Dorothea Orem: Self-Care Deficit Theory

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Donna L. Hartweg

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  • Notes on Nursing Theories

    SERIES EDITORS

    Chris Metzger McQuiston

    Doctoral Candidate, Wayne State University

    Adele A. Webb

    College of Nursing, University of Akron

    Notes on Nursing Theories is a series of monographs designed to provide the reader with a concise description of conceptual frameworks and theories in nursing. Each monograph includes a biographical sketch of the theorist, origin of the theory, assumptions, concepts, propositions, examples for application to practice and research, a glossary of terms, and a bibliography of classic works, critiques, and research.

    • Martha Rogers: The Science of Unitary Human Beings

      Louette R. Johnson Lutjens

    • Imogene King: A Conceptual Framework for Nursing

      Christina L. Sieloff

    • Callista Roy: An Adaptation Model

      Louette R. Johnson Lutjens

    • Dorothea Orem: Self-Care Deficit Theory

      Donna L. Hartweg

    • Rosemarie Parse: Theory of Human Becoming

      Sheila Bunting

    • Margaret Newman: Health as Expanding Consciousness

      Joanne Marchione

    • Paterson and Zderad: Humanistic Nursing Theory

      Nancy O'Connor

    • Madeleine Leininger: Cultural Care Diversity and Universality Theory

      Cheryl L. Reynolds and Madeleine M. Leininger

    • Florence Nightingale: An Environmental Adaptation Theory

      Louise C. Selanders

    • Hildegard ?. Peplau: Interpersonal Nursing Theory

      Cheryl Forchuk

    • Betty Neuman: The Neuman Systems Model

      Karen S. Reed

    • Ida Jean Orlando: A Nursing Process Theory

      Norma Jean Schmieding

    All monographs are available for individual purchase.

    Copyright

    View Copyright Page

    Dedication

    To Dorothea E. Orem whose lifelong search to understand nursing has clarified the structure of nursing knowledge and provided a foundation for the development of a practical nursing science

    Foreword

    Thinking about nursing is as important as doing nursing. The conceptual structure of the discipline of nursing must be known by those nurses who practice nursing and those who teach nursing. Nurses in practice must be able to identify the phenomena that are of concern to them, and must have a framework for reflecting on their practice. The meaning given to data is a direct result of the conceptual frame the nurse brings to the practice situation. Dorothea Orem's general theory of nursing, referred to as the Self-Care Deficit Nursing Theory, provides such a framework for nurses. The elements of the theory and their elaboration in the form of propositions and descriptions provide the starting point for the development of the nurse's understanding of the conceptual framework practice.

    The theory is both simple and complex. Its simplicity is found in the basic structure of the theory; its complexity in the development and implementation of those conceptual elements in practice. In order to make full use of the theory, it is necessary to comprehend the theory. This can only be done through extensive study and reflection on the original work.

    This monograph complements that work, providing the reader with information about the basic structure of the theory from the viewpoint of the user. The author is well qualified to do this. She has studied the theory and has used it in teaching baccalaureate students for nearly a decade. The author draws upon this background to provide examples and interpretations, and our understanding of the theory is enhanced. As theory-based nursing becomes the norm, the expectation will be that nurses be conversant with one or more theories of nursing.

    Susan G.Taylor RN, PhD Associate Professor, School of Nursing, University of Missouri-Columbia

    Preface

    The purpose of this volume is to present a descriptive overview of Dorothea Orem's Self-Care Deficit Theory of Nursing. It is not intended to replace the primary works of Orem, but to provide direction for their use. It is hoped that the reader will be enticed to search the writings of Orem and others for further understanding. A detailed reference list and bibliography of classic works and critiques are included to facilitate the reader's further exploration. Orem (1991), the most recent primary work at the time of this writing, is cited unless other editions or works have greater historical or substantive significance.

    This book is primarily intended for use by beginning students of Orem's theory, including undergraduate students, graduate students encountering their first nursing theory course, and educators, researchers, and practitioners who are unfamiliar with Orem's work. Those familiar with the theory will find that selected chapters present a view of the Orem literature not found in other sources. For example, Chapter 1, which deals with the origins of the theory, incorporates not only the writings of Orem but also selected remarks by Orem at conferences and on videocassettes. Chapter 2 presents the assumptions, three theories, concepts, and propositions, with use of examples for clarification. Chapter 3 presents a summary of application to practice, research, and education. No attempt was made to be comprehensive, but to provide diverse examples of theory application. As this work is descriptive, no critique of Orem's work was included, although the reader should note critiques listed in the bibliography.

