-care model for the first time at the age of 45. Through the succeeding years the model was refined and practiced in the healthcare industry, and in 1980 she published the first edition of Nursing: Concepts of Practice (Sitzman et al., 2010, p. 93). The model offers several major assumptions. Among those assumptions: (a) individuals should be self-reliant and, to the degree possible, responsible "for their own care and for others in their family needing care"; (b) people are "distinct individuals" and nursing is a "form of action-interaction" between two or more persons; (c) a person's knowledge of "potential health problems is necessary for promoting self-care behaviors"; and (d) "self-care and dependent care are behaviors learned within a socio-cultural context" (Current Nursing, 2011).
Orem's self-care model is made up of three interrelated concepts: self-care, self-care deficit, and nursing systems (Sitzman et al., 2010, p. 94). The first concept, self-care, is what it appears to be: it is what people plan to do "on their own behalf to maintain life, health, and well-being" (Sitzman et al., 2010, p. 94). When individuals are knowledgeable and perform self-care effectively, they maintain proper human functioning, preserve their structural physical integrity, and contribute greatly to their own human development and potential. A related sub-concept is self-care agency — an individual's "acquired ability to engage in self-care" (Sitzman et al., 2010, p. 94).
Those self-care abilities that individuals acquire are based on basic conditioning factors that include age, gender, developmental and health state, sociocultural factors, healthcare system factors, family system factors, patterns of living, environmental factors, and the adequacy and availability of resources (Sitzman et al., 2010, p. 94).
Orem's second concept, self-care deficit, arises when a person is incapable of self-care and nursing intervention may therefore be required. Orem presents five methods for use in such situations: acting for and doing for another person; directing and guiding; offering psychological and physical support; teaching; and providing and maintaining a supportive environment (Sitzman et al., 2010, p. 95).
The third concept, nursing systems, encompasses three approaches: (a) the nurse does all the work required in teaching the person self-care and protecting the patient; (b) the patient and nurse work cooperatively to meet self-care needs; and (c) the patient continues providing self-care while the nurse and patient work together to regulate it (Sitzman et al., 2010, p. 95).
An article in the journal Issues in Comprehensive Pediatric Nursing examines how well self-care practices work among adolescents (Callaghan, 2006, p. 1). This survey used 256 adolescents from a Southern New Jersey high school, and the researchers sought to "identify the influences of selected basic conditioning factors on the practice of health behaviors, self-efficacy beliefs, and ability for self-care" among the participants (Callaghan, 2006, p. 1). Several research instruments were employed: the Health-Promoting Lifestyle Profile II Scale (HPLPII); the Self-Rated Abilities for Health Practices Scale (SRAHP); and the Exercise of Self-Care Agency Scale (ESCA). The study was also informed by Bandura's Self-Efficacy Theory, Pender's Health Promotion Model, and Orem's Self-Care Deficit Nursing Theory (Callaghan, 2006, p. 1).
The HPLPII contained 52 items covering health responsibility, physical activity, nutrition, interpersonal relations, spiritual growth, and stress management. The SRAHP covered 28 variables relating to self-care and self-efficacy in exercise, psychological well-being, nutrition, and health practices. The ESCA presented 35 items for adolescents to consider. Students who answered "Yes" to the question "Do you have a support system (family, friends, teachers, neighbors, healthcare providers, clergy) who you feel free to ask for help when needed?" practiced health behaviors more consistently, had higher levels of self-efficacy, and demonstrated greater abilities for self-care (Callaghan, 2006, p. 5). Students who answered "Yes" to "Do you feel that your family has an adequate income to meet your daily needs?" also showed greater self-care abilities.
Based on these findings, nurses working in school districts should be able to identify self-care deficits within their student populations; students who reported having a support system had markedly more self-care abilities than those who did not (Callaghan, 2006, p. 8).
"Theory-based framework applied to burn victim care"
"Five-year review of SCDNT use in cardiac settings"
An editorial in the International Journal of Nursing Practice (Pearson, 2008) lists Orem's basic human needs — air, water, food, digestive systems, rest and activity balance, socialization, prevention of hazards, and social development/human functioning — and adds that Orem identified two further categories of self-care requisites that arise from the influence of health-related events. When the individual is capable of meeting the demands of care arising from poor health, self-care is possible; when the demand "is greater than the individual's capacity" to meet it, self-care deficit comes into play (Pearson, 2008, p. 1).
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