Biography of Theorist
The self-care deficit theory is also referred to as the Orem model of nursing, which is a tribute to the theorist who developed it. A biography of Dorothea Orem is captured in a practitioner website “Nurselabs’ by Gonzalo (2021), who states that this theorist lived between 15 July 1914 and 22 June 2007. She was born in Baltimore, Maryland, where her father was a construction worker and her mother was a homemaker. Orem was the younger of two daughters in the family.
In terms of her education, Orem attended Seton High School, from where she graduated in 1931. She obtained a diploma from the Providence Hospital School of Nursing and graduated in 1934. She pursued higher education at the Catholic University of America where she earned a Bachelor of Science (B.S.) in Nursing Education in 1939 and a Master’s of Science (M.S.) in Nursing in 1945. Her career was based on these academic achievements where her distinguished career earned her an Honorary Doctorate of Science in 1976 from Georgetown University and an Honorary Doctorate of Humate Letters in 1988 from Illinois University. In 1988, she accomplished a Doctorate Honoris Causa from the University of Missouri, Columbia.
Orem’s career and practice have made critical contributions to nursing. She has worked as a curriculum consultant with multiple schools, divisions, and departments of nursing colleges and universities. These include Gorge Brown College of Applied Arts, The Medical College of Virginia, Georgetown University, and The University of Southern Mississippi. Orem also worked in hospitals and other facilities, including The John Hopkins Hospital, the Center for Experimentation and Development in Nursing, the Indiana State Board of Health (Nickle, n.d.). She has served as a director at The John Hopkins Hospital and Wilmer Clinic.
Oren has written several publications in nursing practice, some of which led to the development of key theories. For example, her 1971 Nursing: Concepts and Practice outlined her theory of nursing, which is the Self-care Deficit Theory of Nursing. This publication is now in its sixth edition. Her academic collection also consists of consulting and teaching records, research materials, publications, correspondence, biographical and personal records, and audio-visual materials that describe Orem’s life.
Introduction to Theory
Orem’s self-care deficit theory is founded on the premise that patients are better able to recover from their illnesses if they maintain a certain level of independence over their self-care. The theory comprises three interrelated theories: the theory of self-care, the self-care deficit theory, and the theory of nursing systems (Gonzalo, 2021). According to Gligor and Domnariu (2020), Orem’s theory has been modified over time to fit within the individual and nursing system concepts. Therefore, the self-care deficit nursing theory can be described as a general nursing theory encompassing the three aforementioned theories.
The nursing systems theory covers self-care deficit and explains the relationships necessary to achieve a streamlined care process. In this case, Orem believed that the nursing system is subject to the limitations of care of a patient. This suggestion implies that care tends to vary across the systems, which means that total care can be offered to critically ill patients, partial care to rehabilitation patients, and support and education care for patient education purposes. Self-care deficit described and explains why patients can be helped through nursing (Gligor & Domnariu, 2020). It also expresses the relationship between the needs of a patient and his or her capacity for action.
From the above description of the self-care deficit nursing theory, it is apparent that the basic premise of Orem’s theory is that individuals tend to be interested in such aspects as continuous communication and regular interactions with their living environment. Additionally, human beings can act deliberately as manifested through needs identification and decision-making by the patients. Overall, the theory holds that patients have a critical role to play in the delivery of their own care. The nurses would achieve greater success through constant communication with and engagement of the patients in both the identification of patient needs and the making of critical care decisions.
Components of the Theory
A good theory comprises several components, including concepts, constructs, propositions, and models. According to Gligor and Domnariu (2020), Orem’s theory is formulated around six major concepts: nursing systems, self-care deficit, self-care, nursing agency, self-care agency, and self-care demand. Nursing systems, self-care, and self-care deficit have been described in the introduction section. Selfcare serves a major purpose of meeting the self-care demand, which is based on the aspects of patient’s health, life, or wellness. Self-care agency is the aspect that enables an individual to perform self-care, while the nursing agency is what enables the nurses to assess the actual or potential self-care deficits of a patient (Elalem et al., 2018). Additionally, nursing agency constructs the nursing system such that it can address the self-care deficits.
A few models have been constructed using the self-care deficit nursing theory and its key concepts. For example, the self-care intervention model often recommended for nursing has been recommended by Dorothea Orem (Elalem et al., 2018). The model pays greater attention to such aspects of self-care as the identification of human activities and their conduct for the sake of improving one’s well-being. Additionally, the self-care model acts as a suitable nursing guideline for planning and implementing self-care and developing a conceptual framework for the self-care programs. The relationship between the variables in this model has been described by Ali (2018), who expresses that self-care agency and self-care demand are interrelated such that a weak agency means more self-care demand.