    Teaching Orem's Self-Care Deficit Theory to undergraduate students at Illinois Wesleyan University, and subsequent doctoral study at Wayne State University, served as impetus for in-depth study of Orem's work. I am grateful to undergraduate students who challenged me to explain the theory in practical terms and to doctoral faculty who stimulated me to analyze, critique, and propose ideas and methods for theory development. My dissertation chairperson, Mary J. Denyes, served as a role model, supporting and challenging me throughout the process. The Orem Research Study group at Wayne State University provided a rich forum for further collective exploration. Self-care conferences, particularly those sponsored by the University of Missouri, have been invaluable to my own understanding and clarification. I am hopeful that this description of Orem's work will entice others to study and apply this emerging practical nursing science. I feel the product of Orem's genius is yet to be fully realized, but is indeed a means for nursing to truly make a difference in the health care of the people.

    Donna L.Hartweg

    Acknowledgment

    The author wishes to acknowledge the contribution of Susan G. Taylor, Associate Professor of Nursing, University of Missouri, Columbia, who reviewed the manuscript and made valuable suggestions for revision.

  • Glossary

    • Agency

      ability, capability, or power to engage in action

    • Agent

      the person who has the ability (agency) to perform the action or who actually performs the action

    • Basic conditioning factors (BCFs)

      For the patient: factors that influence, at points in time, the individual's health-related needs/demands (therapeutic self-care demand) and the individual's ability (self-care agency) to engage in self-care. Examples include age, gender, health state, and family patterns.

      For the nurse: factors that influence, at points, in time, the nurse's ability (nurse agency) to form interpersonal relationships and to assist with or perform self-care. Special note: In addition to the general BCFs, such nurse-specific factors as nursing experience and education also influence nursing agency.

    • Deliberate action

      “purposeful goal- or result-seeking activity” (Orem, 1991, p. 162)

    • Dependent care

      activities performed by responsible adults for socially dependent individuals, children, or adults to meet portions of their therapeutic self-care demands

    • Dependent-care agency

      ability, capability, or power of a responsible adult to meet the demands of the dependent individual

    • Dependent-care agent

      the provider of dependent care, such as a parent, family member, or friend. These providers can be mature adults or maturing adults, such as adolescents.

    • Developmental self-care requisite

      needs or goals for self-care that arise from either maturational changes in the life cycle, such as pregnancy, or from situational events that occur throughout human development, such as death of a significant other

    • Estimative self-care operations

      process of seeking knowledge about the self-care that needs to be done (NDCG, 1979, p. 189)

    • Foundational capabilities and dispositions

      general capabilities of self-care agency to engage in deliberate action (NDCG, 1979)

    • Health

      structural and functional soundness and wholeness of the individual (Orem, 1991)

    • Health deviation self-care requisites

      needs or goals for self-care that arise when persons are ill, injured, have defects or disabilities, or are undergoing diagnosis or treatment

    • Methods of assisting

      general ways of helping that can be used by one person to give assistance to others, such as teaching, acting or doing for, guiding, supporting, or providing for a developmental environment

    • Nursing agency

      specialized abilities of nurses for diagnosing, prescribing, and producing nursing care that result in meeting the individual's therapeutic self-care demand or in increasing self-care agency

    • Nursing system

      the totality of the actions and interactions of nurses and patients and/or family in a nursing situation at a point in time

    • Partly compensatory nursing system

      “when both nurse and patient perform care measures or other actions involving manipulative tasks or ambulation” (Orem, 1985b, p. 156)

    • Power components

      enabling capabilities of self-care agency that must be developed and operational for individuals to perform self-care (Orem, 1987)

    • Productive self-care operations

      process of making and doing, including the performance of the actions, monitoring the effects, and deciding to continue the actions (NDCG, 1979, p. 194)

    • Self-care

      “practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being” (Orem, 1991, p. 117)

    • Self-care agency

      the complex, learned ability or power to perform self-care that is described as knowledge, skill, and motivation for self-care actions that promote life, health, and well-being

    • Self-care deficit

      self-care ability of the person is not adequate to meet the therapeutic self-care demand

    • Self-care requisite

      purposes or goals to be achieved through self-care

    • Supportive-educative nursing system

      a nursing system in which the patient performs the actions, and the nurse guides and assists using methods of helping, such as supporting, guiding, providing for a developmental environment, and teaching. The patient is able to perform all self-care actions requiring controlled ambulation and manipulative movement.

