Dorothea Orem is one of America’s well-known nursing theorists. She began her nursing career with a diploma degree in 1930 from the Providence Hospital School of Nursing in Washington, DC and furthered her nursing education receiving her BSN from the Catholic University of America and her Master’s of Science in nursing education in 1945.

In 1959, she began working on her Self-Care Deficit Theory, publishing her theory in 1971. Her self-care deficit Theory of Nursing is a client-based theory. Human functioning and development is identified by the theory. Self-care is important in determining the level that the patient is able to return to their highest level. By using the nursing process, nurses are able to design a plan of care for patients.

Nursing: Concepts of Practice

Orem's search for the meaning of nursing was structured by three questions:

What do nurses do and what should nurses do as practitioners of nursing?
Why do nurses do what they do?
What results from what nurses do as practitioners of nursing?
This in turn led to the central concepts of the theory.

Self-care deficit theory

This consists of three related theories: (sub theories)

Theory of self-care
Theory of self-care deficit
Theory of nursing system

(IMG:http://www.nursesnetwork.co.uk/images/orems%20sc%20deficit%20theory.gif)

The Self -care theory postulates that self-care and the self-care of dependents are learned behaviours that individuals initiate and perform on their own behalf to maintain life, health, and well-being. The individual's ability to perform self-care is called self-care agency. Adults care for themselves, whereas infants, the aged, the ill and the disabled require assistance with self-care activities (Kozier, Erb, Blais & Wilkinson, 1998).

Self-care deficit theory teaches that people benefit from nursing because they have health-related limitations in providing self-care. Limitations may result from illness, injury, or from the effects of medical tests or treatments. Two variables affect these deficits: self care agency (ability) and therapeutic self-care demands (the measures of care required to meet existing requisites). Self-care deficit results when self-care agency is not adequate to meet the known self-care demand.

Nursing system theory suggests that nursing systems form when nurses prescribe, design, and provide nursing that relates the individual's self-care capabilities and meets therapeutic self-care requirements.

Three nursing systems exist within the model

Compensatory system-nurse provides total care
Partially compensatory system-nurse & patient share responsibility for care
Supportive/Educative-development system-client has primary responsibility for personal health, with nurse acting as a consultant
Example case studies

1.Compensatory System-nurse provides total care

Mr X is an elderly bedridden patient who suffered a fall after an episode of confusion. He has an indwelling foley catheter, continuous tube feeds via gastric tube and O2 running at 2l/min via nasal cannula.

2.Partially compensatory system- nurse & patient share responsibility for care

Mrs Y has been discharged home after a mastectomy. Her wound has become infected and the District Nurse is visiting daily to change her dressings.

3. Educative-development system-client has primary responsibility for personal health, with nurse acting as a consultant

Miss Z has smoked for 20 years, is overweight and is now on anti-hypertensive medication. She takes her medication as prescribed, has joined a smoking cessation group and is following a healthy, more balanced diet to aid her weight loss.

Conclusion

Orem is still actively involved with writing and updating theories. Many subsequent theorists have adapted and commented on her work.

"Self-care is ongoing and competence which is in continual development" (Mayo, 1997).

Helping the patient improve self-care skills and move towards being as independent as possible is the nurse's ultimate goal. The patient may need assistance after leaving the hospital, but this can be achieved by assistance from the family members or a home-health agency.

Together with the Nursing Process (Plan, Implement, Evaluate) Orem's theory is used across the world to maintain high standards of nursing care.

References

Kozier, B., Erb, G., Blais, K., Wilkerson, J.M., &Van Leuven, K. (1998) Fundamentals of nursing: concepts, process, and practice (updated 5th ed.). Menlo Park, CA: Addison Wesley Longman.

Mayo, A. (1997). Orem's self care model. Portfolio Professional Nursing.