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Self-Care Deficit Theory

Dorothea E. Orem's Self-Care Deficit Nursing Theory is based on the philosophy that patients want to care for themselves and will recover more quickly if they perform as much self-care as possible. The theory is also called the Orem Model of Nursing.

Dorothea Orem had a long and illustrious nursing career that started in 1934. After having years of clinical experience and earning both bachelor's and master's degrees in nursing education, she began developing her theory in 1959. Her goal was to improve the quality of nursing. In 1971, she published her book, Nursing: Concepts of Practice, that explained the theory in detail. Further editions of the book were published as she refined the theory. The Orem Model of Nursing is regarded as a grand nursing theory because it encompasses broad areas of nursing with general concepts that can be used with a wide variety of patients. It is simple to understand and easily adapted to almost all situations.


Assumptions

  • People need to be able to provide self-care and care for others in their family if needed.
  • Each person is an individual.
  • Nursing is defined as an interaction between two or more people.
  • Meeting self-care needs is a crucial part of preventing ill health.
  • Knowledge of possible health problems is necessary for encouraging self-care behavior.
  • Self-care and dependency are learned behaviors within a sociocultural environment.
Within the Self-Care Deficit Theory are three related theories: self-care, self-care deficit and nursing systems. The concepts of these theories are as follows:

Concepts

  • Self-care is the performance of actions by individuals to maintain life, health and well-being. These actions help maintain a healthy body and contribute to human development.
  • Self-care agency means that individuals have the ability to become involved in self-care. This ability is influenced by a number of factors including age, sex, state of development, health factors, sociocultural background, family dynamics and availability of resources. The basic conditioning factors affect the persons' abilities to care for themselves, but the influence of the conditioning factors are not assumed to be present at all times.
  • Therapeutic self-care demand refers to the needs of every human being. It includes not only physical needs but psychological and social needs as well. It encompasses basic physical needs such as air, water and food to the maintenance of overall balance in one's life. The needs produced by illness or disease result in the deviation from health.
  • Self-care deficit determines when nursing care is needed. Nursing is needed when adults are unable to care for themselves, or parents or guardians are unable to care for those in their care. In other words, self-care deficit occurs when the demand for self-care exceeds the capabilities.
  • Health deviation self-care is needed when there is injury or disease. People accomplish this by seeking medical assistance, by being aware of the results of pathological conditions, by adhering to medically prescribed treatments, by modifying self-concepts and by learning to accept the effects of illness or injury.
  • Nursing systems are based on the needs and abilities of the patient. If there is a deficit between what the patient can do and what needs to be done for optimum health, then nursing care is needed. The ultimate goal of nursing is to help the patient regain and maintain optimum health.
Practical applications of the nursing systems depend on the needs of the patient. There are three classifications of the systems: wholly compensatory, partially compensatory and the supportive-educative system.

The wholly compensatory system provides complete care for patients. This is used for patients who are unable to respond or for infants. These patients are unable to make judgments concerning their health, and the nurse needs to anticipate and meet needs by using critical thinking.

The partially compensatory system is used for patients who are able to contribute to their own self-care. This type of nursing is used for patients who have suffered strokes and for other patients who can do certain things for themselves but require help with other aspects of their care.

The supportive-educative system is used for patients who can perform their own self-care but require instruction and education to regain and maintain optimum health. An example of this would be the diabetic who requires education about diet and medication.

Orem's Self-Care Deficit Theory is broad in scope and can be applied to almost any nursing practice. It supports patients and strives to return them to self-care and optimum health. It is compatible with other theories and protocols. The nursing process can measure the effectiveness of the theory. The first step of the process is patient assessment that collects data and determines the problem. The next step is the nursing diagnosis and formation of the care plan. The final step is the implementation and evaluation of the intervention. This evaluation will determine if the goals set by the patient and health care providers have been met.

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