Orem’s theory is also founded on one major proposition outlining the relationship between nursing and the patient. In other words, the theory is founded on the proposition that patients can provide care for themselves. The concept of self-care deficit is also based on the proposition that nurses will find self-care deficit when individuals are unable to find it. the proposition for the nursing system is that legitimate patients exhibit self-care deficits while attempting to meet the self-care requisites. Therefore, it can be argued that propositions associated with Orem’s theory are found within the various concepts and that all propositions outline the role of the patients and nurses, as well as the relationship between them.
Across the literary materials available, the constructs of Orem’s theory have not been expressly mentioned or outlined, unlike the concepts, models, and propositions. However, inferences can be made when considering all the propositions and concepts given and their relationship. For example, it can be argued that the efficacy of care depends on how well both parties play their role. In this case, the engagement and constant communication mentioned earlier become critical that can be used to design the basic constructs of Orem’s theory.
Orem’s self-care deficit theory has been extensively studied, especially by scholars hoping to examine its applicability in different contexts and health conditions. For example, Tokyildiz and Kasikci (2020) explore how training based on Orem’s theory impacts the quality of life of patients with coronary artery disease. The focus of these scholars is on the self-care agency concept, which has been described earlier as the aspect that allows a patient to conduct self-care. In this case, the proposition of the self-care agency is that individuals with the right self-care capabilities can effectively fulfill self-care goals. Therefore, improving these abilities through training should help a patient achieve greater health outcomes in terms of quality of care. According to Tokyildiz and Kasikci (2020), coronary artery disease is a major cause of death on the planet and it detrimentally affects individuals through reduced functional skills and self-care capabilities, which in turn cause a deterioration of the quality of life. Through a randomized control trial conducted within a cardiology clinic, the findings of their study indicate that the training program developed based on Orem’s theory improved both the self-care agency and the quality of life.
The role of nurses is to help improve the overall well-being of patients, including quality of life. Another study that focuses on quality of life has been conducted by Khademian et al. (2020), who seek to explore how self-care education based on Orem’s theory affects the quality of life and the self-efficacy of hypertension patients. The quasi-experiment was conducted in 2015 in Mamasani, Iran, where 80 patients were recruited. The results indicated that the mean score of the quality of life in the experimental group was higher than the control group, with the results having been taken eight weeks after the intervention. The scholars also noticed that the changes were not significant immediately after the intervention. Overall, the conclusion of the study by Khademian et al. (2020) is that self-care education based on Orem’s theory helps improve the quality of care of patients, as well as their self-efficacy.
Most studies target different concepts of Orem’s theory and examine their application to practice. Such a position is criticized by Yip (2021), who articulates the need to explore how the theory as a whole is understood and practiced. Yip (2021) seeks to fill this gap by presenting a case study of an advanced practice nurse (APN) and its self-care deficit nursing theory-led practices. The setting for the study is primary healthcare, where the researcher observed how a practitioner applied Orem’s theory. Additionally, a comparison between the observed practice and the processes stipulated in the theory is made across four operations: case management, prescription, diagnosis, and treatment. The main outcome of the study was that theory-based practice exhibited several weaknesses and strengths for a primary care setting. Additionally, the study confirms that the role of a nurse as per the theory is to determine how patients can best undertake self-care under specific circumstances and living arrangements. In the case study, the scholar found the theory to offer a critical framework for nursing practice, including allowing the use of nurse-sensitive indicators when determining clinical practice.
The self-care model works best when both patients and practitioners understand their roles and have the right capabilities. A study by Malekzadeh et al. (2018) explored how teaching Orem’s model to nursing students affects their performance and patient satisfaction with their services. The quasi-experimental non-randomized study used a sample of 66 students, who were then divided into an intervention and a control group. The performance of both groups was assessed and compared during the clinical course. The rationale of this study is that clinical education plays a critical role in nursing efficacy, which is affected by such problems as the use of traditional methods coupled with a resistance to innovations. In this case, teaching Orem’s model is perceived to be an intervention designed to help nursing students understand how self-care theory affects their practice and its outcomes, which is often measured in terms of patient satisfaction. The outcome of the study revealed that Orem’s self-care model led to an approximately 23% improvement in student performance. This can be interpreted to mean that training practitioners on Orem’s model help boost patient satisfaction.
All studies on the application of Orem’s theory and its concept led to a similar conclusion regarding the role of the theory in improving patient care. The use of the theory in treating acute coronary syndrome has been explored by Zhu et al. (2021), who seeks to understand how the theory helps improve rehabilitation efficacy and quality of life after PCI. As with all other studies, the results of this research indicate significant improvements in patient outcomes, including negative emotions, self-care capabilities, quality of life, and disease cognition. Additionally, Zhu et al. (2021) also observe an improvement in nursing satisfaction, an element that has not been featured in many experiments.
