Dorothea Orem's Self-Care Theory: Overview and Application

Historical Context of Nursing During Orem's Era

Dorothea Orem is one of the foremost theorists in the field of nursing in the United States. She developed her Self-Care Theory between 1949 and 1957 at a time when nursing was characterized by significant deficits in the training of practical nurses (Basavanthappa, 2007, p. 72). During this period, there was a pressing need to upgrade practical nursing training and to define the subject of nursing as both a profession and a practice. Nurses not only struggled to articulate what nursing was but also faced challenges with its practical aspects. As a result, the quality of nursing in general hospitals was relatively low and in need of significant improvement.

Orem was motivated by several factors to develop her theory, chief among them being the state of nursing during that period. In response to these conditions, she developed the theory to upgrade the quality of nursing in general hospitals across the country (Alligood, 2013, p. 241). A second motivating factor was her personal experience in the nursing field, which encompassed private duty nursing, teaching, and hospital staff nursing. Third, Orem was motivated by her work on a project focused on enhancing practical nursing training and on developing her own concept of the profession and its practice.

Motivating Factors Behind the Theory

Orem's theory development involved defining the metaparadigm concepts of nursing and creating a new conception of the discipline to address deficiencies in practical nursing training. She defined nursing as an art or helping service rather than a technology, and defined health as the state in which an individual is whole or sound both structurally and functionally ("Dorothea Orem's Self-Care Theory," 2012). Orem defined environment as the environmental factors, elements, and conditions as well as the developing external environment surrounding the individual. She defined a human being as a person with the ability to reason and use symbols, functioning as a unit biologically, socially, and symbolically.

Orem's Self-Care Theory is valuable because it provided the basis for creating a body of knowledge for nursing education and for delivering nursing care in real clinical situations (Alligood, 2013, p. 243).

Theory Development and Metaparadigm Concepts

Dorothea Orem's Self-Care Theory is grounded in three core concepts: self-care, self-care deficit, and nursing system. The concept of self-care refers to activities that a person initiates and performs personally to maintain health and well-being. The concept of self-care deficit specifies situations in which nursing is needed — namely, when an adult is limited or unable to provide ongoing, effective self-care. The concept of nursing systems describes how nurses and patients work collaboratively to meet the patient's self-care needs through technologies and processes developed by professionals in the healthcare field.

The strengths of this theory include its provision of a comprehensive framework for nursing practice, its specification of when nursing intervention is necessary, and its alignment with health promotion and maintenance. The weaknesses include its focus on illness, its treatment of health as dynamic and changing, and its definition of the system as a single unified whole.

Overview of Orem's Self-Care Theory

A patient-centered approach to nursing focuses on a person's health needs, desires, and goals and uses these characteristics as the basis of the nursing process and care. Orem's theory is congruent with this approach because it defines who the individual is and specifies when nursing is required to promote the health and well-being of an adult who is limited or unable to provide continuous effective self-care.

Dorothea Orem's Self-Care Theory has been applied in different nursing settings and research contexts, as evidenced in the literature. Coleen P. Kumar conducted a study on the application of this theory and uniform nursing languages in the case of a woman with diabetes. The study was carried out by examining the patient's situation, determining projected health outcomes, and then applying the various concepts in the theory to identify suitable nursing interventions. The researcher assessed the patient and her family and developed a plan of care based on the four client-related concepts in Orem's theory: self-care, self-care agency, therapeutic self-care demand, and self-care deficit (Kumar, 2007, p. 104). The study concluded that applying theory-based nursing care alongside uniform nursing language improves the patient's ability to self-manage chronic illness.

Rebecca Green conducted a study on the use of this theory to provide care for children with special healthcare needs in the school setting. The study examined two children — one with chronic asthma and another with mild to severe cognitive developmental disability — to demonstrate the wide range of disabilities that school nurses encounter (Green, 2012, p. 37). Orem's theory was applied by using her recommended nursing actions to assist patients and their families in assuming ongoing self-care and by promoting patient independence through teaching and implementing a self-care schedule. The study found that the theory is useful in preparing for and caring for such children, as it provides a framework for identifying problems and fostering independence in diverse clinical populations.