    • Therapeutic self-care demand

      all the self-care actions that should be performed by the individual at a point in time to maintain health and promote well-being

    • Transitional self-care operations

      process of making judgments or decisions about what self-care should be performed; includes use of knowledge, experience, and values of the individual (NDCG, 1979, p. 194)

    • Universal self-care requisites

      common human needs or goals of self-care that promote structural and functional integrity of the person and well-being. These include maintenance of air, food, water, and elimination; balance between activity and rest; solitude and social interaction; the prevention of hazards; and the promotion of normalcy.

    • Well-being

      an “individual's perceived condition of existence … a state characterized by experiences of contentment, pleasure, and kinds of happiness; by spiritual experiences; by movement toward fulfillment of one's self-ideal; and by continuing personalization” (Orem, 1991, p. 184)

    • Wholly compensatory nursing system

      a nursing system in which the nurse performs all the self-care actions that require controlled ambulation and manipulative movement

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    Orem, D. E. (1983c). The family experiencing emotional crisis. Analysis and application of Orem's self-care deficit theory. In I. W.Clements & F. B.Roberts (Eds.), Family health: A theoretical approach to nursing care (pp. 367–368). New York: John Wiley.
    Orem, D. E. (1984). Orem's conceptual model and community health nursing. In M. K.Asay & C. C.Ossler (Eds.), Conceptual models of nursing. Applications in community health nursing. Proceedings of the Eighth Annual Community Health Nursing Conference (pp. 35–50). Chapel Hill: Department of Public Health Nursing, School of Public Health, University of North Carolina.
    Orem, D. E. (1985a). A concept of self-care for the rehabilitation client. Rehabilitation Nursing, 10, 33–36. http://dx.doi.org/10.1002/j.2048-7940.1985.tb00428.x
    Orem, D. E. (1985b). Nursing: Concepts of practice (
    3rd ed.
    ). New York: McGraw-Hill.
    Orem, D. E. (1987). Orem's general theory of nursing. In R.Parse (Ed.), Nursing science: Major paradigms, theories, and critiques (pp. 67–89). Philadelphia: W. B. Saunders.
    Orem, D. E. (1988). The form of nursing science. Nursing Science Quarterly, 1 (2), 75–79. http://dx.doi.org/10.1177/089431848800100208
    Orem, D. E. (1988, November). A perspective on theory based nursing. Unpublished paper presented at the Seventh Annual Self-Care Deficit Theory of Nursing Conference, St. Louis.
    Orem, D. E. (1990, September). Discussions on issues in Self-Care Deficit Theory. Remarks presented at a conference on Self-Care Deficit Theory: Contemporary Issues, Veterans Administration Medical Center, Palo Alto, CA.
    Orem, D. E. (1991). Nursing: Concepts of practice (
    4th ed.
    ). St. Louis: Mosby-Year Book, Inc.
    Orem, D. E., & Taylor, S. G. (1986). Orem's general theory of nursing. In P.Winstead-Fry (Ed.), Case studies in nursing theory (Publication No. 15–2152, pp. 37–71). New York: National League for Nursing.
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    Perras, S., & Zappacosta, A. (1982). The application of Orem's theory in promoting self-care in a peritoneal dialysis facility. American Association of Nephrology Nurses and Technicians Journal, 9 (3), 37–39.
    Perry, P., & Sutcliffe, S. (1982). Conceptual frameworks for clinical practice. Journal of Neurosurgical Nursing, 14 (6), 318–321. http://dx.doi.org/10.1097/01376517-198212000-00009
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    Bibliography

    Classic works, articles, and chapters by Orem; critiques; comparisons with other models; and some media are presented below. Many examples of application are presented in the reference chapter. The author recognizes the significant contribution of doctoral dissertations and proceedings of conferences to theory development; they are not included below due to page constraints.

