The self-care theory of nursing was pioneered by Dorothea Orem and proposed a framework for increased independence and self-esteem among patients by letting them take care of some of their basic needs for themselves. The structure is most applicable in rehabilitation settings, where patients often begin their stay unable to perform necessary activities, but gradually recover and have to learn to stop depending on nurses by the time when they are discharged. This theory helps determine when a nursing intervention is appropriate and maximizes the patients’ ability to address their needs without compromising health outcomes.
The self-care theory concentrates on people as distinct entities whose integrity is essential. Chinn and Kramer (2017) postulate that the principal emphasis of Orem’s works is that “self-care maintains wholeness” (p. 43). As such, the theory concentrates on the promotion of patient independence and the ability to maintain oneself. Orem believed that a nurse’s job in a rehabilitative environment was to prepare the patient for the return into the world outside of the hospital by teaching him or her self-care. Many patients would become accustomed to having their needs addressed by nurses, and a combined effort would be necessary to change that perception and to prepare the patient to return to daily life.
Orem’s opinions and her theory were inspired by her experiences while working as a nurse and as an educator. According to Alligood (2017), the foremost question that drove the theorist’s thought was “What condition exists in a person when judgments are made that a nurse(s) should be brought into the situation?” (p. 241). Alligood (2017) also supplies Orem’s model of care, which consists of three systems separated by the degree of the patient’s independence. As a patient regains his or her self-care capacity, a nurse shifts from a direct approach to a supervisory position while remaining supportive and regulating exercise, and ability development. However, the patient is responsible for the monitoring of his or her self-care, as well, making the recovery a collaborative effort between the two parties.
Structural Aspects of the Theory
The self-care theory operates on several basic assumptions about people as well as the nature of nursing. According to “Self Care Deficit Theory” (n.d.), people are distinct and should be self-reliant and able to care for other family members. Meeting self-care requisites are essential to all aspects of primary care, and the task requires ensuring that the person is aware of potential health issues. Lastly, self-care and dependent care are behaviors that are learned socially, and nursing is an effective medium for teaching them due to its interactive nature. As such, nursing and learning are closely associated, and education strongly influences one’s ability to care for oneself.
Orem’s theory is clear and defines all concepts used for postulations and statements within its framework. It is designed to teach nursing students and is incorporated into many curricula (Shah, Abdullah, and Khan, 2015). However, the successful application of the theory’s concepts in a healthcare environment requires a high degree of competence and emotional intelligence. The nurse would have to be able to recognize the patient’s needs as he or she stopped directly caring for the person and to evaluate his or her mental state and self-care capacity. On the other hand, the framework of the theory is consistent and provides a competent set of instructions for the nurse.
The primary areas of application for the theory are working environments and educational facilities. Shad, Rahnama, Shahdadi, and Abdollahimohammad (2018) investigate the psychological implications of the theory, applying it to patients undergoing hemodialysis and inspecting the changes in self-esteem that result. The question answered by the theory is whether a nurse should take care of all of the patient’s needs or allow him or her to exercise self-care for the sake of a complete and quick recovery. The answer lies in a gradual distancing as the patient recovers his or her facilities and the nurse can trust him or her to perform the procedure successfully, first under supervision, then without it.
Rehabilitation wards, in particular, are the appropriate area for the theory’s application. However, it may be used in numerous varieties of inpatient environments to achieve various purposes. Shad et al. (2018) describe a hemodialysis situation, in which the procedure causes the patients to expel wastes and excess liquids, which leads to lowered self-esteem and reduced compliance. However, the use of self-care helps the people undergoing the treatment maintain their self-worth and improves their mood. The theory can be described as highly appropriate to its target environment, as it takes the physical and mental well-being of the patients into account and supplies a robust framework for the nurses to follow.
Evaluation of the Theory
The theory is highly appropriate for its target environment, but it has specific weaknesses, most of which are associated with the period of its development and the basic state of the nursing science at the time. Shah et al. (2015) mention criticisms such as a focus on illness, cultural bias, and overemphasis on independence and self-care. There is a variety of conditions that cannot be effectively treated without regular medical consultations or interventions, and the theory can be challenging to apply in environments outside of the United States. Furthermore, the high requirements for the nurse’s competence can restrict the applicability of the theory in a real situation, as careless use or a mistaken evaluation can lead to neglect or harm for the patient.
As mentioned above, the theory is demanding for a nurse and requires a high degree of theoretical knowledge as well as practical experience. As such, it cannot be considered user-friendly, although it provides a robust conceptual framework for the teaching of care. The addition of dedicated evaluation specialists who would make the judgments on whether the satisfaction of a particular need should be left to the patient would simplify the application for inexperienced nurses. The primary obstacle is the threat of a mistaken assessment, and if evaluations are relegated to other, more qualified nurses, the danger would be minimized, and the nurse in charge of the patient would benefit from the learning opportunities.
Dorothea E. Orem’s theory of self-care is primarily used in rehabilitative environments. It describes the transition from complete dependence, in which the nurse takes care of all of the patient’s needs, to independence, where the patient is fully capable of addressing his or her needs. The theory offers a comprehensive framework for nursing practice aimed at the maintenance of the patient’s physical and mental well-being. However, its high requirements toward the nurse can make practical applications of the theory difficult, particularly for less experienced practitioners.
Alligood, M. R. (2017). Nursing theorists and their work (9th ed.). St. Louis, MO: Elsevier.
Chinn, P. L., & Kramer, M. K. (2017). Knowledge development in nursing: Theory and process (10th ed.). St. Louis, MO: Elsevier.
Self Care Deficit Theory. (n.d.). Web.
Shad, F. S., Rahnama, M., Shahdadi, H., & Abdollahimohammad, A. (2018). The effect of self-care program based on Orem model on the self-esteem of patients undergoing hemodialysis. Medical Science, 22(93), 462-467.
Shah, M., Abdullah, A., & Khan, H. (2015). Compare and contrast grand theories: Orem’s self-care deficit theory and Roy’s adaptation model. International Journal of Nursing Didactics, 5(1), 39-42.