Orem’s Self-Care Deficit Nursing Theory

Orem’s Self-Care Deficit Nursing Theory (SCDNT) Original Source Impetus was to define content for practical nursing curricula for Department of Health, Education, and Welfare References Parson’s structure of social action and von Bertalanfy’s system theory Ontology moderate realism Focus person as agent Source: McEwen & Wills (2007)

SCDNT Paradigmatic Origins Needs Theory (Henderson, 1966) Functional Theory (Abdellah, Beland, Martin, & Matheney, 1961) Uniqueness of Orem’s theory – individual is capable of engaging in own self-care Orem credits reflection on own practice & others for theory beginnings Source: Meleis (1997)

SCDNT Overview “Relationship between self-care agency and therapeutic self-care demands, distinguishing self-care deficit from dependent care” (Romeo & Devereaux, 2006) Composed of 3 nested theories: Self-care Self-care deficit Nursing systems Relationship between the 3 theories: “The theory nursing systems subsumes the theory of self-care deficit, which subsumes the theory of self-care” (Orem, 1991, p. 66)

SCDNT Overview Based on 4 concepts Self-care Self-care agency Activities an individual performs independently throughout life to promote & maintain well-being Self-care agency Individual’s ability to perform self-care activities Self-care requisites Measures or actions to provide self-care Therapeutic self-care demand Self-care activities required to meet self-care requisites Source: Berman, Snyder, Kozier & Erb (2008)

SCDNT Overview Self-care deficit results when the self-care agency can not meet self-care demands Explains when nursing care is needed Explains how people can be assisted through 5 methods of helping: Acting or doing for Guiding Teaching Supporting Providing an environment to promote the person’s abilities to meet current & future demands

Orem’s 3 Types of Nursing Systems Wholly compensatory Required when one cannot control/monitor their environment Nurse accomplishes patient’s therapeutic self-care Partly compensatory Required when one is unable to perform some but not all self-care activities Nurse and patient work together to meet patient’s self-care needs Supportive-educative Required when one needs to learn to perform self-care activities & needs assistance to do so Patient provides necessary self-care and nurse supports/educates client in development of self-care agency Sources: Berman, Snyder, Kozier & Erb (2008) Meleis (1997)

SCDNT and Research Jenny, J. (1991). Self-care deficit theory and nursing diagnosis: A test of conceptual fit. Journal of Nursing Education, 30(5), 227-232. Kumar, C. P. (2007). Application of Orem’s self-care deficit theory and standardized nursing languages in a case study of a woman with diabetes. International Journal of Nursing Terminologies and Classifications, 18(3), 103- 110. Moore, J. B. (1993). Predictors of children’s self-care performance: Testing the theory of self-care deficit. Scholarly Inquiry for Nursing Practice, 7(3), 199-212.

SCDNT Applied to Nursing Practice Burks, K. J. (1999). A nursing practice model for chronic illness. Rehabilitation Nursing, 24(5), 197-200. Frey, M. A. & Fox, M. A. (1990). Assessing and teaching self-care to youths with diabetes mellitus. Pediatric Nursing, 16, 597-800. Geden, E. A., Sang-Arun, I., & Taylor, S. (2001). Self-care deficit nursing theory and the nurse practitioner’s practice. Nursing Science Quarterly, 14(1), 29. Harrison-Raines, K. (1993). Nursing and self-care theory applied to utilization review: Concepts and cases. American Journal of Medical Quality, 8(4), 197-199.

Application of SCDNT To My Practice As a nurse educator, I can use SCDNT to help students identify when patients should receive help to meet their heath care needs. In addition, this theory identifies to what degree the client needs help. I believe in allowing an individual to do what they can for themselves and to support those efforts the best I can. Finally, SCDNT identifies the concept of educating clients, an important role of the professional nurse.

Application of SCDNT to my nursing profession As a Registered Nurse Case Manager is use Orem’s Self Care Deficit Nursing Theory while assisting patients and families in discharge planning. I am able to provide education and the tools needed to allow the patient to care for themselves. Families are incorporated in the teaching and are willing to learn how to assist or allow the patient to care for themselves. SCDNT describes the professional nurse as an educator but also how to provide the knowledge that will allow the patient to care for themselves.