Introduction
Dorothea Orem’s Self-Care Deficit Nursing Theory is one of the many grand theories of nursing. Orem developed the model with the goal of providing a scientific and philosophical account of not only what and why nursing is but also how and by/towards whom it should be directed (Hartweg, 2020). The model represents the four core concepts of the nursing metaparadigm. In fact, one can argue that Orem’s work inspired the metaparadigm, which is supported by numerous similarities in both frameworks. In order to point out the strengths of the theory, this paper will elaborate on its connections to the metaparadigm and draw evidence from recent findings, providing insight into the state of the research and philosophy of nursing.
Conceptual Framework
The Self-Care Theory, also known as the Self-Care Deficit Nursing Theory, was initially described by Dorothea Orem in Nursing: Concepts of Practice in 1971 and has been further developed since. In its current state, the theory is comprised of four constituent sub-theories: Theory of Self-Care (TSC), Theory of Dependent Care (TDC), Theory of Self-Care Deficit (TSCD), and Theory of Nursing Systems (TNS). As claimed by Hartweg (2020), the grand theory incorporates four patient-related, two nurse-related, and one peripheral concept. These concepts are self-care, self-care agency, therapeutic care demand, self-care deficit, nursing agency, nursing systems, and basic conditioning factors. The refinement of the theory also led to the inclusion of notions of dependent care and dependent care demand, which relate to dependency on others and interpersonal communication. If put simply, the theory aims to specify the roles of and explain the relationship between a patient, nurses, and the environments they find themselves in.
Metaparadigm
A set of concepts most commonly referred to as the nursing metaparadigm was conceived by Jacqueline Fawcett as a response to claims of the unfocused state of the research in the field. According to Bender (2018), Fawcett was convinced that nursing has always rested on a set of particular concepts, which include person, health, environment, and nursing. As Bender (2018) states, she “generated three major concept-theme linkages through this analysis: person–health; person–health–environment; and person–health– nursing” (p. 3). As presented, these linkages are strongly reminiscent of Orem’s ideas. In fact, Orem’s framework is arguably person-based, with most conceptual volume related to the patient. According to Hartweg (2020), Orem’s theory emphasizes the role of patients as agents capable of caring for themselves and states that nursing is only required when a self-care deficit is present. In other words, the personal aspect of SCDNT is reflected in the fact that patients have the capacity to achieve well-being without invoking external intervention.
In accordance with Fawcett’s classification of health as a crucial constituent of the metaparadigm, SCDNT recognizes it as an end goal of practicing self-care. However, self-care, in Orem’s understanding, also aims at facilitating well-being. Hartweg (2020) points out that Orem acknowledged the difference between the two terms. She believed health to be the “state of physical–psychological, structural–functional soundness and wholeness,” while defining well-being as “experiences of contentment, pleasure, and kinds of happiness” (Hartweg, 2020, p. 114). Health and well-being are related concepts that are facilitated through different means. Whereas health is attained through conventional medical and precautious practices, well-being might come with the actualization of such spiritual aspects of oneself as personalization and self-fulfillment.
The environmental aspect of Orem’s theory is best reflected in the concept of basic conditioning factors. Basic conditioning factors include but are not limited to sex, gender, age, sociocultural and socioeconomic backgrounds, and family systems of patients and caregivers (Hartweg, 2020). According to Gligor and Domnariu (2020), Orem’s model adheres to the environment aspect in that it accounts for “physical, chemical and biological characteristics: it includes family culture and community” (p. 2). The environmental aspect of the theory postulates that human beings exist in certain environments, which means that the extent of self-care and nursing agencies will vary depending on the context. To provide effective treatment in such cases, practitioners need to account for the effects of the environment, both external and internal.
