The Self-Care Deficit Nursing Theory

Abstract

This paper explores the concept of self-care used in the self-care deficit nursing theory by Dorothea Orem and the importance of the theory in particular. First, it analyzes the importance of the theory and tries to find how it can be applied to the master’s track in the nurse practitioner area. It also explores the key concepts within the theory and the way it addresses the four metaparadigms: person, health, environment, and the nursing profession.

Finally, the paper applies the self-care nursing deficit theory and the concept of self-care to the nurse practitioner in the professional nursing practice area. For this purpose, as an example, it uses the scientific researches of Armer, Shook, Schneider, Brooks, Peterson, and Stewart as well as and Britz and Dunn that applied the concept of self-care in such practice areas as cancer and heart failure treatment respectively. The paper ends with the conclusion on the relevance of the concept and the theory.

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Orem's Model of Nursing or SCDNT

Over the past 40 years, the nursing theory has been the main topic in nursing literature, which contributed to the development of the nursing profession. Nursing theories are of great importance to the development of nursing in the world. More to say, the theories help to look at the function of a nurse in accordance with the requirements of the modern world. The Self-Care Deficit Nursing Theory, abbreviated SCDNT, is one of the most frequently referred and cited nursing theories.

Dorothea Orem, who created this theory, emphasized that the main purpose of nursing was to help the patient to become independent in their actions to the extent that this was possible and that the theory had a relatively specific approach to patient care. Thus, considering the fact that any theory can expand the nursing discipline and science, this paper aims to address the SCDNT critically, identifying the importance, its key concepts, and providing the examples of SCDNT’s application to the particular professional nursing practice area.

Importance of Nursing Theory

The Self-Care Deficit Nursing Theory by Dorothea Orem is one of the most famous and practically used nursing theories. In this theory, Orem develops Henderson’s ideas of which forms of activity (self-care requirements) are necessary for the person to maintain health and an active lifestyle further and highlights the problems that may arise in connection with this (the inability to self-care). She discloses further the actions of the nurse (nursing systems) required in relation to various degrees of impossible self-care (School of Nursing Faculty & Students, 2014). She has also developed terminology in detail that allows designating any concept in the field of nursing.

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This nursing theory helps students and graduates of the master’s program to systematize the knowledge of the nursing discipline. It should be included in the master's program because the nurse must be a highly qualified specialist, a partner of the doctor and the patient. However, a nurse must be able to work independently within a single medical team. In addition to knowledge about health standards and the basics of care, the self-care deficit theory in master’s programs will provide the modern student-nurse with sufficient knowledge in psychology, pedagogy, and management.

The theory will teach how and where to find information on the latest research related to the area of its practices. It will also teach the students to be able to apply the results of these researches in their professional activities. Thus, in Norway, the elements of Orem’s theory of self-care and the idea of the nursing process were primarily introduced in the curricula of med schools (School of Nursing Faculty & Students, 2014).

The importance of Orem’s SCDNT lies in its usefulness in all nursing areas as well as in the knowledge that adds to the nursing science. It is also helpful in nursing curriculum development as well as in developing the guidelines for nursing administration (Queiros, Vidinha, & Filho, 2014). In addition, the self-care deficit nursing theory brings concepts to nursing, such as the theory’s main concept of self-care, thus creating specific disciplinary and professional language (Queiros, Vidinha, & Filho, 2014).

The concept of self-care is one of the most important ones in nursing because it is able to clarify the purpose of the nursing actions, such as the purpose to stimulate or renew the patient’s ability to self-care, as well as explain these actions such as obtaining the skills to reach an autonomy by the patient. Orem’s self-care deficit nursing theory helps to understand the nature and extent of nursing, making nursing more clearly comprehensible, clarifying what it should or should not be. Thus, the SCDNT facilitates the ways, in which to demonstrate the efficacy of nursing care and the fact of its accountability by providing communication, structure, focus, linking necessary knowledge, providing clarity, and specifying the results and purposes for nursing.

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The theory defines the basic differences between nursing and other healthcare professions. In Orem’s theory, nursing is a supplement to the treatment of patients (School of Nursing Faculty & Students, 2014). The nurses’ actions are a continuation of the treatment carried out by a doctor, or they help the patient to carry out such treatment. According to the theory, medical appointments constitute a group of self-care needs that the patient or the nurse satisfies (School of Nursing Faculty & Students, 2014). Orem’s theory does not separate nursing from other professions such as occupational therapy. Orem presents nursing as an ancillary activity that is used where the patient himself or his relatives are not able to carry out actions aimed at preserving and maintaining the patient’s health.

