In the Dorothea Orem Self Care Deficit Nursing Theory, the role of a nurse is to fill-in the gaps of care that an individual cannot provide for themselves. Orem theorizes that individuals will initiate and perform their own self-care activities on a regular basis so that their overall health and well-being can be maximized.
It is only when an individual can no longer care for themselves that they will seek out professional care from a provider, such as a nurse. This means nursing is more of a reactive than proactive action in the eyes of Orem. Only when a person cannot care continuously for themselves is it appropriate for a nurse to provide assistance.
According to Orem, nurses have the ability to provide five different methods of help in order to restore an individual’s ability to care for themselves.
- By acting on a health issue immediately while providing services for others.
- Guiding others in the actions necessary to provide care.
- Supporting other nurses and supporting patients in providing and maintain care needs.
- Continuously providing an environment which promotes personal development instead of nursing reliance.
- Teaching one another to enhance skill-building at all levels of the nursing spectrum.
What Are the Major Assumptions of the Self Care Deficit Nursing Theory?
There are 6 primary assumptions that Orem makes within the Self Care Deficit Nursing Theory.
- People are supposed to be self-reliant, responsible for their personal care and anyone else in their family who may be in need of care.
- Each person is a distinct individual.
- Nursing should be considered a form of action because it is an interaction which occurs between 2+ people.
- One of the most important components of prevention and the removal of ill health at the primary care level is to successfully meet developmental and universal self-care requisites.
- The knowledge an individual has about their potential health issues is a necessary component of any self-care behaviors they may be able to implement.
- Self-care and dependent care are both learned behaviors within the context of a socio-cultural element.
These assumptions are based on the idea that everyone at their core level has a desire to perform the basics of universal self-care. Sometimes referred to as the activities of daily living, or ADLs, these are the life processes of self-care that everyone can perform at some level.
This includes being able to access air, food, and water resources when necessary. It also includes a provision of care when elimination processes need to be implemented. People will seek out a balance between rest and activity, solitude and social interaction, or work and play. They will avoid any hazards that may put their life at risk while promoting the mechanisms of human functioning.
Deviation occurs when these actions cannot be taken independently. Nurses, if they are able to recognize the deviation and why it has occurred, may be able to fill-in the deficit that has occurred so an individual can restore their own self-care.
This may mean a nurse must provide the ADLs an individual requires until they are able to restore their own self-care. It also means that for some individuals, long-term total care may also be required because there is a chronic deficit that has been identified.
The 3 Steps of Orem’s Nursing Process
Based on the need to help others and the assumptions about nursing, Orem developed a 3-step process that helps to determine when there is a self-care deficit that would need to be addressed. These steps are similar to the standard nursing processes of assessment, diagnosis, and implementation/evaluation, but with greater detail.
Step #1: Data Collection. The first step in the Self Care Deficit Nursing Theory is to determine why nursing is required. By evaluating the health status of an individual, what the doctor’s perspective of that health status happens to be, and then the individual’s perception, it becomes possible to analyze and interpret the data collected to make a judgement regarding care.
Additional data to be collected includes the health goals of the individual, how those goals are reflected within the context of that person’s life, and what their requirements for future self-care happen to be.
Step #2: Organization. The second step in this theory has the nurse designing a system that will be at least partially compensatory or supportive in the education of the patient. This is done through an organization of the components an individual would need to perform effective future self-care and then selecting the correct combination of methods to create a treatment plan. The overall goal is for an individual to overcome any current self-care deficits.
Step #3: Assistance. Once the methods for overcoming a self-care deficit are identified, the nurse will then assist the individual or the family/caregivers of the individual in self-care matters. A plan will be implemented so that all goals can be achieved so that the desired health results can happen. Assistance is provided in evaluating results so that actions can be directed or modified based on the events which occur.
Each step is then implemented with current technologies, polices, and skills that are available to the nurse. The goal is always the same: to promote human growth and development within a healthcare perspective.
The Strengths and Weaknesses of the Self Care Deficit Nursing Theory
As with any theory, there are strengths and weaknesses which should be examined when looking at this idea. Orem’s Self Care Deficit Nursing Theory does provide a number of unique strengths to the health care industry. This theory does have some limitations which must be considered as well.
It provides nurses with a comprehensive basis for their practice. It also provides a foundation for research, education, and administration within the nursing industry so that skill-building can occur. It species when nursing is required and promotes ongoing health maintenance through the concept of promoting ongoing good health.
On the other hand, this idea is a general system theory which does not take into account individualized variables. Orem treats the nursing system as a single entity instead. This causes some individuals who may have physical, mental, or emotional deficits that prevent effective self-care from possibly receiving the primary care they need.
Health is also a dynamic entity, always changing under the guise of this theory. This is not always the case. The theory is also orientated to illnesses, so trauma and other health concerns are not addressed whatsoever. If someone is consistently in good health, the assumption is that they are maintaining their own self-care appropriately.
The goal of Dorothea Orem’s Self Care Deficit Nursing Theory is to help nurses understand their patients on a better level. By teaching people and other nurses how self-care can be implemented, it becomes possible to treat illness or disease more effectively. In return, better overall health can be achieved.