Theory Evaluation Paper

Theory Evaluation Paper

NU-500-7B: Theoretical Foundations for Nursing

Within Orem’s Self-Care Deficit Theory (SCDNT), Orem states,” All nurses need to understand that a theory merely points to the situations you have to deal with in the real world and helps you to understand those situations. The theory comes alive in real-world situations (Fawcett, 2016).” Nursing is a disciple, full of knowledge and dedicates its work to the health of humans with a focus on assisting in the maintenance of well-being (Self-Care, 2012). Doretha Orem was a respected nurse, educator, and theorist who gave her life’s work to improve the health of patients, and excel the nursing profession. Orem’s (SCDNT) provides a practical, complete base to nursing practice.

Orem’s grand theory, SCDNT will be evaluated as it pertains to the writers need to understand self-care, self-care deficits, and nursing systems as a foundation to grow as a nurse and eventually a nurse practitioner. The purpose of this paper gains a deeper understanding of Orem’s theory using Chinn and Kramer’s components of theory description, and critically analyze/ evaluate the SCDNT using Fawcett’s criteria for analysis.

Theory Description

Purpose 

Where did it all begin? Orem asked the question, why do people need nursing? In 1959 her first publication sought to answer this question. Orem wrote the human needs, Grand theory- Self-Care Deficit Theory (SCDNT). In Orem’s Explanatory theory, people require nursing when they are unable to care for themselves or depend on others (Petiprin, 2016). The amount and quality of care that is needed depends on where the person is on the self-care continuum. Orem believed that self-care is the goal of the patient to provide for themselves, and thrive in health and life (Orem, 1997). Through empowering patients, this can be accomplished. When self- care is no longer possible, and the patient is sick, this is when nursing is needed. To the degree a patient can provide self-care depends on physical, psychological, interpersonal, and social aspects (Petiprin, 2016).

Concepts

Orem’s Grand theory explains what and why nurses do what they do, and when a nurse is needed. It has three interconnected sub-theories of self-care, self- care deficient, and nursing systems. Each related theory is a link on the health continuum, and a patient can go back and forth as self-care deficit arises. There are six central concepts of SCDNT consisting of self-care, self-care agency, therapeutic self-care demand, self-care deficit, and nursing agency (Petiprin, 2016). As you will see, Orem’s concepts are clearly stated and easily understood.

Definitions

Self-care focuses on how and why individuals care for themselves. The theory says that self-care, and care of dependents are learned behaviors that purposely regulate human structural integrity, functioning, and development (Nursing Theories, 2012). According to Orem, the requirements of self-care subside in three categories—universal, developmental, and health deviation. Universal requirements relate to meeting common human needs. Second, developmental self-care requisites relate to conditions that promote developmental processes throughout the life cycle. Third, health deviation self-care requisites relate to seeking appropriate medical assistance, and adhering to rehabilitation procedures (Nursing Theories, 2012). Self-care agency is a person’s ability to participate in self-care, and affected by conditioning factors such as age, gender, developmental state, health state, sociocultural factors, health care systems factors, family system factors, pattern of living, environment factors, and availability and adequacy of resources (Nursing Theories, 2012). Opposingly, therapeutic self-care demand involves measuring a person’s ability or inability to meet self-care requisites. When therapeutic self-care demand surpasses self-care agency, there is a self-care deficit.

Self- Care Deficient theory explains when nursing is needed and ways people can be assisted through nursing (Self-Care,2012). When a patient can no longer maintain self-care, nursing steps in to assist with guiding, supporting, teaching, providing a healthy environment, and acts of doing for the patient until self- care is regained. Orem’s theory of nursing systems is the legitimate nurse and patient relationship that begins when therapeutic self-care demand exceeds available self-care agency (McEwen, 2019). Further classified as wholly compensatory, partly compensatory, and supportive-educative. Wholly compensatory system is where the nurse is in complete control and the patient has no ability to perform self-care. Partly compensatory neither the nurse, nor the patient play a large role in self-care, and can be nurse lead or shared with the patient. Lastly, supportive-education system, self-care is accomplished and the nurse continues to educate the patient (Orem, 1997).

Relationship 

Relationships between the self-care concepts are explanatory. Each theory is placed on a continuum of care with the goal of self-care. As a patient moves back and forth on the continuum of care, you will move from self-care to self-care deficient. This explains when nursing care is needed. When a person is no longer able to meet self-care requirements, a nurse must assist in the deficient promoting health and self-care. The nurse can assist wholly compensatory, partially compensatory, or supportive-education. The relationship between sub theories is a fluid continuum. It clearly gives direction in this complex theory.

Structure 

Orem’s theory is consistent. You can see that Orem noted the whole person when designing the SCDNT. Note the fluidity in the theory as seen by the intersecting parts of the diagram (McEwen, 2019).

Assumptions 

Assumptions of the Self-Care nursing theory accept that persons be self-reliant, and responsible for self, and their families care. Self-care is also a learned behavior and continual education should be provided to promote self-care (McEwen, 2019). Nursing system is a product of relationship building between the nurse and patient. When mature humans experience limitations, nursing action is needed for the distinct individual (McEwen, 2019).

