Dorothea Orem’s self-help deficit model is based on the principles of self-care (self-help), which Orem defines as activities for the preservation of life, health, and well-being that people start and carry out independently. At the same time, she pays great attention to nursing care in the prevention of diseases, injuries, and training. Dorothea Orem attaches great importance to a person’s responsibility for maintaining their health.
The theoretician determined several basic assumptions of the model. The first one refers to a human’s ability to function rationally and communicate with people in the selected environment. The other principle presumes that when a person learns to act on their own, they exercise to identify actual needs (Orem, 1991). Additionally, Orem (1991) elaborated on the derivations related to self-care and the human will, which manifests itself in the discovery, development, and transfer to others the methods of identifying needs and contributing to oneself and others. Finally, structured groups of individuals are capable of allocating responsibilities carefully to provide high-quality care.
Self-agency is defined as a set of acquired skills that allow for meeting constant care needs, thanks to which life processes are regulated (Younas, 2017). Meanwhile, the structural and functional independence of a person in society is maintained, and their development is carried out. The ability to be independent, in other words, to walk independently, is determined by the amount of knowledge, motivation, and practical experience that allows healthcare professionals to judge a person’s ability to be independent.
She connects the concept of the ability to walk independently with various mental, physical, and mental characteristics of a person, believing that these abilities develop partly spontaneously during self-walking in everyday life, partly during training. The limitation of the possibility of independent walking is defined as an imbalance between the ability to walk independently and the need for therapeutic independent walking (Orem, 1991). The impossibility of self-care is an extreme manifestation of the limited possibility of self-help.
According to Orem (1991), the self-care deficit theory is a description and justification of the need for nursing care in a specific case when the ability to self-care is less than the need for therapeutic self-care. In other words, when a person is unable to carry out the necessary self-care in full, someone else (for example, relatives) should take over its implementation. In cases where neither the individual nor his relatives can carry out this care, it becomes the nurse’s competence.
The patient is considered a single functional system with motivation for self-withdrawal. An individual takes care of themselves regardless of whether they are healthy or ill, meaning that their capabilities and needs for self-care must be balanced (Scott, 2018, p. 14). It presumes that self-agency is an innate ability of a human to meet their own needs. D. Orem divides the needs for self-care into three groups:
- Universal: sufficient air intake; adequate fluid intake; sufficient food intake; sufficient ability to excrete; maintaining a balance between activity and rest; time alone, balanced with time spent in the company of other people; prevention of dangers to life, normal functioning, and well-being; the desire to correspond to a particular social group (social status) following individual abilities and capabilities.
- Related to the stage of development (from birth to old age).
- Health-related disorders that lead to changes: anatomical, physiological, as well as behavior and lifestyle.
Nursing is the art by which a nurse practitioner provides specialized care to disabled people, doing more than the usual care needed to meet self-care needs; the nurse is assigned the role of a teacher. Ali (2018) stated that a nurse “allows the patient to know, to identify, and to help them meet their therapeutic self-care demands by developing their self-care agency” (p. 2). It means that they should teach the patient, following his capabilities, to take care of themselves. They also have a controlling position when monitoring how well the person is adapted to their new habits. The nurse needs to make sure their patients have positive health outcomes in the end.
A professional, according to D. Orem, should determine the main directions of nursing intervention. To do this, it is necessary to identify the lack of self-care needs and establish its causes. The nurse must find out what the patient needs, what they cannot do on their own, and what difficulties they have in taking care of themselves (Alligood, 2021, p. 200). When determining the need and direction of nursing care, the nurse must; first, determine the level of the patient’s self-care requirements. Everyone has their ideas about self-agency; the criteria for self-agency are different. Secondly, according to D. Orem, assessing the patient’s ability to meet these requirements correctly is necessary (Orem, 1991). Thirdly, it is also required to determine the degree of safety for the patient when performing self-service. And finally, it is essential to see the prospects of recusal in the future.
Health is defined as a state of being functionally and structurally sound. It also presumes that one must realize the need for self-care, communicate with others, and reflect on their health. The environment stands for chemical, physical, and biological aspects, including family, culture, and community. The result of the provision of medical care should be the achievement by the patient of an optimal level of self-help (Ali, 2018, p. 3). Even if the nurse has switched from a fully compensating care system to a partially compensating one that supports the patient during self-withdrawal, the nurse’s intervention can be considered adequate. Thus, nursing care can be aimed at expanding self-service opportunities and changing the needs for recovery.
