The purpose of this paper is to inform the reader how Dorothea Orem's nursing theory has been used in research. Orem begin developing her theory in the 1950's, a time when most nursing conceptual models were based on other disciplines such as medicine, psychology and / or sociology (Fawcett, 2000). Orem's theory is a three-part theory of self-care. The three theories that make up the general theory are: Self-Care, Self-Care Deficit, and Nursing Systems. The Self-Care theory states that adults deliberately learn and perform actions to direct their survival, quality of life, and well-being. Self-Care Deficit theory states that nursing is required because of the inability to perform self-care as the result of limitations.
Nursing Systems theory is the product of nursing in nursing system (s) by which nurses use the nursing process to help individuals meet their self-care requisites and build their self-care or dependent-care capabilities. These three theories form the overall Self-Care Deficit Theory. (Alligood & Tomey, 2001) Self-Care Deficit Nursing Theory (SCDNT) is an important component of nursing's theoretical knowledge. It is a highly developed and formalized theoretical system that includes the philosophical foundation, the general theory of nursing with its constituent elements, and an expanding body of knowledge that includes empirical research.
The conceptual structure of SCDNT is constituted from six core concepts (self-care, therapeutic self-care demand, self-care agency, self-care deficit, nursing agency, nursing system, and one peripheral concept -basic conditioning factors. (Taylor, Geden, Isaramalai &, Wongvatunyu, 104) The capacity and ability of the individual to engage in self-care is termed self-care agency (SCA). The Therapeutic Self-Care Demand (TSCD) and SCA are influenced by a number of factors or variables referred to as basic conditioning factors (BCFs). The self-care system is an action system designed in response to the TSCD and is dependent on the quality of the individual's self-care agency. (Geden & Taylor, 329) The first article we reviewed was titled An Empirical Test of a Self-Care Model of Women's Responses to Battering. Battering was conceptualized with Orem's theory as a situation requiring therapeutic self-care.
Based on Orem's theory of self-care deficit a model of women's responses to battering was constructed. This model proposes that age, education, income, and cultural orientation are BCFs that directly related to relational conflict. This conflict would be negatively related to self-care agency and indirectly related to both outcomes of health and well-being. The proposed model suggests that the degree of relational conflict experienced by a woman in a battering situation is directly related to her ability to care for herself. Both frequency and severity of conflict and self-care agency were expected to influence the relationship of the BCF with health outcomes. Health and well-being were deduced as being related to self-care.
Self-care agency is thought to be related to the same outcomes as self-care. Knowledge from prior testing of Orem's self-care deficit theory, particularly related to the conceptual entities of self-care agency, health, and well-being, provided additional scientific support for formulating the hypothesized relationships among the variables. The endogenous variables are identified as health and well-being. These variables are hypothesized to be positively related to self-care agency alone. (Campbell & Weber, 45) The final derivative model structure was different from that originally proposed. The theoretical base of the original model was an effort to extend Orem's self-care deficit theory of nursing with the inclusion of relational conflict.
Relational conflict was placed between the BCF's of age, education and culture, and self-care agency. Self-care agency was proposed to affect both well-being and health. In the final analysis, self-care agency explained 9% of the variance in the final model, with relational conflict explaining 39.9% and health, 51%. The BCF's age and education affected self-care agency which directly influenced health. (Campbell & Weber, 51) Orem's model is supported by these findings in terms of self-care agency having an effect on health.
There was a strong correlation between a measure of the power components of self-care agency and self-esteem. This supported Orem's description of self-care agency as structurally consisting of foundational capabilities, power components, and capabilities for self-care operations. (Campbell & Weber, 45). However, for abused women, the relationship problems had a stronger effect on their physical and mental health then their ability to take care of themselves. The derivative model also supported relationships between basic conditioning factors and self-care agency as proposed by Orem.
(Campbell & Weber, 52) The next article we reviewed was Theoretical and Empirical Description of Adult Couples' Collaborative Self-Care Systems. This article was a descriptive study of a collaborative care system (CCS) using Orem's Self-Care Deficit nursing theory. CCS is an action system. Inherent in the CCS is a concept of shared work resulting in negotiated roles for integrating and performing actions to meet the requirements for care. The negotiation includes the identification of Therapeutic Self-Care Demands (TSCD's). The CCS comprises the interaction of the individuals's elf-care systems.
