Self-care deficit nursing theory

The self-care deficit nursing theory is a grand nursing theory that was developed between 1959 and 2001 by Dorothea Orem. It is also known as the Orem's Model of Nursing. It is particularly used in rehabilitation and primary care settings where the patient is encouraged to be as independent as possible. Orem died in 2007

Central philosophy

The nursing theory is based upon the philosophy that all "patients wish to care for themselves". They can recover more quickly and holistically if they are allowed to perform their own self-cares to the best of their ability.

Self-care requisites

Self-care requisites are groups of needs or requirements that Orem identified. They are classified as either:

• Universal self-care requisites: those needs that all people have
• Developmental self-care requisites
  • 1. maturational: progress toward higher levels of maturation.
  • 2. situational: prevention of deleterious effects related to development.
• Health deviation requisites: those needs that arise as a result of a patient's condition

Self-care deficits

When an individual is unable to meet their own self-care requisites, a "self-care deficit" occurs. It is the job of the Registered Nurse to determine these deficits, and define a support modality.

Support modalities

Nurses are encouraged to rate their patient's dependencies or each of the self-care deficits on the following scale:

• Total Compensation
• Partial Compensation
• Educative/Supportive

Universal Self-Care Requisites (SCRs)

The Universal Self-Care Requisites that are needed for health are:

• Air
• Water
• Food
• Elimination
• Activity and Rest
• Solitude and Social Interaction
• Hazard Prevention
• Promotion of Normality

The nurse is encouraged to assign a support modality to each of the self-care requisites.

Example nursing assessment

This patient is entirely fictitious and any likeness to any person, alive or dead, is purely coincidental.

'J' is a 60-year-old female who has just been diagnosed with Hypertension. She has Diabetes Mellitus, and smokes 2 packs a day.

• AIR: Educative/Supportive - Provide education on associated with HTN patient.
• WATER: Educative/Supportive - Ensure access to adequate hydration is given but not enough to cause fluid overload.
• FOOD: Partial Compensation - Education and an assigned diet that is suitable for her dx of HTN.
• ELIMINATION: Educative/Supportive - May require monitoring.
• ACTIVITY AND REST: Educative/Supportive - Educate patient as to the benefits of cardiovascular exercise, especially for HTN patients.
• SOLITUDE AND SOCIAL INTERACTION: Partial Compensation - Nurses may provide social interaction as hospital admission will cause changes in social behavior and interactions.
• HAZARD PREVENTION: Partial Compensation - Nurses will need to educate regarding the medication that she may be taking and administer this medication initially. Particularly relevant if J is taking insulin injections.
• PROMOTE NORMALITY: Partial Compensation - Nurses will need to facilitate a return to normal lifestyle. This will involve advocating for the patient in a multi-disciplinary team in order to achieve a medication regime that will fit with the patient's life.

References

References Dorothea Orem's Self-Care Theory

Dorothea Orem's Self-Care Deficit Nursing Theory

Hartweg, Donna (1991). Dorothea Orem: Self-Care Deficit Theory. Notes on Nursing Theories 4. Sage Publications. p. 1. ISBN 0803942990

Renpenning KM, SozWiss GB, Denyes MJ, Orem DE, Taylor SG. Nurs Sci Q. 2011 Explication of the nature and meaning of nursing diagnosis.Apr;24(2):130-6. doi: 10.1177/0894318411399451

Orem DE, Taylor SG.Nurs Sci Q. 2011 Reflections on nursing practice science: the nature, the structure, and the foundation of nursing sciences.Jan;24(1):35-41. doi: 10.1177/0894318410389

Medical Archives of the Johns Hopkins Medical Institutions Dorothea Orem Collection