Running head: OREMS SELF CARE DEFICIT THEORY 1

An Individual View of Nursing and its Relationship to Orems Self Care Deficit Theory



OREMS SELF CARE DEFICIT THEORY 2

An Individual View of Nursing and its Relationship to Orems Self Care Deficit Theory

One reason there is a shortage of educated nurses is because these nurses burnout.
Burnout is caused by nurses viewing their workdays as repetitious due to performing the same
tasks over and over each day. Too often we behave as if we are members of a trade rather than of
a professional discipline by ignoring the metaparadigm of nursing and by denying the utility of
nursings discipline-specific knowledge. (Lee & Fawcett, 2013) Nursing is more than just caring
for the sick or injured, following physician orders, and passing medications. A nurse must have
the compassion to care, the knowledge to interpret data, critically think about the data they have
collected, predict possible outcomes and prevent them from occurring. A nurse must also be an
advocate, a teacher, and a support system for their patients. This paper will discuss the Self Care
Deficit Theory by Dorothea Orem, the authors personal philosophy on the contents of the
metaparadigm, and the similarities between the two.
Nursing Metaparadigm
A nursing theory includes of a set of concepts that attempt to account for the central
interests of nursing: person, environment, health/illness, and nursing. (Creasia & Friberg, 2011)
In order for the nursing profession to earn respect from other professions nurses must recognize
the four central components, develop a philosophy for each concept, and incorporate their
philosophy in everyday nursing practice. According to Lee & Fawcett, (2013), the nursing
metaparadigm influences nurses comprehension of what nursing is, and their understanding that
nursing is not only a skill set to care for the ill but an intellectual discipline.

OREMS SELF CARE DEFICIT THEORY 3

Dorothea Orem
The central concept of Orems Self Care Deficit Theory of Nursing can best be explained
as:
The condition that validates the existence of a requirement for nursing in an adult
is the absence of the ability to maintain continuously that amount and quality of
self-care which is therapeutic in sustaining life and health, in recovering from
disease or injury, or in coping with their effects. With children, the condition is
the inability of the parent (or guardian) to maintain continuously for the child the
amount and quality of care that is therapeutic. (Orem, 1991)
Orems theory is further divided into three theories: The self-care theory, which states that
individuals are able to perform self-care activities independently to main their health, the theory
of self-care deficits, which identifies gaps between what an individual is capable of performing
and what is needed to be therapeutic, and the theory of nursing systems, which is when nurses
perform actions for individuals who are experiencing self-care deficits and are no long to
perform activities of daily living (ADLs) without maximum assistance or the individual needs
the services of a nurse to help accomplish their ADLs.
Person, Personal Philosophy, and Similarities
Persons, or patients, are the ones receiving care from a nurse and can also include a
patients family, friends, and communities. As nurses we must look at every aspect of the
patient, including their life before they became sick, their physiological needs, if they are
comfortable, and if all their needs are being met instead of just looking at the patient and seeing a
medical diagnosis. This is applied in my practice by trying to find out what the patient was like
OREMS SELF CARE DEFICIT THEORY 4

