Running head: THEORY-BASED EXEMPLAR FINAL PAPER 1
Dorothea Orem’s Self-Care Deficit Theory
Liberty University
Nursing Theory Advanced Practice
502
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Introduction
Many nursing theories have been developed and implemented throughout the history of
nursing. These theoretical frameworks have been analyzed and critiqued to show the validity of
each theory into nursing practice. One of the most analyzed and revised nursing theories is the
Self-Care Deficit Theory (SCDT) developed by Dorothea Orem. The theory of SCDT approach
provides a contemporary concept that features both health maintenance and health promotion
with the individual or patient being the center of the framework and the nursing system being the
outer layer of the framework providing a nursing process of method in determining self-care
demands of patient (McEwen & Wills, 2018). The work of Orem’s theory has captured the
interest of many and has been used in several countries. Many scholars and graduate students use
the concept of SCDT not only in research, education, and practice purposes but because the
theory itself is a close reflection of the ideal nursing practice (McEwen & Wills, 2018). The
popularity of the SCDT concept continue to grow and many researchers continue to formulate
additional concept to make the theory adapt to the ever changing of health care system. This
paper presents an overview of the ontological and epistemological concept of Dorothea
Orem's Self-Care Deficit Theory, a discussion of personal exemplar story using the SCDT, and
the application of theory into my nursing practice.
Overview of Orem’s Self Care Deficit Theory
The history of Orem’s SCDT was developed during the early nursing career of Dorothea
Orem in order to acknowledge and include the nurse encompassing not only the What and Why,
but also the Who and How. She also developed this theory to improve the quality of nursing care
and emphasize on the idea that the individual is the center of his/her care and will be responsible
for initiating self-care, and the care for their dependents, and perform activities regularly to
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achieve optimal health and well-being (Fawcett, 2016). The concept of SCDT is simple yet
generalized that and it covers a wide range of patients and used to improve clinical nursing
practice. The concept focuses between the individual and the nursing system. The major concept
of SCDT featured the metaparadigm nursing, human, environment and health. The
metaparadigm concept of nursing is described by Orem that nursing is a unique specialty of
knowledge in professional practice capable of providing therapeutic intervention to meet the
need of self-care and medical care of patients (Shah, Abdullah, & Khan, 2015). Orem’s definition
of humans in relation to the SCDT concept is “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”
(McEwen & Wills, 2018, p. 144). Orem also describes humans the subject of care with the
potential to learn and develop self-care actions through education, demonstration, and
experiences (Shah et al., 2015). Environment consist of physical, chemical, and biological
features, and that any changes from the environment or the state of a person’s existence in his/her
environment may have an effect in person’s ability to meet self-care and the need for self-care
(McEwen & Wills, 2018, p. 144). Orem also defines environment as the person’s socioeconomic
features that includes family and community, age, and the cultural roles that plays a role in the
self-care of the individual (Hagran & Fakharany, 2015). The last metaparadigm concept of SCDT
is health, which is defined as the overall structure and functionality of a human being as a whole
in physical, mental and social aspects (McEwen & Wills, 2018).
This theory gives a clear specification of the roles of nurses and patient in providing and
receiving care (Smith & Parker, 2015). The original grand theory comprised of three interrelated
theories: the theory of self-care, the theory of self-care deficit, and the theory of nursing system
(Smith & Parker, 2015, p. 107). Each theory is defined by the concept attached to each theory.
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The theory of self-care focuses on the individual’s learned ability to practice of activities
that are essentials in maintaining life, health, and well-being with considering factors of
developmental age, personal life experience, exposure to different sociocultural orientation, and
available resources (Younas, 2017). Included in the self-care theory is the individual’s
therapeutic self-care demand, which is defined as the required valid methods of self-care actions
to be performed by the individual for a period of time in order to attain the self-care
requisites (Younas, 2017). Self-care requisites are human behaviors that aim towards provision
of self-care: universal self-care requisites, developmental self-care requisites, and health
deviation self-care requisites (McEwen & Wills, 2018, p. 144). The idea of universal self-care
requisites is to address the basic human needs, and maintain the integrity of human structure
associated with performing activities of daily living such as maintaining sufficient food and
fluid intake, ability to care during for oneself during elimination process, maintain balance
between rest and activity, and prevention of threat and insult to the well-being on an individual.
