Orem’s individual behavior, social environment, physical environment and health

Orem’s
Self-Care Deficit Nursing Theory

“The
Centers for Disease Control, named five determinants of health as biology/genetics,
individual behavior, social environment, physical environment and health
services” (CDC, 2011). “The World Health Organization defines the social
determinants of health as the conditions in which people are born, grow, live,
work and age, including the health system” (Green, 2013). Orem’s Self-Care
Deficit Nursing Theory considers these basic factors when examining
individuals, their families, living conditions, environment and other
circumstances that affect their overall health. (Green, 2013) In 1990, nursing
education began regarding the Self-Care Deficit Nursing Theory (SCDNT). Tohoku
Kosai Hospital in Japan incorporated a SCDNT-based nursing research training
system with the goal to determine if nursing education effectively bridged the gap
between theory and practice in the hospital. This research indicated that
nursing educational support was effective in bridging the gap between theory
and practice (Hiroko, Ayaka, Emiko, Hide, Tokiko, & Tokiko,  pp. 27-28) The theory was proven to help in
determining when a condition indicates a need for nursing when there is an inability
to provide self-care due to situations of personal health. (Alligood & Tomey,
p. 267)

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History
of Orem’s Theory

Dorothea
Elizabeth Orem was born in 1914 and died in 2007. Orem received a diploma in
nursing in the early 1930’s, a bachelor of science in 1939, a master of science
in 1945, served as director of school of nursing and nursing services until
1949, served on Indiana State Board of Health from 1949-1957, worked in the department
of health, education, and welfare from 1957-1959, taught and served as interim
dean at CUA from 1959-1970, led nursing development conference group in 1968,
published first book, Nursing: Concepts of Practice in 1971, and was a full
time consultant until she retired in 1984. The Self-Care Deficit Nursing Theory
was developed by Dorothea Orem as a result of her goal to improve the quality
of nursing care. (Petiprin, 2016) Orem’s theory, Self-Care Deficit Nursing
Theory (SCDNT), has been used all over the world in many different nursing
areas, has received high recognitions and has been used in various clinical
settings to assess and create nursing care plans. (Johnson & Webber, 2010)

Basic
Concepts and Relationships presented by Orem’s Theory

The
theory consists of self-care, self-care deficit and the nursing system. In this
theory people are distinct individuals and should be responsible for their own
care and for their families. (Petiprin, 2016) The theory was constructed based
on the fact that people have the ability, right and responsibility to care for
themselves.  (Punjani, 2013) The actions
of the individual to maintain life, health and an overall well-being will
determine if the patient can remain self-reliant. Self-care is a learned
behavior that contributes to maintaining health, life and well-being and the basis
of this theory include factors that affect the individual’s ability of
self-care and depends on the individual’s capability to carry out self-care. These
factors include “age, gender, developmental stage, health state, socio-cultural
factors, health care system factors, family system factors, activities of
living, environmental factors, resource adequacy and availability” (Punjani, p.
1). There are universal self-care requisites that are associated with the life
processes which are also called activities of daily living. These requisites
include: sufficient air, food and water, provisional elimination processes, a
balance between rest, activities, solitude and social interactions, prevention
of hazards to life and well-being, and promotion of human functioning. (Hartweg,
& Pickens, 2016) Self-Care deficit is when a person is incapable or limited
in effective self-care and nursing care is needed. “There are five different methods
mentioned when helping others including: acting for and doing for others;
guiding others; supporting another; providing an environment promoting personal
development in relation to meeting future demands; and teaching another” (Petiprin,
2016). The nursing system meets the patient’s self-care needs when the patient is
unable to provide self-care.

Nursing’s Metaparadigm Presented

The
theory of the nursing system determines the scope of the nurse’s
responsibility, the role of the nurse and the patient, the reason for the
nurse-patient relationship, and what actions will need to be performed to
regulate self-care. There are three classifications of the nursing system
including: “wholly compensatory system, partly compensatory system, and
supportive-educative system” (Petiprin, 2016). The wholly compensatory accomplishes
the patient’s therapeutic self-care, compensates for the patient’s inability to
provide self-care and supports and protects the patient. The partly
compensatory system cares for some of the self-care for the patient, compensates
for the self-care limitations and assists patient as needed. The supportive
education system accomplishes the self-care.

Theory is Applicable to Whom

Orem’s theory puts an emphasis on
“identifying the self-care deficit of an individual to deliver the necessary
care to promote wellbeing” (Punjani, p. 4). Orem’s theory is applicable
to everyone and was established to help patients and nurses in the care.  The theory determines that everyone is
capable of taking care of themselves until a deficit or health problem
arises.  By understanding all the basic
needs of patients regardless of the situation, the nurses can do their part in
helping the patient by meet their needs and offer assistance to meet the self-care
needs. The theory also depends on other factors of normalcy: having adequate
resources such as money to provide basic needs, being able to perform
activities of daily living, realistic expectations, accepting new normal due to
limitations or life changes, interpersonal relationships, and being safe  in a safe environment. (Hartwig, p. 8)

How does This Theory Lead to Favorable Client Outcomes?

Whenever there is a deficit in self-care the nurse can assess the patient
and identify their needs. The nurse can select the necessary nursing system
either wholly compensatory, partly compensatory or supportive and educative. By
determining the necessary care and identifying the deficit, nursing care plans
can be established and proper care can be provided for the patient. This allows
the theory to be successful in the care and healing of the patient. The theory
can also be helpful when transitioning a patient in a rehabilitation setting
back to a self-care environment. (Petiprin, 2016)

Current Use of Theory

There are many benefits of the theory that is applied to practice today.
The theory can be applied to many different situations and is adaptable to just
about any circumstance. The theory allows for the patient and the nurse to
prepare a plan to provide the best care possible while under nursing care and
help the patient to regain self-care when goals are met. This makes the transition
from hospital, rehab or long-term care back to home being self-reliant a much
smoother process.

Summary

The theory supports the holistic health of a patient and takes into
account all the variables that can affect the well-being of the patient.  The environment in which a patient resides
can be a positive or negative influence on the patient’s ability to care for
themselves. Basic needs like air, ventilation and hazard preventions are needed
to maintain human integrity. The health of an individual is also dependent on
what care is provided and needed in order to maintain that level of health. (Punjani,
p. 3) The theory provides information that nursing support should only be utilized
when there is a self-care deficit in order to assist the patient to maximize
their self-care abilities. (Punjani, p. 3) The theory provides a logical analysis
of self-care, is simple to use and can be utilized by the medical team when providing
guidance and care for their patients.