Chapter 14: Self-care deficit theory of nursing’

Chapter 14: Self-care deficit theory of nursing

Violeta A. Berbiglia, Barbara Banfield*

PowerPoit by Dr. Sergio Osegueda

Dorothea E. Orem (1914–2007)

“Nursing is practical endeavor, but it is practical endeavor engaged in by persons who have specialized theoretic nursing knowledge with developed capabilities to put this knowledge to work in concrete situations of nursing practice.” (Orem, 2001)

Credentials and background of the theorist

Dorothea Elizabeth Orem was born in Baltimore, Maryland, in 1914.

She began her nursing career at Providence Hospital School of Nursing in Washington, DC, where she received a diploma of nursing in the early 1930s.

Orem received a bachelor of science degree in Nursing Education from Catholic University of America (CUA) in 1939, and she received a master’s of science degree in Nursing Education from the same university in 1946.

Background

Orem’s early nursing experiences included operating room nursing, private duty nursing (home and hospital), hospital staff nursing on pediatric and adult medical and surgical units, evening supervisor in the emergency room, and biological science teaching.

Orem held the directorship of both the nursing school and the Department of Nursing at Providence Hospital, Detroit, from 1940 to 1949. After leaving Detroit, she spent 8 years (1949–1957) in Indiana working at the Division of Hospital and Institutional Services of the Indiana State Board of Health.

In 1957, Orem moved to Washington, DC, to take a position at the Office of Education, U.S. Department of Health, Education, and Welfare, as a curriculum consultant. From 1958 to 1960, she worked on a project to upgrade practical nurse training.

That project stimulated a need to address the question: What is the subject matter of nursing? As a result, Guides for Developing Curricula for the Education of Practical Nurses was developed (Orem, 1959).

Background

In 1970, Orem left CUA and began her consulting firm. Orem’s first published book was Nursing: Concepts of Practice (Orem, 1971).

She was editor for the NDCG as they prepared and later revised Concept Formalization in Nursing: Process and Product (NDCG, 1973, 1979).

In 2004 a reprint of the second edition was produced and distributed by the International Orem Society for Nursing Science and Scholarship (IOS). Subsequent editions of Nursing: Concepts of Practice were published in 1980, 1985, 1991, 1995, and 2001. Orem retired in 1984 and continued developing the self-care deficit nursing theory (SCDNT).

Background

Georgetown University conferred the honorary degree of Doctor of Science on Orem in 1976.

She received the CUA Alumni Association Award for Nursing Theory in 1980.

Other honors included Honorary Doctor of Science, Incarnate Word College, 1980; Doctor of Humane Letters, Illinois Wesleyan University, 1988; Linda Richards Award, National League for Nursing, 1991; and Honorary Fellow of the American Academy of Nursing, 1992.

She was awarded the Doctor of Nursing from the University of Missouri in 1998.

Background

At age 92, Dorothea Orem’s life ended after a period of being bedridden. She died Friday, June 22, 2007, at her residence on Skidaway Island, Georgia.

Orem’s many papers and presentations provide insight into her views on nursing practice, nursing education, and nursing science.

Theoretical sources

Orem (2001) stated, “Nursing belongs to the family of health services that are organized to provide direct care to persons who have legitimate needs for different forms of direct care because of their health states or the nature of their health care requirements”

Like other direct health services, nursing has social features and interpersonal features that characterize the helping relations between those who need care and those who provide the required care.

Theoretical sources

Orem’s SCDNT provides a conceptualization of the distinct helping service that nursing provides.

The primary source for Orem’s ideas about nursing was her experiences in nursing. Through reflection on nursing practice situations, she was able to identify the proper object, or focus, of nursing. The question that directed Orem’s (2001) thinking was, “What condition exists in a person when judgments are made that a nurse(s) should be brought into the situation?”

The condition that indicates the need for nursing assistance is “the inability of persons to provide continuously for themselves the amount and quality of required self-care because of situations of personal health”

Theoretical sources

Originally, three specific theories were articulated: the theory of nursing systems, the theory of self-care deficits, and the theory of self-care.

