The Self-Care Deficit Theory developed as a result of Dorothea E. Orem working toward her goal of improving the quality of nursing in general hospitals in her state. The model interrelates concepts in such a way as to create a different way of looking at a particular phenomenon. The theory is relatively simple, but generalizable to apply to a wide variety of patients. It can be used by nurses to guide and improve practice, but it must be consistent with other validated theories, laws and principles.
The major assumptions of Orem’s Self-Care Deficit Theory are:
- People should be self-reliant, and responsible for their care, as well as others in their family who need care.
- People are distinct individuals.
- Nursing is a form of action. It is an interaction between two or more people.
- Successfully meeting universal and development self-care requisites is an important component of primary care prevention and ill health.
- A person’s knowledge of potential health problems is needed for promoting self-care behaviors.
- Self-care and dependent care are behaviors learned within a socio-cultural context.
Orem’s theory is comprised of three related parts: theory of self-care; theory of self-care deficit; and theory of nursing system.
The theory of self-care includes self-care, which is the practice of activities that an individual initiates and performs on his or her own behalf to maintain life, health, and well-being; self-care agency, which is a human ability that is “the ability for engaging in self-care,” conditioned by age, developmental state, life experience, socio-cultural orientation, health, and available resources; therapeutic self-care demand, which is the total self-care actions to be performed over a specific duration to meet self-care requisites by using valid methods and related sets of operations and actions; and self-care requisites, which include the categories of universal, developmental, and health deviation self-care requisites.
Universal self-care requisites are associated with life processes, as well as the maintenance of the integrity of human structure and functioning. Orem identifies these requisites, also called activities of daily living, or ADLs, as:
- the maintenance of sufficient intake of air, food, and water
- provision of care associated with the elimination process
- a balance between activities and rest, as well as between solitude and social interaction
- the prevention of hazards to human life and well-being
- the promotion of human functioning
Developmental self-care requisites are associated with developmental processes. They are generally derived from a condition or associated with an event.
Health deviation self-care is required in conditions of illness, injury, or disease. These include:
- Seeking and securing appropriate medical assistance
- Being aware of and attending to the effects and results of pathologic conditions
- Effectively carrying out medically prescribed measures
- Modifying self-concepts to accept onseself as being in a particular state of health and in specific forms of health care
- Learning to live with the effects of pathologic conditions.
The second part of the theory, self-care deficit, specifies when nursing is needed. According to Orem, nursing is required when an adult is incapable or limited in the provision of continuous, effective self-care. The theory identifies five methods of helping: acting for and doing for others; guiding others; supporting another; providing an environment promoting personal development in relation to meet future demands; and teaching another.
The theory of nursing systems describes how the patient’s self-care needs will be met by the nurse, the patient, or by both. Orem identifies three classifications of nursing system to meet the self-care requisites of the patient: wholly compensatory system, partly compensatory system, and supportive-educative system.
Orem recognized that specialized technologies are usually developed by members of the health care industry. The theory identifies two categories of technologies.
The first is social or interpersonal. In this category, communication is adjusted to age and health status. The nurse helps maintain interpersonal, intra-group, or inter-group relations for the coordination of efforts. The nurse should also maintain a therapeutic relationship in light of pscyhosocial modes of functioning in health and disease. In this category, human assistance adapted to human needs, actions, abilities, and limitations is given by the nurse.
The second is regulatory technologies, which maintain and promote life processes. This category regulates psycho- and physiological modes of functioning in health and disease. Nurses should promote human growth and development, as well as regulating position and movement in space.
Orem’s approach to the nursing process provides a method to determine the self-care deficits and then to define the roles of patient or nurse to meet the self-care demands. The steps in the approach are thought of uas the technical component of the nursing process. Orem emphasizes that the technological component “must be coordinated with interpersonal and social pressures within nursing situations.
The nursing process in this model has three parts. First is the assessment, which collects data to determine the problem or concern that needs to be addressed. The next step is the diagnosis and creation of a nursing care plan. The third and final step of the nursing process is implementation and evaluation. The nurse sets the health care plan into motion to meet the goals set by the patient and his or her health care team, and, when finished, evaluate the nursing care by interpreting the results of the implementation of the plan.