Part 1 – Formative (50%)

The student will present a short PowerPoint presentation on a chosen Nursing theory or

model This will be followed by a 2000-word assignment to critically analyse the model in

relation to the student’s own professional practice arena.

INTRODUCTION

The goal of Dorothy Orem’s theory is to help patients regain the ability to care for

themselves. Using this theory as a model for nursing care requires finding out what self-care

needs the client cannot meet and why he or she cannot do those things, then providing the help

needed to help the client perform those activities with the intention of improving the client’s ability

to do so later.

The nursing theory has been a dominant topic in the nursing literature for the past 50

years, requiring the development of nursing as a profession. The era of theory, along with the

awareness of nursing as a profession and academic discipline, emerged from the debates and

discussions that took place in the 1960s. The transition from occupation to profession in the

1970s was highly determined for nursing because it questioned the discipline that must be

underpinned, the answer being the science of nursing (Tomey & Alligood, 2002). According to

Meleis (2011), advances in nursing theory are an important aspect of the scientific evolution and

foundation of nursing disciplines.

One of the theories that is often mentioned in the field of nursing is Dorothea Orem’s

Theory of Self -Care Deficit Nursing (SCDNT), which was developed between 1959 and 1985 and

incorporates the nursing model proposed by the authors. Assuming that any theory has the

potential to extend the discipline and science of nursing, the purpose of this study was to address

SCDNT critically.

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 This study is theoretical in nature that implies reading the Orem SCDNT, using different

bibliographic sources, and further analysis and critical discussion of the most important

components. Given the emerging conceptual wealth, when possible, concepts put forward by

other theorists and writers will also be discussed.

KEY ASSUMPTIONS AND CONCEPTS

Orem calls her SCDNT theory a general / grand theory composed of the following 3

interrelated theories:

1. Self-care theory, which describes why and how humans care for themselves.

2. Self-care deficit theory, which describes and explains why humans can be helped

through nursing.

3. Nursing systems theory, which describes and explains the relationships that must be

built and maintained in order for nursing to be productive.

This theory has several conceptual elements, namely self-care, agency, and nursing. In

theory Orem establishes four concepts which in turn together with other nursing theories form the

metaparadigm of nursing, namely: human being, environment, health, and nursing.

1. Self-Care Theory (self-care)

Self-care consists of activities in which adults take the initiative and demonstrate, over a

period of time, their interest in sustaining life, functioning healthily, continuing personal and life

development through fulfilling known needs for developmental and functional regulation.

Another definition of self-care: an implementation of activities initiated and carried out by

the individual himself to meet the needs in order to maintain his life, health and well-being

according to conditions, both healthy and sick (Orem's 1980).

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 This theory views that an individual will always want his involvement in self-care, and that

the individual also has a desire to be able to care for himself independently. The need for an

individual to be involved and take care of himself is what is known as self-care therapeutic

demand or also called self-care requisites (Parker, 2001). Self-care is something that can be

learned and an individual's ability to determine actions taken in response to needs.

a. Self-care requisites

Self-care needs are formulated and expressed in terms of performed actions

that are known or deemed necessary in regulating human developmental and

functional aspects, continuously or with certain conditions.

There are three kinds of self-care requisites, namely: universal self-care

requisites, developmental self-care requisites, and health deviation self-care

requisites (Ladner, 2002).

Universal self-care requisites is a need that exists in every human being and

is related to human functions and life processes, usually referring to basic human

needs: 8 basic needs of every human being, namely the need for: air, food, water,

elimination, balance of activity and rest, balance to be alone and interact social, free

from threats, and personal development in groups according to each individual's

ability (Alligood, 2006).

1) Self-care needs according to development (developmental self-care requisites)

Divided into three parts, namely: conditions that require development,

involvement in self-development, protection of life conditions and situations that

threaten self-development (Alligood, 2010). This need occurs related to the level of

individual development and the environment in which they live, which is related to

changes in a person's life or the level of the life cycle.

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 2) The need for self-care when experiencing health problems (health deviation self-

care requisites)

There are people who are sick or injured, who have specific forms of

pathological conditions or disorders, including defects and disabilities, and who are

in the process of treatment and care (Alligood, 2010). These needs are needs that

become real because of illness or disability that want a change in behaviour in self-

care.

Illness / injury affects not only specific physiological / psychological structures

and mechanisms, but also human function as a whole. When the function of

integration is seriously affected (severe mental retardation, coma, or autism), the

development of the individual is also seriously damaged temporarily or permanently.