An additional theory, the theory of dependent-care, has been articulated.

This theory is regarded as being parallel with the theory of self-care and serves to illustrate the ongoing development of the SCDNT

In addition to her experiences in nursing practice situations, Orem was well versed in contemporary nursing literature and thought.

Theoretical sources

Foundational to Orem’s SCDNT is the philosophical system of moderate realism.

These inquiries revealed consistency between Orem’s views regarding the nature of reality, human beings, the environment, and nursing as a science–ideas and positions associated with the philosophy of moderate realism

Orem did not specifically address the nature of reality; however, statements and phrases that she uses reflect a moderate realist position. Four categories of postulated entities are identified as establishing the ontology of the SCDNT (Orem, 2001, p. 141). These four categories are (1) persons in space-time localizations, (2) attributes or properties of these persons, (3) motion or change, and (4) products brought into being.

Theoretical sources

Orem (1997) identified “five broad views of human beings that are necessary for developing understanding of the conceptual constructs of the SCDNT and for understanding the interpersonal and societal aspects of nursing systems” (p. 28). These are the view of person, agent, user of symbols, organism, and object.

The view of person-as-agent is central to the SCDNT. Self-care, which refers to those actions in which a person engages for the purpose of promoting and maintaining life, health, and well-being, is conceptualized as a form of deliberate action.

Theoretical sources

Orem (2001) identified two sets of speculatively practical nursing science: nursing practice sciences and foundational nursing sciences.

The set of nursing practice sciences includes (1) wholly compensatory nursing science, (2) partly compensatory nursing science, and (3) supportive developmental nursing science.

The foundational nursing sciences are (1) the science of self-care, (2) the science of the development and exercise of the self-care agency in the absence or presence of limitations for deliberate action, and (3) the science of human assistance for persons with health-associated self-care deficits.

Structure of nursing science

Wholly compensatory nursing

Partly compensatory nursing

Supportive-developmental nursing

Foundational nursing sciences

The science of self-care

The science of the development and exercise of self-care agency in the absence or presence of limitations for deliberate action

The science of human assistance for persons with health-associated self-care deficits

Applied nursing sciences

Basic nonnursing sciences

Biological

Medical

Human

Environmental

MAJOR CONCEPTS & DEFINITIONS

The self-care deficit nursing theory is a general theory composed of the following four related theories:

The theory of self-care, which describes why and how people care for themselves

The theory of dependent-care, which explains how family members and/or friends provide dependent-care for a person who is socially dependent

The theory of self-care deficit, which describes and explains why people can be helped through nursing

The theory of nursing systems, which describes and explains relationships that must be brought about and maintained for nursing to be produced

Basic nursing systems.

Self-care

Self-care comprises the practice of activities that maturing and mature persons initiate and perform, within time frames, on their own behalf in the interest of maintaining life, healthful functioning, continuing personal development, and well-being by meeting known requisites for functional and developmental regulations (Orem, 2001

Dependent-care

Dependent-care refers to the care that is provided to a person who, because of age or related factors, is unable to perform the self-care needed to maintain life, healthful functioning, continuing personal development, and well-being.

Self-care requisites

A self-care requisite is a formulated and expressed insight about actions to be performed that are known or hypothesized to be necessary in the regulation of an aspect of human functioning and development, continuously or under specified conditions and circumstances.

A formulated self-care requisite names the following two elements:

The factor to be controlled or managed to keep an aspect of human functioning and development within the norms compatible with life, health, and personal well-being

The nature of the required action

Universal self-care requisites

Universally required goals are to be met through self-care or dependent care, and they have their origins in what is known and what is validated, or what is in the process of being validated, about human structural and functional integrity at various stages of the life cycle

Eight self-care requisites common to men, women, and children are suggested:

Maintenance of a sufficient intake of air

Maintenance of a sufficient intake of food

Maintenance of a sufficient intake of water