The main concern of the SCDNT regarding the use of it within the profession is to teach self-care. According to Orem’s theory, the person is able to perceive and to reflect (School of Nursing Faculty & Students, 2014). In some cases, the human being is able to self-care, but in other cases, the person may have some deviations thus, not being able to self-care, which will prompt this person to rely on nursing care. In the latter situation, the nurse has to teach the patient to perform self-care oneself. Therefore, if a person is unable to maintain one’s health under some circumstances, his or her health becomes a sphere of nurse’s responsibility who compensates for this ability and helps the patient so that he or she could become able to gain independence as fully as possible.

Summary of Selected Nursing Theory

The SCDNT was first formulated by Dorothea Orem and published in 1971. Later, she also developed her theory in the next editions. Thus, the different editions of the theory were published in 1985, 1991, 1995, and 2001. The most recent and actual publications of Orem are the sixth edition of Nursing: Concepts of Practice in 2001, and the fifth edition of Nursing: Concepts of Practice in 1995 (School of Nursing Faculty & Students, 2014).

According to Orem, the Self-Care Deficit Nursing Theory represents a general theory that is formed by three interconnected theories such as the theory of self-care, of self-care deficit, and the theory of nursing systems. The key concepts are contained within the first theory. They include self-care, self-care agency, self-care requisites, and the therapeutic self-care demand (School of Nursing Faculty & Students, 2014).

Self-care is the central concept in the SCDNT. According to Orem, self-care is the “practice of activities that individuals initiate and carry out to maintain life, health, and well-being by themselves” (p. 43). Self-care agency is described as the ability to perform self-care by the individual, which includes the ability to learn and have specific needs and skills that will help to perform self-care (Taylor & Renpenning, 2011, p. 5).

Self-care requisites are actions directed at providing self-care to individuals. The self-care requisites include universal, developmental, and health deviation requisites. The universal requisites are directed to maintain the integrity of the patients and they cannot be separated from their lives. The developmental requisites are directed at the processes of development and the conditions that follow them. Health deviation requisites are directed at the illnesses, injuries, and physical and mental pathologies of people (Taylor & Renpenning, 2011, p. 5). Therapeutic self-care demand is the complex of actions aimed at complying with the self-care requirements utilizing specific complex of technologies (Hagran & Fakharany, 2015).

Orem’s SCDNT is an individual-oriented theory. It concerns the self and ‘I’ of a person. In the SCDNT, the nursing metaparadigm ‘person’ is a rational being by nature, capable of solving problems and meeting one’s needs. This applies to any person, including the patient and the nurse. The basic premise of the theory is that if a person has some kind of knowledge and skills to carry out the necessary self-care, then he or she would do it. The belief in the capacity for purposeful actions is a crucial moment in Orem’s worldview (School of Nursing Faculty & Students, 2014).

According to Orem, the environment is where the person lives, including the physical things and the socio-economic, such as family. It has a direct impact on the performance of self-care by the person (School of Nursing Faculty & Students, 2014). Additionally, as a metaparadigm, health is a good performance of physical, social, and mental functions by the person. The healthy condition is significantly influenced by the environment as well as self-care behavior of the person. Finally, according to Orem, nursing as a metaparadigm is the actions of the nursing professionals directed at providing care to the person who has some health deviations and who is unable to perform the self-care himself or herself (School of Nursing Faculty & Students, 2014).

Orem’s SCDNT has been selected because it can be potentially used within the selected Master’s track (practice, education, informatics, or administration.) The SCDNT can help students to understand how to provide the best care services for the patients on an individual basis. In addition, in the practice area, the SCDNT can be integrated into it and it can help to increase the health conditions of the patients. In fact, the theory can help to integrate the knowledge of students gained during the Bachelor’s track and thus, improve the nursing practice. The SCDNT can be also a great basis for the research in different nursing areas that the Master students will need to conduct during the study. Thus, the ability to use Orem’s theory in different areas of research ensures that it is well integrated.

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Application of Specific Nursing Theory to Selected Professional Nursing Practice Area

Orem’s SCDNT can be applied to many different professional nursing practice areas and it can help to form the care plan. The SCDNT can be applied to different nursing specialties and patient situations. Thus, in the nurse practitioner area, it can be applied the most broadly.