before admission, if they were able to take care of themselves, if they were able to perform
actions to maintain their health, if they have a support system available to them, and whether or
not they were in an emotionally sound place. I also make sure all their needs are being met and
they are comfortable. Because my patients are critical and usually intubated, connected to a
ventilator and receiving multiple drips I make sure they are not in any pain. I do this by
monitoring their vital signs and using critical thinking skills to conclude whether pain medication
is needed to make the patient comfortable. According to Dorothea Orems Self Care Deficit
Theory, humans are defined as men, women, and children cared for either singly or as social
units, and are the material object of nurses and others who provide direct care ("Dorothea
orem's self-care," 2011).
Similarities with Orems theory include the feeling that sometimes a patient can be seen
as a material object because there are instinctual feelings of responsibility to project and care
for them. Family and friends are treated equally by assuring they are comfortable, including
them in the treatment by educating them on what is happening and teaching activities they can do
to promote the patients wellbeing.
Health, Personal Philosophy, and Similarities
Health can be viewed as the total wellbeing of a person. As nurses, we must assess the
patients or their familys knowledge about disease processes, educate them on disease
prevention and maintenance of a healthy lifestyle. We need to be advocates for patients so they
can become more knowledgeable and take control of their health. Since the majority of my
patients are unable to take care of themselves I use my philosophy on health by assessing the
clients needs, formulating an appropriate nursing diagnosis with nursing actions to be
implemented, evaluating the effectiveness of the interventions, and making changes if needed so
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I am able to deliver the best possible care for that patient. My philosophy on health is very
similar to Orems self-care deficit theory, which states that when a person can no longer meet
their self-care needs or when the self-care needed exceeds the self-care capability of the
individual, nursing is needed. ("Dorothea orem's self-care," 2011) When this occurs the nurse
must assess the level of self-care a patient requires so that the nurse can utilize the nursing
system that best fits the patients ability to perform self-care (Orem, 1990, p. 49). Orems
Nursing Systems theory is composed of nursing actions for patients with limitation in self-care,
and is divided into three systems. Wholly compensatory: The person needs maximum assistance
by the nurse in performing ADLs, Partly compensatory: the nurse compensates for the
individuals limited ability to perform self-care activities, and Supportive-educative: The
individual can perform ADLS independently so the nurse assists the client in decision making,
behavior control, and the acquisition of knowledge. (Creasia & Friberg, 2011)
Environment, Personal Philosophy, and Similarities
Another concept is the environment, which is the interaction of physical, chemical, and
biological components. Since nurses care for patients from all cultures, environment can also
include societal beliefs, values, customs, and morals. A nurse must be open to new cultures and
able to accept the differences in people. We as nurses should try and learn about our patients
culture and what could be done to make them as comfortable as possible. I apply this philosophy
in practice by providing a language line to the patient so they are able to communicate with
someone in their nave language, and also allow family members to bring in food that the patient
is more comfortable with, as long as the doctor approves. According to Orem, the persons health
status is mediated by his/her environment. I agree with Orems theory that internal and external
OREMS SELF CARE DEFICIT THEORY 6

factors can affect the health of a patient and why nurses should attempt to make the patients
environment a comfortable for them as possible.
Nursing, Personal Philosophy, and Similarities
Lastly, nursing, is unique in that it is a profession where there are aspects of science and
aspects of art, and to excel in the nursing profession you must show skill in both areas. Nurses
use a systematic process of critical thinking to collect and analyze data, and diagnose, plan,
therapeutically intervene, and evaluate outcomes. (Philosophy, 2013) Using professional values,
ethics, and therapeutic communication, nurses implement this process (Philosophy, 2013) My
philosophy is implemented in my nursing practice by using the nursing process to collect patient
data, prioritize needed interventions, and evaluate if those interventions are successful or need to
be modified. In addition, I educate the patient (if possible) and any family or friends on the
disease process, what can be done at home to evaluate their condition and promote wellbeing and
try to convince them to become more active in their medical treatment. "Dorothea orem's self-
care," (2011) suggested that nursing involves assisting the individual with self-care practices to
sustain life and health, recover from disease or injury, and cope with their effects. The similarity
in the above philosophy and Orems philosophy is both believe that the goal of nursing is to
assist a patient in becoming responsible for their own care.
Conclusion
Nursing theories derived from nurses wanting nursing to be valued as a profession and to
guide professional nursing practice, education, and research. Nurses need to take a step back and
really think about how their personal philosophy regarding nursing and if they are practicing
what they believe.
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References

(2011). Dorothea orem's self-care theory. Nursing Theories, Retrieved from
http://currentnursing.com/nursing_theory/self_care_deficit_theory.html
Creasia, J. L. & Friberg, E.E. (Eds.). (2011). Conceptual foundations: The bridge to professional

nursing practice (5th ed.). St. Louis, MO: Mosby Elsevier.

Lee, R. C., & Fawcett, J. (2013). The influence of the metaparadigm of nursing on professional
identity development among rn-bsn students.Nursing Science Quarterly, 26(1), 96-98.
doi: 10.1177//0894318412466734
Philosophy. (2013). Unpublished raw data, College of Nursing-Philosophy, . Retrieved from
http://nursing.uams.edu/about/philosophy/