Page 391 - Encyclopedia of Nursing Research

358 n OReM’S SeLF-CARe THeORy

Orem to recognize that effort needed to be of their practice had not evolved at the
exerted on the conceptualization of nursing same pace as had patient needs. The obvi-
O and nursing’s relationships to patient needs ous starting point for Orem toward under-
and patient care. Orem proposed that nurses standing the care needs of the patient was to
should be expected to have specialized abil- define “What is self-care?” “When is nurs-
ities that qualifies a person to nurse. She ing needed?” and “How do nurses provide
called these abilities nursing agency, which nursing care?” The answers to these ques-
together with patient needs and patient abil- tions are derived from three interconnected
ities became the structure and focus of the theories central to the SCDNT: the theory of
SCDNT. nursing systems, the theory of self-care, and
In 1952, working as a hospital consul- the theory of self-care deficit. All three the-
tant nurse with the Indiana State Board of ories combined become one general theory
Health, Dorothea Orem was concerned about of nursing, with self-care deficit as the most
the state to which nursing was evolving. comprehensive and at the core of her ideas.
Nurses were engaging in nursing practice The relationship between the three theo-
but were not able to articulate what nurs- ries is described in the following way. In the
ing was. “Nursing” of the patient provided a theory of self-care, self-care is an activity
major part of patient care. A person becomes initiated on one’s own behalf in the inter-
a patient because of a legitimate inability to est of health and well-being. The theory of
care for himself or herself when recovering self-care deficit is the relationship between
from illness or injury. One of the problems therapeutic self-care demand and self-care
Orem evaluated was how patient care did agency whereas self-care capabilities are not
not truly meet patient needs. The advances known or able to be met. The theory of nurs-
in medical and allied research and treat- ing systems is the deliberate practice actions
ment changed the way nurses evaluated and of nurses carried out to meet the therapeu-
planned patient care. A broader concept of tic self-care or develop the patients self-care
patient care was necessary. The active partici- agency. This answers the questions about the
pation of patients in their treatment would be nature of care and the nature of nursing.
required to successfully meet the changing The central concepts of Orem’s theory
perspectives of patient care. Understanding consist of (a) self-care—caring for one’s self to
the care needs of the patient was the obvious maintain life, health, and well-being; (b) self-
starting point for Orem. “The act of nursing care demands—varied degrees and kinds of
is practiced by ‘doing for’ the person with the care requirements needed at specific times or
disability, by ‘helping him to do for himself,’ over a duration of time for meeting all of an
and/or ‘by helping him to learn how to do it individual’s needs; (c) self-care agency—the
for himself’ ” (Orem, 1956, p. 85). power and capabilities to engage in self-care,
This general nursing theory is accepted influenced by external and internal factors;
as a relationship between self-care agency (d) nursing agency—the broad ability of
and therapeutic self-care demands, dis- nurses to perform nursing; (e) self-care defi-
tinguishing self-care deficit from depen- cit—the actions and demands needed for self-
dent care. Orem deliberately selected the care that are greater than the person’s current
term “deficit” for this relationship to be capability for self-care; and (f) condition-
interpreted as insufficient, not as a human ing factors—internal or external factors that
disorder. The incapacity to meet demands affect an individual’s ability to engage the
of self-care reflects the fact that a need for kind and degree of self-care required (Orem,
nursing exists. Orem recognized an appar- 2001). This view distinguishes self-care from
ent discontinuity between patient care and dependent care and nursing care, in which
patient needs. The concept that nurses had the agent acts on behalf of another person.