For example, in October of 2009, Armer, Shook, Schneider, Brooks, Peterson, and Stewart applied Orem’s SCDNT when diagnosing those who survived after the post-surgery breast cancer and the risk of those people to have lymphedema. They have found that the implementation of a supportive-educative nursing system, that the SCDNT and the self-care, in particular, involve, is very important as it helps to reduce this risk of lymphedema.

Those who survive after breast cancer are at high risk for obstruction in the lymph that causes the lymphedema because of the surgical intervention and radiation treatment (Smith & Parker, 2015, p. 118). Lymphedema can be a chronic or even perpetual condition that creates the risk for near ten million people who survived after the post-surgery breast cancer (Smith & Parker, 2015, p. 118).

However, there are the self-care actions that Dorothea Orem has formulated for the world. These actions are able to reduce the risk of lymphedema development and increase the quality of care, which can lower the severity of the disease. The researchers explored the utilization of these and educative-supportive activities, the results, and the level of effectiveness of the self-care requisites (Smith and Parker, 2015, p. 118).

In order to reduce the risk of lymphedema, the self-care actions should include the avoidance of gaining weight and being obese, maintaining the affected area clean not allowing the infection to hit it, and touching it as little possible. The lymph function will be better if one utilizes such self-care activities as manual lymph drainage, deep breathing techniques, abdominal massage, and additional cleaning (Smith & Parker, 2015, p. 118).

The research utilizes the supportive-educative nursing system that is completely complied with Orem’s Self-Care Deficit Theory (Smith & Parker, 2015, p. 118). Thus, the research shows that Orem’s theory can help nurse practitioners provide an aid for a patient using the supportive and educative system; it also shows the benefit of such things as following the goal and motivation when utilizing the theory of self-care deficit (Smith & Parker, 2015, p. 118).

Moreover, there is another example of SCDNT application to the nursing practice and the way it can be successful. In 2005, more than 5,000 cases of heart failure in people older than twenty years of age were reported. There were more than a million hospitalizations of people with heart failure annually and that cost more than 30 billion dollars (Britz & Dunn, 2014). Moreover, the people who are unable to perform self-care (comply with medication, control weight daily) or those who have decreased abilities are more frequently hospitalized and they have a low quality of life.

Increasing the abilities to perform self-care enables people to control their life qualities better, because the person, who follows their own treatment regimen and cares about oneself better, has a better functional capacity that helps in improvement of life quality (Britz & Dunn, 2014).

Thus, the purpose of the research was to find the important statistical relationship between heart failure, reduced self-care, and life quality among people with heart failure. Britz and Dunn (2014) took into account age, gender, and level of education and used the Orem’s Self-care deficit nursing theory “because concepts and relational statements are consistent with the variables and hypotheses.”

The research included 30 patients with heart conditions that were hospitalized to the Midwestern hospital (Britz & Dunn, 2014). As a result, Britz and Dunn (2014) have found that confidence in self-care and the perception of health as being better than it significantly improves the health conditions and life quality of patients. Such a serious disease as heart failure requires developing self-care confidence by patients in order to improve their conditions and prevent deterioration of symptoms and hospital readmissions (Britz & Dunn, 2014).

The research’s value for nursing practice is that nurses and nurse practitioners should identify patients with heart failure and low confidence in their self-care abilities and develop specific education programs to increase their self-care confidence, thus helping patients recuperate (Dunn, 2014). Thus, the SCDNT can be used to identify the patients with the self-care deficit and provide them supportive-educative services that help to reduce the risk of serious illness and improve the quality of life.

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Conclusion

In conclusion, in nursing activities, there are various theories and knowledge in use. The nurse uses this knowledge in informing the patient, teaching him, and guiding him. A scientific theory analyzes the development of science and studies how it relates to the practice. All nursing theories are able to extend nursing as a practical human science. The Self-care deficit nursing theory by Dorothea Orem is one of the most frequently cited theories. The concept of self-care, on which it is based, is very useful in guiding nursing practice, in education on the Master’s programs in particular, and in management.

It is also a great basis for the development of more accurate concepts that can be easily tested. Although this theory has only been used sparingly due to its complexity and the lack of validation, it has proven to be important and useful in expanding nursing science. Orem’s theory emerges from a specific mixture of conceptual attributes present in all nursing circumstances; thus, the theory should be utilized by every person involved in the nursing discipline, profession, and practice.

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