Dorothea Orem Nursing Theory
Catherine Groggel, Trevor Mattarella, Cheryl Nienaber, & Jeremy Spencer Ferris State University
Each group in the class was given a unique theorist who assisted in the development of nursing through distinct characteristics. Dorothea Orem was one of the many nursing theorists who helped form the field of nursing into what it is today. This conceptual theory assignment is designed for us as nurses to understand where these theories and ideas originated from and what we can do to make a difference in the future. Orem designed the Self-Care Deficit Nursing Theory (SCDNT) to improve overall patient care and implement methods to provide optimal holistic care. After creating this theory and its components, all members of the nursing
discipline were able to work together more efficiently to achieve a common goal, expert patient care.
Dorothea Orem (1914-2007) was born and raised in Baltimore, Maryland. She was the younger of two children. Her mother was a housewife and her father worked as a construction worker. After graduation from High School, she received her diploma from Providence Hospital School of Nursing in 1934. Orem then earned a Bachelor of Science in Nursing Education in 1939 and in 1945 her Masters in Nursing Education, both from the Catholic University of America. Throughout her career she worked, in numerous nursing positions such as the
operating room, private duty nursing, nursing instructor and running departments within various hospitals throughout the country.
Orem continued her studies which earned her advanced degrees enabling her to teach at the university level. With Orem’s strong understanding of biology and how the body works, it was not surprising that nursing and science would influence her development of the nursing theory. She used “explorations of the nature, form, and the proper objects of the various medical sciences” (Orem & Taylor, 2011, p. 37), and knowledge gained through studies, colleagues, nursing literature, and experiences to assist her in forming a foundation to base her nursing
theory.
When the SCDNT was first published in 1971, (Kozier, 2008, p. 44) it was an era where nursing was trying to define itself. From 1950 to 1980, nursing scholars, including Orem, “recognized the lack of disciplinary structure for nursing and began to develop a variety of conceptual models and theories which were to serve as frameworks for practice, education, and research” (D. Orem, S. Taylor, 2011, p. 35). Orem wanted to define nursing science and differentiate it from other health care forms. Her early questioning; as to what nursing is and what nurses do was prompted by her recognition of the insufficiency of the existing body of nursing knowledge and her desire to define nursing (Berbiglia, 2011). By defining the concepts, nursing students would be better able to understand nursing science and apply it to their own practices. As cited in Berbiglia, (2011), “Orem was dedicated to explaining the theoretical basis for nursing and establishing nursing as a discipline with its own body of knowledge” (p.138).
Orem is credited with SCDNT which, “is a theory that expresses the dominate features of any one and all situations that are nursing practice situations” (Orem & Taylor, 2011, p. 38). It was about learning how to think nursing instead of only caring for a patient. The SCDNT explains that each adult has the desire to care for themselves, however at times illness can make self-care difficult to complete.
Orem felt that it was imperative for “identification and acceptance of the proper object of the science, what the science is about, what the science describes and explains” (Orem & Taylor, 2011, p. 37) and without it, nursing science could not be defined. She used two premises to define the proper object of nursing. First, “nursing is a social institution established and
maintained by societies for the purpose of meeting the needs of the people for specialized health services named nursing” and second, “the needs of the people for specific human health services
are associated with their requirements for bringing about and maintaining or regulating specific human or environmental conditions” (Orem & Taylor, 2011, p. 37). This allows explanation of why nursing care is different than other healthcare needs and patient benefits from nursing.
Traces of Orem's theory can be found in a set of guidelines, previously written by Orem in 1959, stating that the purpose of a staff nurse was to provide assistance “necessary to meet daily needs for self-care” (Orem, 1956/2003, p 6). In 1971, Orem told a colleague that the SCDNT was published with the purpose of “laying out the structure of nursing knowledge and explicating the domains of nursing knowledge” (Taylor, 2011).
Orem was “guided by a philosophy of moderate realism and by the acceptance that nursing science would have the form and structure of practical science with attached sets of applied sciences” (Orem, & Taylor, 2011, p.36). According to Alligood and Tomey (2010) an “inquiry revealed consistency between Orem’s views regarding the nature of reality, the nature of human beings, and the nature of nursing as a science and the ideas and positions associated with the philosophy of modern realism” (p. 276).
Dorothea Orem's Self Care Deficit Theory of Nursing is just one of many conceptual models of nursing. While based on research and theorists, these models are the basis for the techniques and standards of care used today in nursing care. Orem's conceptual model focuses on the global concepts of human beings, the environment, patient health, and nursing care. The conceptual model begins with human beings as the focal point of healthcare and the purpose of its existence. According to Berbiglia and Banfield (2003), Orem's nursing theory focuses on "Promotion of human functioning and development within social groups in accordance with human potential, known human limitations, and the human desire to be normal." Human beings are placed in the hospital with abnormal health issues and Orem's theory places the patient as the
first priority to optimize health and return to normalcy. The hospital environment directly relates to patient welfare since, health success is dependent on the nursing care provided. Renpenning (2003) states in regard to Orem's conceptual model, "Nurses must be able to think nursing, to communicate about nursing, to determine when and how individuals can be helped through nursing, and to design and produce nursing for individuals and groups” (p. 178). Through these methods, Orem's theory provides safety and continuity of care for patients to achieve optimal recovery. Patients in health care environments have deficits in physical or mental conditions and they rely on resources such as nurses and other members of the discipline to accept the
responsibility of treating their illness.