In an abnormal health status, the need for self-care arises from both the illness and

the actions taken in the diagnosis or treatment.

b. Therapeutic Self-Care Demands

The entire nursing action required within a certain period of time to meet all self-

care needs, especially in such circumstances, is called therapeutic self-care

demand. To fulfil therapeutic self-care demand, 2 methods are used, namely:

1) Control or regulate the factors identified in the need, regulatory aspects of

human function (adequacy of water, air, food).

2) Meet the activity elements of the needs (maintenance, promotion,

preventive, and provision).

c. Self-Care Agency and Dependent Care Agent

The complex ability that adult individuals acquire to recognize and fulfil the

need to regulate its development and function is called a self-care agency. Self-care

agency can change every time it is influenced by the health condition of an

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 individual. When there is an imbalance between self-care agency and therapeutic

self-care demand, there is a self-care deficit (Parker, 2001). A person who has the

ability to take self-care actions is called an agent. An adult human who can accept

and fulfil the responsibility of knowing and fulfilling the therapeutic self-care

demands of others who are socially dependent on him or to regulate the

development and training of that person's self-care agency is called a dependent-

care agent.

2. Self-Care Deficit Theory

Self-care deficit is the relationship between a person's therapeutic self-care demands and

the strength of their self-care agency where the ability of self-care in a self-care agency is

inadequate to know and fulfil some or all of the components of therapeutic self-care demand

(Orem in IOS, 2010).

Self-Care Deficits are an important part of general care where all nursing planning is provided

when care is needed. Nursing is needed by someone when they are unable or limited to do self-

caring continuously. Self-care deficits can be applied to:

 children who are not yet mature

 needs that exceed ability.

 there is an estimate of decreased ability in care and demands for increased self-care, both

in quality and quantity.

When there is a desire to take care of oneself and a person is able to find his desire, then self-

care is possible. But if the desire is greater than the individual's capacity or ability to find it, there

is an imbalance, and this is said to be a self-care deficit.

3. Nursing Systems Theory

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 The nursing system is a series of practical actions performed by nurses in coordination

with the patient's actions to fulfil the therapeutic components of their patients' self-care demands

and to protect and regulate the practice or development of the patient's self-care agency

(Alligood, 2006). The components of self-care and deficit self-care are incorporated into nursing

systems theory. This nursing system theory connects the actions and roles of nurses with the

actions and roles of patients (Hartweg, 1995).

Nursing systems theory wants to state that nursing is a human action; the nursing system

is a system of actions that are planned and produced by the nurse. The nursing system is

produced through their experience of caring for people with decreased health or health-related

disabilities in caring for themselves, or people who are dependent (Alligood, 2010).

In fulfilling self-care and helping in the problem-solving process, Orem has a method for

this process, namely the helping method. From a nursing perspective, assisting methods are a

gradual series of actions, which, if done, overcome or replace individual limitations in terms of

health. The nurse uses all methods, selects, and combines them in relation to the actions

required by the individual being treated and the limitations of these health care measures, such

as:

a. Acting or acting for others.

b. As a guide and direct others

c. Provide physical / psychological support.

d. Provide and maintain an environment that supports personal development.

e. Teach or educate others.

CRITICAL ANALYSIS

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 Orem’s view of nursing science as a practical science is crucial to understanding how

empirical evidence is collected and interpreted. Orem identifies two groups of nursing sciences:

1) nursing practice science, which includes full nursing science, partially compensatory nursing

science and support-educational nursing science; and 2) basic nursing science, which includes

self -care science, self -care activities and human assistance (Tomey & Alligood, 2002). The

concept of self -care may have different meanings in other disciplines; however, Orem defines

and organizes it in a unique way (Tomey & Alligood, 2002). The author's theory is expressed

through a number of terms, which are clear and appropriate between them. SCDNT

encompasses three interrelated theories: self -treatment; self -care deficit; and the nursing

system. This theory is a synthesis of knowledge about self -care (and dependent care), self -care

activities (and dependent care), therapeutic self -care demands, self -care deficits and nursing

actions (Orem, 2001).

According to Orem, this theory is not an explanation of a particular situation / personality

specific to nursing practice, but rather a combination of conceptual traits or characteristics

common to all nursing conditions. As a general theory, it may be appropriate for nurses involved

in the clinical practice of nursing, the development and validation of nursing knowledge, and the

teaching and learning of nursing (Orem, 2001).