The developmental self-care is related to a person’s social and life experience such stress from a
new employment, or adapting to body changes (McEwen & Wills, 2018, p. 144). Lastly, health
care deviation self-care refers to the individuals adaptation or reaction to conditions of illness
and injury that may require the individual to explore appropriate medical assistance, adjusting to
the result of a condition, and ability to perform the prescribed plan of treatment, and having the
physical and mental resilience to live with the effects of illness or injury (McEwen & Wills,
2018).
The theory of self-care deficit determines that nursing care and intervention is needed due
to circumstances when a human being becomes incapable or develop limitations in providing
consistent self-care. This theory defines how nursing functions around the needs of human
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beings (Younas, 2017). The nursing-specific ontological assumptions about human beings is
derived from a perspective that human beings need continuous self-maintenance and self-
regulation through self-care (Younas, 2017). Orem’s philosophical belief dictates that human
beings have the potential to learn new methods to meet self-care needs with the epistemological
assumption that nurses plays a vital role in encouraging human beings to perform deliberate
action on themselves and the environment to maintain self-care continuity (Alligood, 2016).
The theory of the nursing system is defined as the course of plan developed by the
nursing system in order to meet the self-care needs of the individual (McEwen & Wills, 2018, p.
143). Depending on the status of the individual’s self-care needs, the nursing system is classified
into three parts: wholly compensatory, partly compensatory, and supportive/educative system. A
simple summary of these three nursing system classification means that either the nurse perform
and meet all the self-care needs of a patient (wholly compensatory), the patient meets their own
needs with little to no guidance from the nursing staff (partially compensatory), or the nurse and
the patient work together to meet patient needs (supportive/educative) (Alligood, 2016 , p. 198).
The theory of nursing system also describes the scope of nursing practice in health care events,
and also the recognition of use of technology when performing nursing care (McEwen & Wills,
2018, p. 144).
The foundation of the development of SCDT constitutes major assumptions. In Orem’s
theory, she viewed two types of human beings: the ones who need nursing care and the ones who
provide care (Orem, 2015). Orem’s ontological assumptions of human beings present them as
unique individuals who interest the same basic needs for self-preservation, have the ability of
self-reflection and their environment, capable of learning from experiences, and resourceful and
self-reliant when addressing the need for self-care (Orem, 2015). Orem’s ontological assumption
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about nursing is the person capable of assisting people who require support in disease
prevention, health promotion, and maintaining life (Orem, 2015). Orem also believed that nurses
have the technology and moral assets in health care. (Younas, 2017).
Exemplar: Care encounter with L.V.
In 2014, I was working in medical-surgical oncology and telemetry unit in a suburban
hospital in Illinois. I was notified by my charge nurse that I was going to get an admission from
the emergency department. A 25 years old female with a diagnosis of sickle cell anemia. Upon
assessment she told me that she had been battling sickle cell since she was 15 years of age and
that the disease had gradually made her body deteriorate. LV’s physical assessment findings
included scleral icterus, pale mucous membrane, longer skinnier extremities, bone deformities
noticeably in the hands and feet, and acute generalized bone pain. In general, LV is able to
perform self-care with little to no assistance from her family at home, but every time she
experienced a crisis from her sickle cell, she became debilitated and relied on the assistance of
nursing staff and her family in order to perform and carry out self-care. LV had pride. She would
make an effort to perform her ADLs with minimal assist even when it would be difficult for her
to perform self-care such as eating, drinking, bathing, elimination, social interaction activity, and
rest. She complied with her medical regimen but felt that her condition would not improve
regardless of what was professionally recommended. She had a great support system at home
where she was being taken care of by her mother and her siblings. Her social interaction was
somehow limited to her family and a few friends because of her medical condition. Her main
social interaction was through social network and occasional face to face encounter with her
friends. During my first encounter with LV, I assessed her needs in performing self-care. She
mentioned things that she could do and the things that she needed help with. We created daily
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goals for her and included these goals in her plan of care. I took care of LV for six days out of the
two weeks she stayed in the hospital. She worked with physical and occupational therapy in
order to strengthen her muscles and perform exercises to prevent further debilitation. I found it
reassuring that she was able to adapt and modify self-care if the prescribed therapy did not work
for her. The overall goal for LV was to perform self-care with as minimal physical support as
possible and be self-reliant in performing self-care. When the achievable self-care requisites
were addressed and LV was in physical condition to take care of herself, she was discharged to
home. Unfortunately, it would only be a matter of time before she would come back again for
another treatment of sickle cell crisis. For every time she got admitted to the hospital she would
be worse. This is a simple exemplar that reflects the work of Orem’s Self-Care Deficit Theory. It
is important that the client or patient is identified as the caregiver for oneself. Human beings are
capable of performing self-care and has the ability to learn new methods in order to meet self-
care demands.
