Orem’s Self-Care Deficit Nursing Theory

Orem’s theory provides a valid framework for the nursing profession through its assessment, identification, and evaluation of multiple factors affecting patients. In the study by Campbell and Weber (2000) the SCDT was utilized to assess the responses of battered women. Self-esteem is classified as a foundational capability in SCDT and as a result of applying Orem’s theory to the study, group responses indicated a strong correlation between one’s ability to care for self, self-care agency, and self-esteem. The study also identified the power that abusers had versus that of the lack of self-care and armed with this information and knowledge nurse are better able to devise strategies that address the unique needs of the population (Campbell & Weber, 2000).

The art of nursing includes the ongoing assessment of patients and a large portion of nursing diagnosis includes addressing potential risks. The application of Orem’s theory allows nurses to assess for factors that could present as future risks as noted in the study by Hart and Foster in 1998.

They sought to examine the relationships between basic conditioning factors and self-care agency (ability) in a group of pregnant women. Their study identified correlations of enhanced self-care agency amongst those who had higher levels of education, medical insurance and were primiparous.

The identification of lower levels of education and absence of medical insurance with lower self-care agency scores allowed nurses to address the deficits in a proactive manner to increase self-care agency and positively impact not only the pregnancy experience but outcomes for mother and child (Hart & Foster, 1998).

While Orem’s theory is based in the nursing discipline its application is not restricted to such and is widely generalizable. Independence and self-care agency are interchangeable and applicable across many persons, professions and situations. From the administrative-work place platform, Orem’s theory can provide insight as to barriers that prevent employees from obtaining self-sufficiency. While the study of Wilson, Mood, Risk, and Kershaw (2003) is based in nursing its results can be applied across many disciplines. Their study examined BCF’s such as age, educational level and culture to evaluate effective educational material. Disciplines outside of nursing can apply findings from the study that indicate not only evaluating the appropriateness of the materials utilized, for the administrative setting this could be methods for teaching, but also in evaluating comprehension in the form of follow up questions or provision of supplemental materials.

As mentioned in the study some factors may not be altered by outside forces (literacy, cognitive ability) however using the framework of the theory to assess and identify deficits can lead to increased understanding and application of strategies to ultimately increase ones ability for independence or self-care (Wilson, Mood, Risk, & Kershaw, 2003).
One of the strengths of Orem’s SCDT is that its goal is to identify deficits or barriers to patients achieving independence in the form of self-care. As Orem (1995) stated when self-care is practiced and the universal care requirements met, positive health and well being are promoted (Orem, 1995, p. 192). As a profession, nursing aims to empower patients to be active participants in their health care and Orem’s theory focuses on this goal for patients. Another strength found in Orem’s theory is the ability to utilize it to assess and customize patient interventions and strategies in a unique and holistic manner. Orem’s theory not only addresses factors that arise during illness but also accounts for outside factors such as the basic needs of access and availability of food and water, sense of security and freedom from hazards, as well as the abstract such as self-esteem. Each of these are unique to each patient and utilizing Orem’s theory allows nurses to assess a myriad of factors and formulate plans that address each patients actual and potential deficits to achieving self-care. While Orem’s theory provides a strong foundational framework for nursing there are some aspects that could be considered weaknesses. One of these potential weaknesses is that Orem states that self-care is a ‘learned behavior’ (Orem, 1995, p. 225).

In situations where cultural beliefs mirror that of lack of self-care this aspect of the theory would not necessarily provide effective data or influence effective strategies. In the culture of my youth it was widely believed that post-partum women should not be active and at times remain in bed at the insistence of the elder women. As nurses we recognize that immobility is not an effective strategy for patients and that ambulation and mobility should be encouraged. In situations such as this Orem’s theory would not provide effective data on rationale for the patient’s lack of self-care. Another weakness in Orem’s theory is that the focus is on the patient and immediate care givers as the agents of care (Geden & Taylor, 1999), but doesn’t take into consideration the entire familial unit as a caregiver, which in some cultures is very prominent and influential in patient care. Orem’s theory provides a valid useful tool for assessing and identifying social factors such as self-esteem and support that contribute to deficits, however, it is lacking in its focus on community care style and applicability in some ‘traditional cultural’ remedies seen in some families.
Orem’s theory though conceptualized in the 1950’s continues to provide meaning insight as to patient needs and barriers. Nursing practice today is largely based on measurable data and evidence-based practices. The application of Orem’s theory in both patient care and research continues to provide meaningful data and evidence aligned with the current trends in nursing. With patients and the goal of self-management and active participation in health as the focus and goal of Orem’s SCDT, it continues to be a useful, valid, and effective theory in the care of today’s patient.

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