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CHAPTER 14 Dorothea E. Orem 251

in the expression of the theory. Orem’s general theory, system are systems of care that are designed and
the SCDNT, comprises the following four constituent implemented to achieve desired outcomes. Basic
theories: self-care, dependent-care, self-care deficit,and conditioning factors refer to factors that condition or
nursing systems. The SCDNT is a synthesis of knowl- influence the variables of persons. These factors may
edge about eight entities, which include self-care (and be internal to the person, such as developmental
dependent care), self-care agency (and dependent-care level, or external, such as available resources. In nurs-
agency), therapeutic self-care demand, self-care deficit, ing practice situations, the data collected by nurses
nursing agency, and nursing system. Development of can be categorized readily according to the concepts
the theory using these entities is parsimonious. The of the SCDNT.
relationship between and among these entities can For research purposes, both quantitative and quali-
be presented in a simple diagram. The substantive tative research methods are appropriate for the devel-
structure of the theory is seen in the development of opment of knowledge related to the SCDNT. Specific
these entities. The depth of development of the con- research methods to be used in any investigation are
cepts gives the theory the complexity necessary to selected on the basis of the questions being asked.
describe and understand a human practice discipline. Examples of various approaches can be found in this
publication’s companion text summary of recent
Generality SCDNT-based research (Berbiglia, in press). Although
Orem (1995) commented on the generality, or univer- the concepts of the SCDNT refer to real entities, they
sality, of the theory as follows: are complex in nature. Operationalization of these
concepts requires a comprehensive understanding of
The self-care deficit theory of nursing is not an Orem’s work. Instruments to measure some of these
explanation of the individuality of a particular concepts have been developed.
concrete nursing practice situation, but rather The current emphasis in the SCDNT is on building
the expression of a singular combination of a body of knowledge-related nursing practice, rather
conceptualized properties or features common than engaging in theory-testing research. Instrument
to all instances of nursing. As a general theory, development has an important role in building nurs-
it serves nurses engaged in nursing practice, in ing knowledge as well as other types of scholarly
development and validation of nursing knowl- work. A great deal of work is needed with regard
edge, and in teaching and learning nursing to the structuring of existent knowledge around the
(pp. 166–167).
practice sciences and the foundational nursing sci-
A review of the research and other literature attests ences identified by Orem. Therefore, comprehensive
to the generality of the theory. descriptive studies of various populations in terms
of their self-care requisites and self-care practices
Accessibility are needed. The structuring of existent knowledge
As a general theory, the SCDNT provides a descrip- and the findings from descriptive studies will provide
tive explanation of why persons require nursing and a solid base for the development of instruments to
what processes are needed for the production of measure the concepts of the SCDNT.
required nursing care. The concepts of the theory are
abstractions of the entities that represent the proper Importance
object of nurses in concrete nursing practice situa- The SCDNT differentiates the focus of nursing from
tions. Self-care, dependent care, and nursing care other disciplines. Although other disciplines find the
all are forms of deliberate action engaged in to theory of self-care helpful and contribute to its devel-
achieve a particular purpose. The concepts of thera- opment, the theory of nursing systems provides a
peutic self-care demand, self-care agency, dependent- unique focus for nursing. The significance of Orem’s
care agency, and nursing agency refer to properties of work extends far beyond the development of the
persons. Self-care deficitand dependent-care deficit SCDNT. In her works, she provided expression of the
refer to relationships between properties of persons. form of nursing science as practical science, along
Self-care system, dependent-care system,and nursing with a structure for ongoing development of nursing