Application of Theory
Most nursing practice will encounter and reflect the work of Dorothea Orem’s Self-Care
Deficit Theory simply because of the conceptual framework of the theory that when human
beings encounter injury or illness, the automatic response is to seek help and go to the hospital.
Nurses who provide care to patient are taught to perform initial assessment that includes data
collection for patient profile, identifying the needs of patients including the universal self-care
requisites, developmental self-care requisites, and health deviation self-care requisites. My
encounter with LV depicts the Self-Care Deficit theory because of how the nursing process took
place and how the concept of self-care deficit and the nursing system theory is applied into my
experience. One of the major concepts of SCDT is to evaluate patient needs in performing self-
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care to address requisites that may involve the need for nursing system in performing either
wholly or partially compensatory system, and supportive/educative system (McEwen & Wills,
2018). By assessing and evaluating the needs of LV, I was able to formulate a plan and identify
objectives that reflect to understand about the changes in the behavior to meet the requisites.
Application of the nursing system theory during my encounter with LV in addressing her self-
care deficit was achieved through nursing assessment and evaluation of LV. The concept of
deliberate action also reflected during my encounter with LV when she would find motivation in
creating her own ways of performing self-care that would work for her and incorporate these
new techniques in her daily activities carrying on until she was discharge at home.
Encouragement and positive reinforcement in minor health progression were constantly shared
between LV and I as part of nursing support. To address the developmental self-care requisites of
LV, I provided her and her family with the information regarding episodes of pain and refer to
that periodically and the necessary treatment in pain control regimen.
Conclusion
The concept of Orem’s Self-Care Deficit Theory is applicable into nursing practice
because of its interrelation of the nursing system, the human beings, and the perspective of self-
care. Most nurses may find that this theory is commonly used in nursing practice due to its
conceptual framework that embody the aspect of self-care, self-care deficit, and the nursing
system. The application of this theory may not be compatible in all healthcare settings, but it is
certainly useful in practice situations, extensive research, projects, and graduate thesis because of
its relative realistic reflection of nursing practice that the potential to improve patient outcomes.
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References
Alligood, M. R. (2016). Nursing Theorist and Their Work (9th ed.). St. Louis, MO: Elsevier.
Fawcett, J. (2016). Applying conceptual models of nursing: quality improvement, research, and
practice. New York, NY: Springer Publishing Company.
Hagran , A., & Fakharany , E. (2015 ). Critique of Orem's Theory. The Journal of Middle East
and North Africa Sciences, 1(5), 12-17. Retrieved from
https://pdfs.semanticscholar.org/5761/17009ae992dc2e2ee652cb66c03020d633f2.pdf
McEwen, M., & Wills, E. M. (2018). Philosophy, science, and nursing. In Theoretical basis for
nursing (5th ed. (p. 8). Philadelphia, PA: Wolters Kluwer.
Orem, D. E. (2015). Dorothea Orem’s Self-Care Deficit Nursing Theory. In M. Smith & M. E.
Parker (Eds.), Nursing Theories and Nursing Practice (4th ed. (pp. 105-132).
Philadelphia, PA: Davis.
Shah, M., Abdullah, A., & Khan, H. (2015, January 1). Compare and Contrast of Grand
Theories: Orem’s Self-Care Deficit Theory and Roy’s Adaptation Model. International
Journal of Nursing Didactics, 5. http://dx.doi.org/10.15520/ijnd.2015.vol5.iss01.28.39-42
Smith, M. C., & Parker, M. E. (2015). Nursing Theories & Nursing Practice (4th ed.).
Philadelphia, PA: F.A. Davis Company.
Younas, A. (2017, February). A Foundational Analysis of Dorothea Orem's Self-Care Theory and
Evaluation of Its Significance for Nursing Practice and Research. Creative Nursing,
23(1), 13-23. http://dx.doi.org/10.1891/1078-4535.23.1.13
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