Self-Care Deficit Theory

Practicing as a nurse, I realize I follow my own metaparadigm of nursing. In this paper, I relate my own personal beliefs with that of a popular nursing theorist. Though my research on theory is just beginning, I feel my metaparadigm most relates to that of Katharine Kolcaba and her theory of comfort. I will seek to illustrate my philosophy with the knowledge and nursing experience I have.

Dorothea Orem’s Self Care Model states, “Nursing care is required when an adult is unable to perform self-care sufficiently to sustain life, maintain health, recover from disease or injury, or cope with the effects of disease or injury” (Orem, 1991). Orem also takes into account that caregivers also need nursing care. Six concepts:

Dorothea Orem is known as one of the foremost nursing theorists. She is credited with the development of a nursing grand theory, the self-care deficit nursing theory (SCDNT). The beginning of her career can be traced back to Washington, D.C. in the mid 1930’s. Though she was a Baltimore, Maryland native, Orem pursued her nursing education at Catholic University of America (CUA) in Washington, D.C., graduating with baccalaureate and Master’s degrees in 1939 and 1945 respectively. Following her education, Orem held many job positions across multiple nursing disciplines, including working as a private nurse, nurse educator, administrator, director, and private contractor (McEwen & Wills, 2011).

“Nursing Care plans are created from key parts of the theory and identify patient goals and the nursing interventions to achieve those goals. Orem’s self-care deficit theory uses three systems to show how nursing care can be implemented to meet self-care needs of patients: wholly compensatory, partial compensatory, and health education” (McEwen, & Wills,2011). “Futher-more, there is supportive evidence that the theory has been used to develop nursing research and education. Orem’s model of theory is used to develop nursing curriculum in numerous universities, colleges, and schools of nursing all over the country. It has also added to nursing knowledge, has created new hypothesis in nursing through research, and Orem’s self-care theory has had numerous research studies conducted on her

Throughout the history of nursing, there have been many nursing theorists who have each made significant contributions towards the shaping of nursing knowledge. Each of these theorists have differing perspectives and interpretations of how each domain of the nursing metaparadigm fit into their respective theories. The four domains of the nursing metaparadigm are: person, environment, health and illness, and nursing. The purpose of this reflection is to provide an overview of the domains related to the metaparadigm of nursing as well as to introduce this author’s perspective on their developing personal philosophy of nursing. In this paper, the author will take a closer look at each of these areas, how they are individually defined, and how they each fit into the nursing metaparadigm as a whole. At the conclusion of this overview, readers will be introduced to how these theorists and their perspectives have enabled this author to begin to create their own philosophy of nursing.

Each professional discipline has a responsibility to identify concepts that provide a general description of the discipline. It is these concepts that comprise the profession’s metaparadigm (Fawcett, 1984). Much of the philosophy and theory of nursing stems from the work of Florence Nightingale. The diaries, letters, and books that she left behind containing her statements and beliefs have been fundamental to the development of the concepts comprising the nursing metaparadigm (Selanders, 2010). Fawcett’s (1984) stated there was a general consensus among scholars that the concepts of nursing were person, environment, health, and nursing.

The purpose of this paper is to discuss my personal beliefs pertaining to the profession of nursing. As well I will discuss the (4) metaparadigms in nursing which are known as; human beings, environment, health, and nursing, and my personal beliefs on these concepts and how they have similarities to the nursing philosophy of a nursing theorist.

Nursing theories play an integral role in guiding practice, education, and research. Many different theoretical perspectives are maintained in the field of nursing due to the diversity of the field, no single theory is able to account for all nursing knowledge. The purpose of this paper is to compare and contrast two nursing theories that have produced a profound impact on nursing practice. The theories being compared are Dorothea Orem’s Self Care Deficit Nursing Theory (SCDNT) and Sister Callista Roy’s Adaptation Model (RAM). Both theorists have profoundly influenced nursing science, research, practice, and education. Similarly, both of these theories fall into the category of Grand nursing theories which are the most complex theory level and explain broad areas of the discipline, as well as being the broadest in scope (McEwen & Wills, 2014).

Kristen M. Swanson may not be as well-known as Florence Nightingale in the nursing field, but she has made great contributions with the Theory of Caring that has been used in many hospitals, even internationally, for their framework to guide patient care. Through the study of her practice, I have realized much of her practice is reflected in mine. This paper will present the basic concept of nursing known as the metaparadigm concepts of person, health, environment, and nursing as presented by Swanson, as well as provide my own philosophy of nursing, which in many ways mirrors Swanson’s.

Dorothea Orem's self-care deficit theory was born while Dorothea Orem (1917-2007) was working in the Department of Health Education and Welfare (HEW) as a curriculum consultant. At this time in the history of the profession, nursing was just emerging as a unique academic discipline. Orem's theory was designed to answer the fundamental question: What is nursing? Orem defined nursing as a way of realizing every patient's desire to engage in self-care in a manner to "sustain life and health, recover from disease or injury and cope" with the consequences of major health events and daily life (El-Kader n.d.). Major assumptions of the theory include that "people should be self-reliant and responsible for their own care and others in their family needing care" (Dorothea Orem's self-care deficit theory, 2012, Current Nursing). Fundamentally, nursing and the nursing process is designed to enhance self-care and to address deficits in self-care.

Orem’s four metaparadigm principles are important in understanding the theory as a whole. Nursing is the actions performed by nurses to assist patients towards the goal of self-care. Health describes a patient being structurally and functionally whole. An environment that promotes self-care is equally as important as human’s being allowed to function at their highest self-care level.

Dorothea Orem created the self-care theory in 1959 and continued to build upon her theory until 2001. The purpose of Orem’s theory was to define nursing, discuss the relationship among the nurse and the patient, and to promote a clear understanding of the scope of nursing (Taylor, Self-Care Deficit Theory of Nursing, 2006). Today, Orem’s theory is widely known and is utilized in nursing curriculum, as well as continuing education topics for healthcare providers.

Like any scientific discipline, the nursing profession has evolved over time. Nurses, once regarded as housemaids and lower class citizens, now hold positions of authority and stature in our modern society. These changes in the profession are attributed to the many nurse theorists who devoted their lives to the improvement of patient care. Through their theoretical advancements, the public perception of nursing has gone from dismissive to reverential. Today, our culture considers the nursing profession to be one of the most rewarding and respected career paths an individual can pursue. Through a review of one such patient theorist, Dorothea Orem, one can witness this change in the perception of the nursing profession. As a first semester student in a professional nursing course of study, Orem has already influenced my personal nursing philosophy.

By outlining the focus and boundaries of the discipline nursing is able to highlight areas of study that are significant to nursing education and practice, all of which can be traced back to the fundamental concepts. These central ideas feature as integral to nursing development and continue to demonstrate their influence by shaping the way nurses learn and do. The concepts of person, health, environment and nursing are all interrelated, as are the concepts put forward by Newman, Smith, Dexheimer-Pharris and Jones (2008), and can be identified as prominent in nursing studies and the development of nursing theories. The nursing theories based on these fundamental concepts serve as the building blocks for all nursing knowledge and as Smith and Parker (2010) explain “the primary purpose of nursing theories is to further the development and understanding of nursing practice” (p. 8). The structure of knowledge as described by Smith and Parker provides a clear example of how nursing metaparadigms have implications for all levels of nursing theory, education and research from the most abstract or global concepts to the more concrete

Three connecting theories developed by Dorothea Orem are the theory of self- care, the theory of self-care deficit and the theory of the nurse system (George, 2011). Self-care theory is offering an