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Nursing Theories
Self Care Deficit Theory - Nursing Theory

The Self Care Deficit Theory is the brainchild of Dorothea Orem. She is the recipient of various honorary degrees as well as many professional awards. She has experience in pediatrics, operating rooms, emergency rooms, surgical units, and adult medical units. She has been involved as a nurse in the offices of staff, administrator, private duty, consultant, directors, and professor.

This nursing theory states that every individual has within them, the ability for performing self-care. Therefore, they are responsible for taking care of their own health as well as the health of their dependents. Self-care is a set of practice activities, used by individuals to initiate, as well as perform, specific tasks pertaining to health, well-being, and maintaining life, and to do it on their own behalf.

Dorothea Orem had an initial definition as the basis of her theory, which was 'overcoming human limitations'. She believed that mankind had a need to take self-care action and for the management and provision of it continually. This was a necessity in the sustaining of life and health, to recover from injuries and disease, and to cope with the effects of those things.

Sitzman & Eichelberger stated in 2011, that Orem's Self-Care Model was the description of a structure in which the nurse assists his/her client, wherever needed, in order to help them maintain a level of self-care that was adequate. The Dorothy Orem Self Care Theory is a combination of 3 related theories - One theory of Self-Care, one of Self-Care Deficit, and one of Nursing Systems.

Major Concept Examples

There are some major concepts involved in her theory. One is that nursing is an artform. It puts the practitioner in the position of giving specialized assistance to those in need with disabilities, which is the assistance that is necessary for meeting the needs for self-care.

Environment is another major concept in the self care deficit theory. According to Dorothy Orem, the environment features chemical, biological, and physical components, including community, culture, and family.

Self-care, as she puts it, is the performing of, or practicing of, activities in which the individuals actually initiate and do the performing for themselves, in order to maintain life and health, and overall well-being.

She has numerous of major concepts that she applies to her self deficit theory, but the list is too long to go into now. The above are adequate examples of what she is talking about.

Self care deficit theory

3 Basic Systems of Nursing

She gives a 3-system basis for her conclusions in the form of 3 different nursing systems -

  1. Wholly Compensatory System - This nursing system is one in which the individual is unable to actually 'engage in the self-care actions that require self-directed, controlled ambulation, as well as manipulative movement and medical prescription for refraining from such activities'. These individuals having these limitations, are therefore socially dependent on other people for their continuing existence and overall well-being.

  2. Party Compensatory System - This nursing system represents a situation wherein both the nurse and patient will perform the necessary care measures or any other actions that involve manipulative tasks or ambulation. Either the nurse or the patient will take the major role in performing these care measures.

  3. Supportive-Education System - This nursing system is also referred to as the 'supportive-development' system. This is one in which the patient can actually perform the required actions, or can and will learn to perform them (both external and internal type of therapeutical self-care), but is unable to do so without some assistance.

Strengths and Weaknesses

Strengths - One major strength of her theory is that it can be applied even by a beginner practitioner as well as an advanced clinician. All the terms involved like 'nursing systems', 'self-care', and 'self-care deficit', are all easily understood by beginning student nurses, and may always be explored in more depth as the nurses gain in knowledge and experience.

Orem states that 'nursing is needed whenever an individual is unable to maintain on a continual basis, the amount of quality self-care necessary for sustaining health and life, recover from injury or disease, or to cope with the effects of those things.

Weaknesses - While her theory is simple, it is also quite complex. Using self-care in a multitude of terms like 'self-care agency', 'self-care deficit', 'universal self-care', 'self-care demand', and 'self-care requisites', can be quite confusing to readers.

Her definition of health she kept confined within 3 static conditions she calls a 'concrete nursing system'. This gives a connotation of rigidity. It is seen all throughout her work that she gives a limited acknowledgment of the patient's emotional needs.

According to Dorothea Orem, the theory of self care deficit does the following two things:

  1. It specifies when actual nursing is needed.

  2. It states that nursing for an adult is required when that person is incapable of, or limited in, the providing of effective and continuous self care.

She identifies five helping methods involved:

  1. Acting For/Doing For Others

  2. Guiding Others

  3. Supporting Another Person

  4. Teaching Another Person

  5. Providing A Proper Environment For The Promotion of Personal Development in Regard to Meeting Future Demands

Dorothea Orem's entire theory is a method of determining what the exact self care deficits are, and then to define the exact role of the nurse for meeting those self care demands. The steps that exist within this approach are viewed as being the technical components of the nursing process.

She places an emphasis on the fact that the technological component 'has got to be coordinated with both social and interpersonal processes, found within nursing situations.

The Dorothea Orem self care theory has gained in popularity as more and more countries across the globe are facing an increase in the complexity of health needs and costs for health care. This belief that individual people can participate in the necessary health decisions and rituals concerning their own health, is growing increasingly popular as well as necessary.

While health status changes might impair someone's ability to maintain their own self care, it does not necessarily mandate permanently moving into professional or dependent nursing care.

Orem has identified 6 different categories for health-deviation self-care:

  1. Seeking Out & Securing Medical Assistance

  2. Becoming Aware of/Attending to Effects of Conditions

  3. Carrying Out of Diagnostic, Rehabilitative, & Therapeutic Measures

  4. Understanding Deleterious Effects From Treatments

  5. Modification of The 'Self' Concept/ Accepting This New State of Overall Well-Being

  6. Learning to Live Within This New Condition & With The Effects of it, as Well as any Modifications Necessary For Regaining Self Care

Nursing Roles

Nurses work at the front lines in providing education, support, and care, that will enable individuals experiencing health care deviations to properly identify their health status changes, and to locate the appropriate assistance.

It is the nurses who will take on the primary role for empowering self care, and to make their patients aware of such deleterious effects as their condition may have on them in regard to their self-care requisites, and in the carrying out of the necessary treatment modalities for stabilizing their conditions via self care measures.

Nurses have routinely been positioned to support people in modifying their dreams or lifestyles to adjust to the demands of self care. Learning to live with a chronic illness has become even more prevalent among today's population. Whether it is children or it is adults who suffer disabilities, people whose lifestyles have increased their chances of health deviations like diabetes, hypertension, the effects in regard to obesity, or adults who are now living longer, it is the nurses who are now stepping up to the new challenges and having their roles expanded. Orem provides them with a blueprint for governing nursing action.

The Dorothea Orem theory of self care is playing a major role in the interaction between nurses and patients today. It is a concept that is complex yet easy to grasp and to put into motion across a broad range of illnesses and health-deviation situations.

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