Dorothea was born in Maryland in 1914 and she graduated from Providence Hospital School of Nursing with a Diploma in Nursing in 1934. She later received a Bachelor of Science degree in Nursing Education and a Master of Science degree in Nursing Education in 1939 and 1945 respectively (The University of Tennessee at Chattanooga School of Nursing Faculty & Students, 2016). She had a background in different clinical practices including private-duty, OR, adult medical-surgical, pediatrics, and ER supervisor. She also taught biological sciences and was a director in a nursing school. In 1949, she worked with the Indiana State Board of Health to assist in upgrading the nursing services in Indiana’s general hospitals. During her Master’s degree, she worked on a project to define nursing. Between 1958 and 1959, she was a consultant for the Department of Health, Office of Education, and Education and Welfare in Washington to improve nurse training.
Her engagement in these positions helped her understand the circumstances under which self-care decisions were made. Her answer to this led to the description of a nurse as “another self”. Later, her idea evolved to the “self-care” nursing concept and further evolved to the Self-Care Deficit Nursing Theory (The University of Tennessee at Chattanooga School of Nursing Faculty & Students, 2016). The self-care concept implies that when people are able, they care for themselves and when they are unable, nurses provide the required assistance. In the case of children, nurses provide care when parents or guardians are not able to provide the appropriate and quality care needed. The concept was published in 1959 for the first time and Dorothea worked with other nurses at the Catholic University of America to develop the concept further. She published Nursing: Concepts of Practice in 1971 which is now in its 6th edition. Her work was recognized with different awards and honorary degrees before her demise in June 2007 (The University of Tennessee at Chattanooga School of Nursing Faculty & Students, 2016).
Current works on self-care theory use references of articles and books by Dorothea while others use articles of authors who have interpreted her work in a simpler way. One of the common references is Nursing Concepts of Practice by Orem, which is currently in its sixth edition. Self-care Deficit Theory of Nursing: Concepts and Applications by Dennis Connie is also a common reference material among other similar sources (The University of Tennessee at Chattanooga School of Nursing Faculty & Students, 2016).
The development of the self-care theory was motivated by the concern accruing from the lack of an organizing framework in nursing and the belief that these nursing concepts would help formalize this framework. Also, it was developed as a solution to a problem of the lack of agreement or specification about the general nursing elements that directed the definition of problems. That changed the definition of nursing problems and the organization of research results, especially in research conducted in problem areas (Orem, 2001). The ideas that led to the formulation of this theory came to be when Orem was exposed to nursing endeavors between 1949 and 1957. Her observations during this time brought about the ideas that nursing was made up of a certain mode of thinking and communication. Her interest in the boundaries and domains of nursing later advanced to a need to understand the deeper meaning of nursing.
Orem’s theory seeks to answer the questions; why would someone need a nurse? What do nurses do? And why they do whatever they do? To come up with this theory, Orem made a number of assumptions about individuals and nurses leading to a conclusion that nursing is made up of deliberate actions that include adaptation and reflection. To develop this theory, she used both deductive and inductive reasoning. Deductive reasoning is evident when she gathered knowledge from scholars and people in the nursing faculty to define the differences between nursing and other related fields. The origin of self-care theory was derived from her work in clinical practices and the constant reevaluation of nursing since the field was constantly changing leading her to update her model a number of times. On the other hand, inductive reasoning was evident by how Orem used her personal experiences to give explanations on what drove individuals into requiring nursing care (Swain, n.d.).
Every discipline has concepts that act as a guide to knowledge development in the field; this is referred to as metaparadigm (Shah, Abdullah, & Khan, 2015). Health, person, environment, and nursing are the metaparadigm of most nursing theories and these concepts are used in the Self-care theory by Orem. Orem defined health as a person’s mental, physical, and social well-being. The basic principle of the self-care theory is to come up with a plan that enhances and maintains a patient’s health. According to Orem, a person is a social, physical, and psychological character that has varying degrees of abilities to take care of themselves (Shah et al., 2015). A person is also a recipient of care and has the potential to learn and develop how to meet their self-care needs. Also, she explained that human beings, unlike other creatures, can reflect on their surroundings and on themselves. Therefore, they can use creative words and ideas to communicate and improve things for themselves and others. In the concept of environment, Orem explained that a person and an environment are different entities that should be thought of as so. Furthermore, she presented a number of environmental features and classified them into chemical, physical, social and biological types. In this theory, an environment is a number of related factors that affect a person’s self-care needs and their abilities to care for themselves (Shah et al., 2015). In the fourth concept of nursing, Orem defined it as a certain field of knowledge or action system. It is the intervention that helps meet the required self-care needs and the patients’ medical care needs. She used the terms nursing agency and nursing system to explain this concept further with a nursing system being the nurses’ and patients’ relationships that are made up of actions to fulfill the self-care requirements. A nursing agency is people trained as nurses and provide required care (Shah et al., 2015).
Orem used theoretical definitions since the all terms are defined in relation to the nursing discipline and in a way that fits into the self-care theory. These concepts are used consistently throughout the self-care theory to explain the reasoning behind this theory (Shah et al., 2015). The concepts are subdivided further and thoroughly analyzed in relation to the theory. However, in some instance, there are unclear boundaries among the concepts. It is also important to note that the definitions of these concepts are explicit, whereby nothing is left to be implied. For instance, in the definition of nursing system and nursing agency as explained above. Also, during the formulation of this theory, a number of assumptions were made. The theory assumed that nurses perform nursing services in order to serve others. It assumed that people are both capable and willing to care for themselves and other people who depend on them. The theory assumed that health, human development, and well-being are dependent on self-care and hence a necessity in people’s lives. Thus resulting in the definition of self-care as a function that every person must perform for themselves so that they can maintain their lives which includes individuals learning practical and intellectual skills in order to sustain themselves. The self-care theory is still referred to date and has acted as a guide in my work as a dialysis nurse whereby patients are encouraged to care for themselves as well as receive necessary treatments.
Orem, D. (2001). The Nurse Theorists: 21st-Century Updates—Dorothea E. Orem. Nursing science quarterly, 14(1), 34-38.
Shah, M., Abdullah, A., & Khan, H. (2015). Compare and Contrast of Grand Theories: Orem’s Self-Care Deficit Theory and Roy’s Adaptation Model. International Journal of Nursing, 5(1), 1834-1836.
Swain, C. (n.d.). The Concept of Self-Care Deficit in Nursing Practice and Beyond: Part One. Retrieved from http://cjswain94.weebly.com/self-care-deficit-part-one.html
The University of Tennessee at Chattanooga School of Nursing Faculty & Students. (2016). Theory Based Nursing Practice (TBNP). Retrieved from http://www.utc.edu/nursing/pdfs/classes/orem-handbook.pdf