Whereas the TSCD and self-care agency can be described for each individual, the action system in a CCS is less open to such individual analysis. The CCS is described by measuring the capabilities of the adults for self-care and their estimates of the other's capacity to care for self. (Geden & Taylor, 329-330) BCF's measured were cohesion, adaptability, age, reciprocity, self-reported estimate of health in general, and self-reported estimate of health at this time. The study hypothesized that the couple's family system score would predict the couple's CCS and that their ages and estimates of health in general and health at this time, as well as estimates of caregiver reciprocity, would add to the explanation of the couples CCS. Cohesion in the family, dyad gender, and the couple's estimate of their health now accounted for 27% of the variance in the couple's CCS. Caregiver reciprocity scores, age, and estimates of health in general failed to make a significant contribution to the statistical model.
In this study several shortfalls were noted, but it was proven that there was congruence between the data analyses and theoretical model. (Geden & Taylor, 331&334) The last article reviewed was Research-Based Evaluation of Conceptual Models of Nursing. This article reviewed the research done to date on Orem's self-care deficit nursing theory. The authors identified 143 studies and 66 of the studies were used in this review. The article discusses philosophical perspective, Ontology of Orem's Theory, Epistemology, Practical Science and Models and Theories.
The authors used an electronic search using six databases. The subject and key terms used were Orem's self-care model. A total of 143 journal articles were identified as using Orem's self-care deficit nursing theory. Sixty-seven of the articles were dropped because self-care theory was used only as an organizing framework or a rational for the research or because a general definition or concept of self-care was used for the study. The remaining 66 articles were synopsize d using the theoretical elements, unit of analysis subject characteristics, instruments used, and research method used.
The intent was to identify contributions and trends. (Taylor et al., 107) The study concluded that less than half examined elements of the theory of self-care without making the link to nursing practice an explicit part of the study. Studies like these increases our knowledge about self-care but further work is needed to put the results of these in the context of nursing practices. Most of the studies provided an enhanced or broader description of an element or component of the theory, empirically describing the relationship between or among age, gender, self-care actions, disease, and so forth. These studies add to our understanding of existing and known or proposed relationships within the extant theory. There are many studies but little evidence that sustained research program are developing and expanding the theory.
(Taylor et al., 108) In conclusion I use an excerpt from Ms Orem from a newsletter of the International Orem Society for Nursing Science and Scholarship. "The task of nursing science development may appear overwhelming. However, the vast and accumulation of subject matter in nursing could be examined for its location within the domain and boundaries of nursing or its location in the basic sciences and then examined for its validity and reliability in its reflection of human nature and in its value in guiding nursing practice. This would be accompanied by its allocation to one of the suggested nursing sciences or to its elimination.
This form of scholarly activity has been engaged in be scholars and researchers in other fields, at some stage of development of their sciences". (Nov, 2000) Reference Alligood, R.A., and Tomey A.M. (2002). Nursing Theory: Utilization & Application (2nd Ed.) St. Louis: Mosby. Campbell, J., and Weber, N. (2000). An Empirical Test of a Self-Care Model of Women's Responses to Battering.
Nursing Science Quarterly, 13: 1, 45-53. Fawcett, J. (2000). Analysis and Evaluation of Contemporary Nursing Knowledge: Nursing Models and Theories. Philadelphia: F.A. Davis Company. Geden, E., & Taylor, S. (1999).
Theoretical and Empirical Description of Adult Couples' Collaborative Self-Care Systems. Nursing Science Quarterly, 12: 4,329-334. Orem, D., Online (2000). International Orem Society Newsletter. web S.G., Geden, E., Isaramalai, S., and Wongvatunyu, S. (2000).
Orem's Self-Care Deficit Nursing Theory: Its Philosophic Foundation and the State of the Science. Nursing Science Quarterly, 13: 2, April 103-110.