The relevance of Orem’s theory is in its scope, complexity, and clinical use, as well as its

ability to generate hypotheses and add knowledge to a body of knowledge. Has proven equally

useful in both curriculum design for training nurses in several colleges and universities and

development of nursing management / administration guidelines (Tomey & Alligood, 2002).

We believe that Orem’s contribution to theory, specialized nursing knowledge and nursing

science is explained by the creation of a theory comprehensive enough to frame and convey the

meaning of the discipline to professional activity. This makes it possible to develop an

explanatory narrative of what nurses do, knowing patterns they use and which they, at the same

time, create and enrich when they need to find answers to problems related to the health, disease

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and well -being of individuals and populations. they must help. On the other hand, through

SCDNT, Orem contributes to the development of the language of a particular discipline, by

bringing concepts into nursing (the concept of migration) which are then reinvented and acquire

certain characteristics, such as the main concept of self-care.

This concept is important for the nursing discipline given its ability to explain its purpose (to

promote or restore an individual’s ability to manage oneself) and the power of action explanation

(acquisition of skills to achieve autonomy and self -determination)). The germination power of this

concept should also be emphasized, as it makes it possible to develop other concepts, such as

self-estimation, transitional care and productive self-care. This acquires operational strength and

can be used to describe what we do and identify the level at which the recipients of our actions

are.

CONCLUSION

Professionals develop nursing theories to inform nursing practice, advance care strategies,

and improve patient outcomes for a better quality of life. Nurses can apply them to all six steps of

the nursing process: assessment, diagnosis, outcome, planning, implementation, and evaluation.

Nursing theories can also help nurses better understand the reasoning behind using care

procedures, which outcomes those procedures might yield, and how to optimize practices for the

future of care.

Health care professionals can use different methodologies to turn theory into applicable

practice. They may use descriptive theories, for example, to further nursing research. These

theories describe the properties of a nursing phenomenon or situation. Predictive theories, by

contrast, forecast the relationships between nursing properties of phenomena. Meanwhile,

prescriptive theories propose specific nursing practices and outcomes for addressing a

phenomenon.

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 Advanced practice nurses must understand how to apply nursing theories to their roles in

the medical field. These applications of nursing theory and practice can allow health care

professionals to more effectively evaluate and assess their care initiatives, as well as predict

outcomes in lifesaving situations. Nursing theory comprehension can also help nursing

professionals use their practice to develop and inform new theories that may influence the future

of their discipline.

Cultural competence, for example, is a developing concept in nursing theory and practice.

Cultural competence involves being sensitive, respectful, and informed regarding each patient’s

cultural background and needs. Culture informs patients’ language, values, religion, and

beliefs, potentially influencing their health history, care preferences, and requirements. Through

nursing theory, medical professionals are building a deeper understanding of how to incorporate

cultural competence into their work and improve health care outcomes for all patients.

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REFERENCES

UKEssays. November 2018. Evaluation of Dorothea Orem’s Theory. [online]. Available from:

https://www.ukessays.com/essays/nursing/evaluation-of-dorothea-orems-theory.php?vref=1

[Accessed 20 May 2021].

“Obituary: Dorothea Elizabeth Orem,” Savannah Morning News, June 24, 2007, retrieved June

17, 2014

Taylor, Carol R.; Lillis, Carol; LeMone, Priscilla; Lynn, Pamela (2011). Fundamentals of Nursing.

Philadelphia: Wolters Kluwer Health. p. 74. ISBN 978-0-7817-9383-4.

Orem, D. (1991). Nursing: Concepts of practice. (4th ed.). In George, J. (Ed.). Nursing theories:

the base for professional nursing practice. Norwalk, Connecticut: Appleton & Lange.

Orem, D. (1995). Nursing: Concepts of practice. (5th ed.). In McEwen, M. and Wills, E. (Ed.).

Theoretical basis for nursing. USA: Lippincott Williams & Wilkins.

Orem, D. (2001). Nursing: Concepts of practice. (6th ed.). In McEwen, M. and Wills, E. (Ed.).

Theoretical basis for nursing. USA: Lippincott Williams & Wilkins.

Taylor, S.G. (2006). Dorothea E. Orem: Self-care deficit theory of nursing. 

Meleis Ibrahim Afaf (1997), Theoretical Nursing: Development & Progress 3rd ed. Philadelphia,

Lippincott.

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