Dorothea Orem believes that every person should have a balance between the need for self-help and the ability to manifest it. Having determined the therapeutically necessary behavior during self-withdrawal during injury or illness or after surgery, the nurse, together with the patient, determines the method and type of nursing intervention. This is reflected in the work of nurses in surgical and therapeutic departments. Such assistance is necessary for patients in trauma departments, working with disabled people, and others. According to the model, Orem defines therapeutically necessary behavior during independent walking and determines the balance between needs and opportunities for independent walking (Alligood, 2021, p.199). By conducting an initial examination of the patient’s condition in a medical institution, the nurse determines whether her intervention is necessary and whether her help is needed in self-help.
When applying this theory to the chosen case, it is primarily vital to view the metaparadigm. The patient is Janice, a 22-year-old university student admitted to a surgical unit after a colectomy and temporary ileostomy. Janice has two siblings and her parents are divorced. She is a full-time university student in an engineering program but is currently on a leave of absence due to health problems. Noteworthy, Janice smokes one pack of cigarettes a day and occasionally drinks.
The patient had issues with her bowel since the age of 19 and recently has had her first surgical intervention. Janice has decided to have her first surgical intervention – colectomy and temporary ileostomy. The decision was made because of recurrent flare-ups; she also could not manage the pain any longer.
When it comes to nursing – there is not much to state since the case does not specify the nurse’s role in her recovery process. However, hypothetically, the nurse should teach Janice how to cope with her condition in terms of the self-care deficit model. A nurse should develop a plan of action which will be discussed below.
The environment she resides in seems regular – she lives with her mother, occasionally sees her father because her parents are divorced, and has a long-term relationship with her boyfriend. Janice likes attending the gym when she feels healthy and doing yoga which gives her spiritual support. In addition, she seems to receive sufficient support from her family and boyfriend which keeps her sustain more or less stable condition.
Theoretician’s Approach to Treating Janice
Within the framework of the chosen scenario, a theorist could approach Janice’s situation by collecting information about the patient. It presumes that a nurse should gather as much personal data as possible to assess possible interventions. Apart from the environmental factor, one should make sure the patient has enough self-care requisites, including air, water, food, level of activity, rest, social interaction, and others. It is expected that based on these indicators, a nurse will be able to establish if an individual lacks self-care. For example, Janice has a high level of self-awareness, yet she may quickly get down because of her condition. What is more, she is suffering from poor appetite, which presumes her daily diet should be monitored strictly. Since Janice lives with her mother, this issue can be eliminated. However, the patient should be trained to eat regularly despite the disease for better digestion and general well-being.
Moreover, when considering the medical condition, a patient must stick to taking the prescribed drugs to maintain balance. It also presumes that Janice needs to regularly check up with her doctor to identify the fluctuations in her health. When this condition is followed, a nurse may be sure there is no self-help deficit in providing medical assistance. Hence, adherence to medical regimens bears importance to positive health outcomes.
Furthermore, a nurse must assess the patient’s self-image, which presumes the perception of oneself. Janice has a fighter spirit, yet she is tired of her disease and wants to give up. In this case, a nurse should ensure the people around Janice fully support her and do everything possible to protect her from mental damage. Moreover, it is indispensable to instill a sense of faith in Janice so that she believes in her future recovery. Apart from that, Janice herself needs to accept her condition and take it as something easy to get over. She needs to realize that disease does not impede a happy future.
Since Janice pays much attention to her mental state by doing yoga, it is recommended that a nurse suggest other similar activities to sustain her psyche. Noteworthy, Janice is responsible for keeping fit and attends the gym three times a week when the disease does not bother her. Her sleeping regimen also seems decent because she gets normal eight-hour sleep. Despite her feeling down sometimes, she still manages to apply self-care methods aimed at recovery.
On the other hand, there is a significant issue with keeping a balanced diet. In case Janice cannot provide a healthy diet, a nurse may offer to visit a nutritionist or try to compile a list of products for her patient. Additionally, her parents, siblings, or boyfriend may encourage Janice to eat in a balanced way. In general, when a nurse contributes to the development of physical, psychological, and other aspects of a patient’s life, the health outcomes are likely to improve.
Ali, B. (2018). Application of Orem self-care deficit theory on psychiatric patient. Annals of Nursing and Practice, 5(1), 1-3.
Alligood, M. R. (2021). Nursing theorists and their work e-book. Elsevier Health Sciences.
Orem, D. (1991). Nursing: Concepts of practice. (4th ed.). In George, J. (Ed.). Nursing theories: the base for professional nursing practice. Appleton & Lange.
Scott, B. (2018). Transitioning from RN to MSN: Principles of professional role development. Springer Publishing Company.
Younas A. (2017). A foundational analysis of Dorothea Orem’s self-care theory and evaluation of its significance for nursing practice and research. Creative nursing, 23(1), 13-23. Web.