Theory Analysis

Theory’s Origin 

Orem’s experience included OR, ER, Medical Surgical, and management in nursing. As she progressed in her academics and career, she saw a need to better define nursing. Orem formulated the SCDNT in 1956. SCDNT was published in 1959. The theory was developed as Orem sought her goal of improving the quality of nursing in general hospitals in her state (Petiprin, 2016). As a nurse she felt it necessary to help nurses answer what nurses do, why they do what they do, and why a person needs nursing care (Orem, 1997). Orem used both deductive and inductive reasoning to form her theory. Orem used her own experience to inductively answer questions of why people need nursing care. She deductively gathered knowledge from other scholars and disciplines to define nursing (Fawcett, 1995). This grand nursing theory with a broad scope, and general concepts allowed nurses to understand the why of nursing and not just the how. The profession and increased knowledge of nursing was very important to Orem and the author said much about the need for continued education and growth as a professional nurse (Orem, 1997).

Unique Focus 

Orem’s focus was on self-care. She not only included the patient, but factors surrounding the patient that were barriers to self-care. Her inclusion of family units also provided a unique and holistic view of the patient.

Content 

In the totality paradigm, nursing theory views the person with respects of integrated biological, physiological, sociological, and spiritual. It considers that a person can adapt to changes in external environment, and that wellness and illness is a continuum health state (totality paradigm, 2009). Orem’s theory encompasses this totality paradigm, and describes all four metaparadigms, with her main premise of self-care as the driving factor. Orem defines nursing as an art, a helping service to assist a person with disabilities and supports when self-care cannot be obtained (McEwen, 2019). By assisting the disabled during times of self-care deficit, nurses can move the patient along the continuum to self-care. “Humans are defined as “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, 2019).” Orem provides data to make the assumption that humans require deliberate input, and need continuous self-care maintenance which enables purposeful action (Chinn, 2018). Environment has physical, chemical, and biological features. It includes the family culture and community (McEwen, 2019). Orem saw that both environment and developmental factors had effects of self-care. Health is defined by the state of the person being mentally and functionally whole (McEwen, 2019). Also, health is a state that encompasses both the health of individuals and of groups, and human health is the ability to reflect on one’s self, to symbolize experience, and to communicate with others (McEwen, 2019). Orem clearly stated the relationship between concepts of her theory and metaparadigms of nursing theory. She made it simple for the reader to understand. Her definitions also wove into her sub theories to give a deeper understanding and reflection.

Theory Evaluation

Significance 

Orem’s theory stood the test of time. 50 plus years and it is still around today. This longevity proves its social significance. Theories of the past has made great foundation for future theories. Orem’s contribution lays a foundation for next theories in nursing practice, self-care needs and nursing research. Without this unrestricted thinker, nursing may not have progressed to the stage it is. Many colleges and schools of nursing base their curriculum on self- care nursing deficit theory (McEwen, 2019). Hospitals have applied Orem’s SCDNT in their ambulatory care setting, and the theory has been used to structure care for medication conditions, and areas of practice. Internationally, Orem’s theory has been integrated in practice, serving diverse populations in a variety of clinical settings (McEwen, 2019). Orem’s self-care theory is testable as well. Over the years, many researchers have tested her theory. Research also utilizes her theory as a framework for their research (McEwen, 2019).

Comprehensiveness 

The theory at first seems complex, but after research, comprehension is gained in an insightful, logical manner. The theory is straightforward, and can be used from novice to expert nursing. The scope of nursing is clearly understood, as to when a nurse is needed in the continuum of care. The structure is reasonable for usage in daily practice, while broad concepts make the self-care theory applicable in all nursing settings such as; rehabilitation centers, primary care, and other environments, whereby nurses encourage patients to be independent (McEwen, 2019).

Logical Congruence

Definitions are well defined. Concepts are specific to the practice of nursing and self-care. The concepts are easily integrated into application of nurse practice. A limiting factor in Orem’s theory is that it is illness driven. The theory limits nursing intervention until the self-deficient of a person, causing a need for nursing. Further study is needed to provide a greater look at preventive care in order to sustain self-care.

When utilizing the SCDNT, the nurse must remember influencing factors that will cause the need for adjustment with the plan of care. Factors such as an environment that is not sufficient for self-care. The nurse and patient, as a team, will have to find solutions to help the patient regain self-care. Another example of barriers to self-care would be non-adherence of medication. The nurse and patient entering into a healing relationship, must identify factors for non-adherence, and make plans to adjust the plan of care, in order to move the patient into a state of self-care.

Credibility 

Orem’s SCDNT has been empirically tested, and continues to be a sound theory. Concepts are also used for other development of nursing models (Nursing Theories, 2012). As seen in Seeds study, the research utilizing SCDNT, guided self-care of patients in psychiatric units with known improvement in patient outcomes (Seed, 2012).

Contribution to Nursing 

The theory recognizes that the person strives for self-care, and nurses assist during times of deficits. This patient -center approach is both useful to the patient and nurse. In daily practice, the nurse assisting in rehabilitation to self-care, has a sound structural guideline by which to practice. Defined outcomes lead the nurse and patient on the continuum of care from self-care deficit to a place of self-care. As mentioned above, Orem’s contribution to nursing education, and research is profound. Longevity is evident. The relevancy of the self-care deficit theory that comes from its structural and functional components can predict outcomes in clinical practice, education, and provide a foundation for nursing knowledge.

Conclusion

Orem’s SCDNT has made a significant impact on the profession and practice of nursing. This grand theory is practical in every day nursing, patient-centered, and relative to both the novice and expert nurse. Deeper comprehension was gained through this research of theory description, critical analysis, and evaluation of Orem’s Theory.

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