The Pivotal Role of Orem’s Self-Care Deficit Theory

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A nurse applies medication cream on an elderly patient.
Certain theories can redefine the ways professionals approach their fields. The ideas of Isaac Newton, Marie Curie, and Immanuel Kant made lasting impacts on their disciplines. In the nursing field, Dorothea Orem was one such influential thinker. Born in 1914, Orem worked all over the country as an expert nurse until her death in 2007. Her 1971 theory of self-care deficit is still taught today in nursing schools, and she helped shape the holistic approach nurses now take toward patient care. The theory helps nurses determine what aspects of patient care they should focus on in a given situation, and it stresses the importance to patients themselves of maintaining autonomy over their self-care processes.

Orem’s theory of self-care deficits explains how nurses can and should intervene to help patients maintain autonomy. She became widely acclaimed within her field, and she served as a consultant for numerous universities and government organizations throughout her career. The Orem International Society was founded in 1991 to continue the legacy of Orem’s research and advocacy. Experimentation with this theory continues today, with many studies published each year that assess its effectiveness in patient treatment. One study published in the Iranian Red Crescent Medical Journal demonstrated a statistically significant difference in fatigue levels among multiple sclerosis patients when nurses used Orem’s self-care model. Moreover, hundreds of other studies have examined Orem’s model applied to all different kinds of patients and syndromes.

Self-Care Deficits

A self-care deficit is an inability to perform certain daily functions related to health and well-being, such as dressing or bathing. Self-care deficits can arise from physical or mental impairments, such as surgery recovery, depression, or age-related mobility issues. Nurses play an important role when it comes to addressing self-care deficits through assessment and intervention. For assessment, nurses must be aware of the patient’s strengths, weaknesses, environment, and situational needs. Intervention can include, but is not limited to, helping patients create short-term goals, spurring motivation, creating opportunities for independence, and offering help with daily activities.

Orem’s self-care deficit theory suggests patients are better able to recover when they maintain some independence over their own self-care. This theory, which is applied often in the field of nursing, is studied in Doctor of Nursing Practice (DNP) programs. Later, we will discuss the application of this theory. Now, we will examine how nurses diagnose self-care deficits.

Self-Care Deficit Nursing Diagnosis

According to Nurseslabs, signs and symptoms associated with self-care deficits include:

● Inability to maintain proper hygiene
● Inability to dress oneself
● Inability to feed oneself
● Mobility issues
● Frustration/depression
● Problems with using the toilet

Nurses use the term activities of daily living, or ADL, to refer to the aspects of self-care that patients are having trouble with. When nurses find that patients are showing signs of self-care deficit, they look for ways to help them while allowing for individual autonomy.

Orem’s Self-Care Deficit Theory

Before we examine Orem’s theory, it is important to understand some key terminology:

Self-care — the acts individuals perform to maintain their well-being, such as showering, eating, moving, etc.
Self-care agency — the ability for individuals to practice self-care, which can be affected by their environment or health considerations
Self-care demand — the actions performed to meet the specific deficits identified in the patient

According to Nurselabs, Orem’s self-care deficit theory focuses on the specific scenarios needing the attention of nurses, and it lists five ways to help:

1. Acting for and doing for others
2. Guiding others
3. Supporting another
4. Providing an environment promoting personal development in relation to meeting future demands
5. Teaching another

How do nurses determine whether a patient is facing a self-care deficit? Orem’s theory includes three steps. First, a nurse gathers information about the patient. This includes the patient’s health, needs, goals, and capacity, from the perspective of both the patient and the attending physician. Next, the nurse strategizes ways to help the patient with his or her self-care deficit. Next, the nurse works directly with the patient to meet these needs.

DNP Intervention

DNPs are well equipped to meet the various needs of patients demonstrating self-care deficits. Let’s examine the methods nurses can follow to address certain issues.

Hygiene — Nurses can help patients maintain their own personal hygiene by providing reminders and motivation for self-care. This could include daily prompting for activities like bathing and washing up.
Dressing/grooming — Nurses can help their patients by recommending clothing that is easy to put on and remove, giving them privacy, and providing frequent motivation.
Feeding — Nurses can help enable patients to feed themselves as soon as possible. By creating a conducive environment to eating (positioning the patient, ensuring they have access to their dentures, etc.), patients can stay independent throughout their meals.
Toileting — Nurses should work to simplify toileting for patients. This can include using bedpans, suppositories, stool softeners, or commodes. Nurses should also be nearby in case of any accidents or falls.
Speech deficit — Nurses should work closely with speech pathologists to ensure that any type of speech deficit will not interfere with communication about care.

Conclusion Learn How You Can Help Foster Patient Independence

Orem’s contribution to the field of nursing is substantial. Every day, nurses diagnose self-care deficits, and this allows them to craft solutions for their patients while staying mindful of their need to be independent and feel like they have control over their rehabilitation and treatment. If this rewarding aspect of nursing interests you, Regis College offers online Master of Science in Nursing and Doctor of Nursing Practice degrees. With 100% online courses, attending Regis College can allow you to continue nursing while pursuing an advanced degree.

Recommended Readings
What Makes a Good Nurse? Key Skills for an Essential Profession
What Are Some Doctor of Nursing Practice Specialties?
What Is a Substance Abuse Nurse?

Iranian Red Crescent Medical Journal, “The Effect of Orem’s Self-Care Model on Fatigue in Patients With Multiple Sclerosis”
Nurseslabs, “Dorothea Orem’s Self-Care Theory”
Nurselabs, “Self-Care Deficit”
Orem International Society, “Orem International Society”
Regis College, “Doctor of Nursing Practice”
Regis College, “Online Master of Science in Nursing”, Sample Records for Self-Care Deficit Nursing