    Classic Works
    Nursing Development Conference Group. (1973). Concept formalization: Process and product. D. E.Orem (Ed.). Boston: Little, Brown.
    Nursing Development Conference Group. (1979). Concept formalization: Process and product (
    2nd ed.
    ). D. E.Orem (Ed.). Boston: Little, Brown.
    Orem, D. E. (1956, October). Hospital nursing service, an analysis. Indianapolis: The Division of Hospital and Institutional Services, Indiana State Board of Health.
    Orem, D. E. (1959) Guides to developing curricula for the education of practical nurses. Vocational Division No. 274, Trade and Industrial Education No. 68. Washington, DC: Government Printing Office. U.S. Department of Health, Education, and Welfare, Office of Education.
    Orem, D. E. (1971). Nursing: Concepts of practice. New York: McGraw-Hill.
    Orem, D. E. (1980). Nursing: Concepts of practice (
    2nd ed.
    ). New York: McGraw-Hill.
    Orem, D. E. (1985). Nursing: Concepts of practice (
    3rd ed.
    ). New York: McGraw-Hill.
    Orem, D. E. (1991). Nursing: Concepts of practice (
    4th ed.
    ). St. Louis: C. V. Mosby.
    Articles and Book Chapters by Orem
    Orem, D. E. (1981). Nursing: a triad of action systems. In G.Lasker (Ed.), Applied systems and cybernetics. Vol. 4. Systems research in health care, biocybernetics and ecology. New York: Pergamon.
    Orem, D. E. (1983a). The self-care deficit theory of nursing: A general theory. In I. W.Clements & F. B.Roberts (Eds.), Family health: A theoretical approach to nursing care (pp. 205–217). New York: John Wiley.
    Orem, D. E. (1983b). The family coping with a medical illness. Analysis and application of Orem's self-care theory. In I. W.Clements & F. B.Roberts (Eds.), Family health: A theoretical approach to nursing care (pp. 385–386). New York: John Wiley.
    Orem, D. E. (1983c). The family experiencing emotional crisis. Analysis and application of Orem's self-care deficit theory. In I. W.Clements & F. B.Roberts (Eds.), Family health: A theoretical approach to nursing care (pp. 367–368). New York: John Wiley.
    Orem, D. E. (1984). Orem's conceptual model and community health nursing. In M. K.Asay & C. C.Ossler (Eds.), Conceptual models of nursing. Applications in community health nursing. Proceedings of the Eighth Annual Community Health Nursing Conference (pp. 35–50). Chapel Hill: Department of Public Health Nursing, School of Public Health, University of North Carolina.
    Orem, D. E. (1985). A concept of self-care for the rehabilitation client. Rehabilitation Nursing, 10 (3), 33–36. http://dx.doi.org/10.1002/j.2048-7940.1985.tb00428.x
    Orem, D. E. (1987). Orem's general theory of nursing. In R.Parse (Ed.), Nursing science: Major paradigms, theories, and critiques (pp. 67–89). Philadelphia: W. B. Saunders.
    Orem, D. E. (1988). The form of nursing science. Nursing Science Quarterly, 1 (2), 75–79. http://dx.doi.org/10.1177/089431848800100208
    Orem, D. E. (1989). Theories and hypotheses for nursing administration. In B.Henry , C.Arndt , M.DiVincenti , & A.Marriner-Tomey (Eds.), Dimensions of nursing administration. Boston: Blackwell Scientific.
    Orem, D. E., & Taylor, S. G. (1986). Orem's general theory of nursing. In P.Winstead-Fry (Ed.), Case studies in nursing theory (Publication No. 15–2152, pp. 37–71). New York: National League for Nursing.
    Analyses and Critiques of Self-Care Deficit Theory of Nursing
    Dashiff, C. J. (1988). Theory development in psychiatric-mental health nursing: An analysis of Orem's theory. Archives of Psychiatric Nursing, 11, 366–372.
    Davidhizar, R. (1989). Critique of Orem's self-care model. Nursing Management, 19 (11), 78–79.
    Eben, J. D., Gashti, N. N., Nation, M. J., Marriner-Tomey, A., & Nordmeyer, S. B. (1989). Dorothea E. Orem: Self-care deficit theory of nursing. In A.Marriner-Tomey (Ed.), Nursing theorists and their work (
    2nd ed.
    , pp. 118–132), St. Louis: C. V. Mosby.
    Fawcett, J. (1989). Analysis and evaluation of conceptual models in nursing (
    2nd ed.
    ). Philadelphia: F. A. Davis.
    Johnston, R. L. (1989). Orem's self-care model of nursing. In J.Fitzpatrick & A.Whall (Eds.), Conceptual models of nursing: Analysis and application (