Finally, nursing is, self-evidently, a central concept of both the paradigm and Orem’s theory. In SCDNT, nursing is thoroughly explored in the form of such notions as nursing systems and nursing agencies. A nursing agency is conceptually similar to a self-care agency, as it can be understood as a nurse’s ability to provide care. On the other hand, the nursing system, as defined by Hartweg (2020), is “a composite of all the nurse’s concrete actions completed or to be completed for or with a self-care agent to promote life, health, and well-being” (p. 118). Considering this, nursing is a process that unifies all other entities of the metaparadigm, as it involves a nurse taking care of a recipient who lacks the agency to apply self-care due to various environmental influences.
Application to APN Role
Dorothea Orem’s model has obtained numerous accolades and persists in being utilized and refined to this date. It has proven to possess significant practical value throughout the extensive history of nursing research. For instance, the study by Nasresabetghadam et al. (2022) investigated the effects of SCDNT on self-care behaviors in elderly women suffering from high blood pressure. The study revealed that the application of Orem’s principles increased the efficacy of medical treatment in the subjects. According to the researchers, “findings revealed that the use of the OSCD theory was effective in significantly improving medication adherence, weight control, physical activity, and nutrition self‑care behaviors among older women with hypertension” (Nasresabetghadam et al., 2022, p. 103). The incorporation of SCDNT resulted in developing an adequate understanding of the effects of hypertension medication and mitigation of self-care deficit among the examined patients.
In addition, SCDNT has been studied for application value in advanced nursing practitioner settings. For example, the study by Yip (2021) assessed the effects of the application of Orem’s model to a case study of a 61-year-old smoker. The researcher indicates that the theory “offers a robust discipline-specific model to promote high-quality nursing practice by enhancing the client’s SCA concerning their health outcomes within a care management plan” (Yip, 2021, p. 5). The incorporation of the model allowed for the development of the most effective plan of action and facilitated the identification of disruptive environmental factors which triggered the patient’s asthma. Yip (2021) also states that SCDNT appears to be a valuable tool for treating chronic diseases. In short, the model of Self-Care Deficit Nursing proves viability in research and practical application.
Conclusion
In conclusion, Self-Care Deficit Nursing Theory, or SCDNT, reflects key concepts of Fawcett’s nursing metaparadigm and presents value for academic researchers and applied nursing practitioners. The model is predicated on six core and one peripheral concept that interconnect with and affect each other, equipping practitioners with useful tools to apply to a wide range of hands-on situations. The theory emphasizes the importance of personal capability to maintain one’s health and well-being, also known as self-care agency (Hartweg, 2020). In its current state, SCDNT stands up to modern standards of scrutiny and continues to refine and expand. It provides a simple yet exhaustive account of the roles of and relationships between patients, caregivers, and the environment. Although the scope of the theory might not make it excel in specific scenarios, it provides measurable benefits in a wide range of settings.
References
Bender, M. (2018). Re-conceptualizing the nursing metaparadigm: Articulating the philosophical ontology of the nursing discipline that orients inquiry and practice. Nursing Inquiry, 25(3). Web.
Gligor, L., & Domnariu, C. D. (2020). Patient care approach using nursing theories – comparative analysis of Orem’s self-care deficit theory and Henderson’s model. Acta Medica Transilvanica, 25(3), 11–14. Web.
Hartweg, D. L. (2020). Dorothea Orem’s Self-Care Chapter 8 Deficit Nursing Theory. In M. C. Smith, & Gullett, D.L., (Ed.), Nursing theories and nursing practice (5th ed., pp. 109–134). F.A. Davis.
Nasresabetghadam, S., Fotokian, Z., Jahanshahi, M., Nasiri, M., & Hajiahmadi, M. (2022). The effects of Orem’s self-care theory on self-care behaviors among older women with hypertension: a randomized controlled trial. Nursing and Midwifery Studies, 10(2), 100. Web.
Yip, J. Y. (2021). Theory-based advanced nursing practice: a practice update on the application of Orem’s self-care deficit nursing theory. SAGE Open Nursing. Web.