Orem’s theory is based on the premise that patients have a certain degree of control over their well-being through their practices and decisions. Many of the studies highlighted above prove this point by indicating that both patients and nurses who have certain capabilities in self-care achieve greater patient outcomes. The proposed capstone project focuses on a fall prevention program in homebound patients. Orem’s theory is related to this project in the sense that it helps determine the practices of both the practitioners and patients. In this case, the patients will be expected to act deliberately in such processes as identifying their needs and making core decisions regarding how to address them. As mentioned earlier, self-efficacy demand and the nursing agency are tied by the proposition that a weaker agency means more demand (Elalem et al., 2018). Therefore, the application of the theory is used to study how both the home-based care practitioner and the patient can improve their capabilities to achieve positive health outcomes.
One of the uses of Orem’s theory in the past is by examining the role of training and education in improving the quality of life among patients with specified illnesses. In the capstone project, a similar approach can be adopted where the basic premise is that training both nurses and patients will improve both self-care activities and quality of care. According to Tokyildiz and Kasikci (2020), the training proved effective in improving both agency and quality of life. For homebound patients, the expected outcomes include reduced fall rates among patients through deliberate actions of self-care. A training program can be developed that targets the patients and teaches them the key measures to take to avoid falls. Similar programs can be developed for nurses who would use the theory to determine care needs and their delivery. The findings of the capstone project can also be used to inform research and make a case for educating nursing students on the theory. The quality of life of homebound patients includes fewer injuries from falls. Nurses and patients can be assessed in terms f the specific actions they take towards this goal.
In addition to training, the capstone project can also explore the efficacy of Orem’s theory in improving patient outcomes. A similar approach to Yip (2021) can be adopted where the focus is on understanding the outcomes of theory-led practices. In such a scenario, the capstone project would seek to use similar methodologies, which included observing a practitioner at work and comparing actions to the procedures stipulated by Orem’s theory. In other words, a home-based nurse will be observed in terms of how he or she applies Orem’s theory in preventing falls. The specific actions of self-care used by the practitioner and passed down to the patient would be explored to assess how the nurse understands the theory and seeks to apply it. This way, the capstone helps to fill similar gaps to Yip (2021) regarding the use of the broader theory as opposed to specific concepts. A nurse is expected to know her role and responsibility to the patients, which means that the type of care given is based on the needs identified by both the patient and the nurse.
In homebound patients, the attention of the scholar is majorly on the programs implemented and the outcomes they have regarding fall prevention. Multiple pathways to research are available, including assessing the performance of the nurse when delivering care. Such a path has been used by Malekzadeh et al. (2018), who makes a case for teaching Orem’s theory during nursing courses. For the capstone project, the main idea is to make observations of the activities undertaken and their outcomes. Rather than exploring the nursing course, an assumption can be made that the practitioners have been taught Orem’s theory as part of the nursing course. Alternatively, it can be assumed that the nurses fully understand the theory and are applying it in delivering care. Such a case would require a control group comprising nurses who have not been taught about the theory or who do not apply it to fall prevention among homebound patients. Successful completion of the capstone project following this path should replicate previous findings.
Overall, the past use of Orem’s theory offers alternatives to the capstone project, including the research question, approaches, and even methodologies. The topic has been determined to be fall prevention among homebound patients, which is relatively broad. With the multiple alternatives from previous studies, the capstone project can be narrowed down further to explore a particular element of the theory. While training and education are major pathways among researchers, there is a need to examine performances resulting from the knowledge in Orem’s theory. Therefore, the capstone will be designed to assess how knowledge of the theory by home-based nurses affects their performance and critical decisions regarding care delivery. Additionally, the performance metrics will also be linked to the overall well-being of the patient.
Ali, B. (2018). Application of Orem self care deficit theory on psychiatric patients. Annals of Nursing and Practice, 5(1), 1-3.
Elalem, S., Shehata, O., & Shattla, S. (2018). The effect of self-care nursing intervention model on self-esteem and quality of life among burn patients. Clinical Nursing Studies, 6(2), 79-90. Web.
Gligor, L., & Domnariu, C. (2020). PAtient care approach using nursing theories – comparative analysis of Orem’s self-care deficit theory and Henderson’s model. Acta Medica Transilvanica, 25(2), 11-14. Web.
Gonzalo, A. (2021). Dorothea Orem: Self-Care Deficit Theory. Nurselabs. Web.
Khademian, Z., Ara, F., & Gholamzadeh, S. (2020). The effects of self care education based on Orem’s nursing theory on quality of life and self-efficacy in patients with hypertension: A quasi-experimental study. International Journal of Community Based Nursing and Midwifery, 8(2), 140-149. Web.
Malekzadeh, J., Amouzeshi, Z., & Mazlom, S. (2018). A quasi-experimental study of the effect of teaching Orem’s self-care model on nursing students’ clinical performance and patient satisfaction. Nursing Open, 5(3), 370-375. Web.
Nickle, L. (n.d.). Dorothea E. Orem collection. Web.
Tokyildiz, F., & Kasikci, M. (2020). Impact of training based on Orem’s theory on self-care agency and quality of life in patients with coronary artery disease. The Journal of Nursing Research, 28(6), 1-10. Web.