    2nd ed.
    , pp. 165–184). Norwalk, CT: Appleton & Lange.
    Foster, P. C., & Janssens, N. P. (1985). Dorothea E. Orem. In Nursing Theories Conference Group, Nursing theories: The base for professional nursing practice (
    2nd ed.
    , pp. 124–139). Englewood Cliffs, NJ: Prentice-Hall.
    Meleis, A. I. (1985). Theoretical nursing: Development and progress. Philadelphia: J. B. Lippincott.
    Meleis, A. I. (1991). Theoretical nursing: Development and progress (
    2nd ed.
    ). Philadelphia: J. B. Lippincott.
    Melynk, K. A. M. (1983). The process of theory analysis: An examination of the nursing theory of Dorothea E. Orem. Nursing Research, 32, 170–174. [Letters to the editor and responses by the author, Nursing Research, 32, 318; 381–383.]
    Lundh, U., Soder, M., & Waerness, K. (1988). Nursing theories: A critical view. IMAGE: Journal of Nursing Scholarship, 20 (1), 36–40. http://dx.doi.org/10.1111/j.1547-5069.1988.tb00027.x
    Smith, M. C. (1979). Proposed metaparadigm for nursing research and theory development. An analysis of Orem's self-care theory. IMAGE: The Journal of Nursing Scholarship, 11, 75–79. http://dx.doi.org/10.1111/j.1547-5069.1979.tb01441.x
    Smith, M. J. (1987). A critique of Orem's theory. In R. R.Parse (Ed.), Nursing science: Major paradigms, theories, and critiques (pp. 91–105). Philadelphia: W. B. Saunders.
    Stevens, B. J. (1984). Nursing theory: Analysis, application, and evaluation. (
    2nd ed.
    ). Boston: Little, Brown.
    Thibodeau, J. A. (1983). Nursing models: Analysis and evaluation. Monterey, CA: Wadsworth Health Science Division.
    Whelan, E. G. (1984). Analysis and application of Dorothea Orem's self-care practice model. Journal of Nursing Education, 23 (8), 342–345.
    Media and Software
    Helene Fuld Health Trust, 1988. The Nurse Theorists. Portraits of Excellence: Dorothea Orem (VHS videocassette). Oakland, CA: Studio III.
    National League for Nursing. (1987). Nursing theory: A circle of knowledge. New York: Author.
    Orem, D. E. (1978, December). A general theory of nursing [Audio cassette recording]. Paper presented at the Second Annual Nurse Educator Conference, New York.
    Self-care deficit theory of nursing: Software for bedside care [computer program]. Bordentown, NJ: Nursing Systems International.
    Comparisons with Self-Care Models and Nursing Models
    Butterfield, S. (1983). In search of commonalities: An analysis of two theoretical frameworks. International Journal of Nursing Studies, 20, 15–22. http://dx.doi.org/10.1016/0020-7489%2883%2990035-4
    Gantz, S. B. (1990). Self-care: Perspectives from six disciplines. Holistic Nursing Practice, 4 (2), 1–12.
    Hanucharurnkul, S. (1989). Comparative analysis of Orem's and King's theories. Journal of Advanced Nursing, 14, 365–372. http://dx.doi.org/10.1111/j.1365-2648.1989.tb01542.x
    Rosenbaum, J. (1986). Comparison of two theorists: Orem and Leininger. Journal of Advanced Nursing, 11, 409–419. http://dx.doi.org/10.1111/j.1365-2648.1986.tb01268.x
    Steiger, N. J., & Lipson, J. G. (1985). Self-care nursing. Theory & practice. Bowie, MD: Brady Communications.
    Woods, N. F. (1989). Conceptualizations of self-care: Toward health-oriented models. Advances in Nursing Science, 12 (1), 1–13.

    About the Author

    Donna L. Hartweg is an Associate Professor and Director, School of Nursing, Illinois Wesleyan University, Bloomington, IL, where she has taught in the Orem guided curriculum for over 10 years. She has presented at national and international conferences on Self-Care Deficit Theory of nursing and is author and coauthor of several self-care articles. Her most recent work is on Health Promotion Self-Care within Orem's general theory of nursing, published in the Journal of Advanced Nursing. Her current research is on the health promotion self-care practices of healthy middle-aged women. Throughout her doctoral studies at the College of Nursing, Wayne State University, Detroit, she was active in the Orem Research Group.

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