Renpenning (2003) said about Orem's theory, "Nurses have advanced understanding of some health care problems. At times they have been in the forefront of the health professions in using new knowledge from other fields in their own practice” (p. 181). Health care technology has advanced drastically in the last half century, and according to Orem's theory, nurses were using knowledge from other fields to learn more and improve health and nursing wellness for patients even before technology expanded. Human beings, the environment, patient health, and nursing care are directly correlated through Orem's SCDNT. Patients depend on nursing care within a health care environment to directly impact their health in positive ways to better their condition. Orem's nursing model exploits the correlation of these four components of health care to provide optimal care for patients requiring treatment. Human beings require nursing care when they have bodily restrictions due to self-limiting conditions that do not allow independent self-care. Nurses assist patients with performance of daily living activities, self-care, which may be embarrassing and they must recognize techniques to ensure comfort. Orem's theory
information and proper communication.
SCDNT seems to be primarily evident in the nursing profession. The concepts used to define the theory; self-care, self-care deficit, and nursing systems are terms that are nursing specific (Kozier, 2008, p 44). Other members of the medical profession that may use the
SCDNT are physical therapy and occupational therapy. Members of health care primarily focus to restore patient abilities by decreasing pain, increasing mobility, which should increase the likelihood of self-care.
SCDNT effectively describes the four global concepts. It does not consider the
environment that the person comes from, however the environment where the care takes place is addressed. It is implied that the nursing care will take place anywhere that there is a need for nursing care. The concept of the human being is at the forefront of the theory, and is the primary reason for the theory. The entire idea of self-care agency requires that there is a human that is capable of meeting the requirements of self-care, and the idea of universal self-care requisites are centered on the very necessities of life. The theory addresses health as it is related to self-care, not directly to health. The purpose of continuing self-care is to maintain an optimal level of health (Kozier, 2008). The nurse is a major aspect of Orem’s theory, the nurse is who is sought during times of need, in fact in 2001 Orem wrote , “What condition exists in a person when judgments are made that a nurse(s) should be brought into the situation?” (Orem, 2001).
This model can be used in any aspect of health care. If a patient has a health need, the SCDNT can be applied. For example, in the operating room if there is a need to repair a fractured bone or to improve the quality of life, then self-care is at stake. The majority of
surgeries are done to improve or enhance the overall function of a person’s body. This increases the likelihood of being able to take of one’s self. Obstetrics is a great example of this theory in
practice, especially postpartum. The baby has been delivered and now the mother is torn
between caring for her new baby and caring for herself. The nurse’s primary role is to take care of the baby’s initial needs so that the mother can take care of herself. This allows the mother to take care of the baby more effectively when she is ready.
According to Berbiglia and Banfield (2008), Orem’s work was the foundation for nursing sciences and has been the “structure for the organization of existing nursing knowledge, as well as for the generation of new knowledge”. Since the initial publishing of Orem’s theory in 1971, there have been a total of seven editions published, with the most recent being in 2001. The SCDNT continues to evolve over time and its implementation in nursing schools has been very successful (2008). This theory can be used in many situations. In fact, any situation where there is a person in need of a nursing care, Orem’s theory of SCDNT is evident.
The theory composed by Orem stands out since it is still relevant information today, just as it was after it was created. It was a theory that was continuously adapted to new standards of care and changes among nursing ideals. Orem’s theory was designed to improve medical outcomes when patients are unable to provide sufficient self-care. Orem’s Self Care Deficit Theory of Nursing has helped nurses provide better care for patients. Her theory has allowed nurses to understand patient’s needs at their level therefore improving holistic care and decreasing recovery time. Patients require nursing expertise within a healthcare facility to positively influence their health. Orem's nursing model focuses on human beings, health, nursing, and the environment to create a successful patient recovery.
References
Alligood, M. R., & Tomey, A. M. (2010). Nursing theorists and their work (Seventh ed., 265-269). Maryland Heights, MO: Mosby Elsevier.
Berbiglia, V. A. (2011). The self-care deficit nursing theory as a curriculum conceptual framework in baccalaureate education. Nursing Science Quarterly, 24(2), 137-145. doi:10.177/0894318411399452
Berbiglia, V. A. & Banfield, B. (2003). Dorothea Orem: Self-care deficit theory of nursing. In M. R. Alligood & A. M. Tomey, (Eds.), Nursing theorists and their work (7th ed., pp. 270-271). Maryland Heights, MO: Mosby Elsevier.
Kozier, B. & Erb, G.L. (2008). Fundamentals of nursing: Concepts, process, and practice. 8th Ed. Upper Saddle River, NJ: Pearson.
Orem, D. E., & Taylor, S. G. (2011, January 10). Reflections on nursing practice science: The nature, the structure, and the foundation of nursing sciences. Nursing Science Quarterly, 35-41. doi:10.1177/0894318410389061
Renpenning, K., & Taylor, S. (2003). Self care theory in nursing: Selected papers of Dorothea Orem. 178-181.
Taylor, S.G. (2011). Dorothea Orem’s legacy. Nursing Science Quarterly, 5-6. doi: 10.1177/0894318410389064
