NURSING THEORIES

Dororthea E. Orem: Self – Care Deficit Theory of Nursing

Dororthea E. Orem, MSNEd, DSc, RN was born in 1914 in

Baltimore, Maryland. She began her nursing education at
Providence Hospital School of Nursing in Washington, DC.
After receiving her diploma in early 1930s, she earned her BS
Nursing education in 1939 and her Master of Science in
nursing education in 1945 from the Catholic University of
America.

The focus on the general theory of Orem is the absence of the

ability to care for one’s self or self-care deficit and how this
condition validates the existence of nursing. The Self-Care
Deficit Theory of Nursing is composed of 3 interrelated theories which are the Theory of Self-
Care, The Self-Care Deficit Theory, and the Theory of Nursing System. Incorporated within and
supportive of these theories are six central concepts of self-care, self-care agency, therapeutic
self-care demand, self-care deficit, nursing agency, and nursing system, as well as the peripheral
concept of basic conditioning factors.

As stated by Orem, nursing is needed when self-care demands exceed that of self-care abilities.
Nursing systems are designed by the nurse when it has been determined that nursing care is
needed. The systems of wholly compensatory, partly compensatory, and supportive-educative
specify the role of the nurse and the patient (Orem & Taylor, 1986)
Person: Individuals are an integrated whole composed of an internal physical, psychological and
social nature with varying degrees of self-care ability.

Health: Health and healthy are terms to describe living things according to Orem, they are
structurally and functionally whole or sound, includes that which make a person human, she
defines health as "a state of physical, mental and social sell-being, and not merely the absence of
disease or infirmity”.

Nursing: According to Orem Nursing is an art through which the practitioner of nursing gives
specialized assistance to persons with disabilities that needed greater than ordinary assistance to
meet the daily needs for self-care. It consists of actions deliberately selected and performed by
nurses to help patients under their care to maintain or change conditions in themselves or their
environment.

Environment: Environment according to Orem, is the surrounding of the patients may affect their
ability to perform their selfcare activity. Includes two dimensions a. physical, chemical, biologic
features and socioeconomic features.

Application:

This theory can be applied to our patient’s condition, because the theory of Self-Care deficit can
be applied religiously. The client is unable to perform certain self-care needs because of his
current condition. Activities such as cleaning oneself and one’s surrounding are some of the
activities the patient are currently unable to do. Furthermore, his self-care agency is also
affected by the basic conditioning factor of health these aspects the patient has an increased
therapeutic self-care demand and the requirement of a nurse is greatly needed.

Jean Watson: Theory of Human Caring

Jean Watson’s theory was developed between 1975-1979, while

engaged in teaching at the University of Colorado; it emerged
from my own views of nursing, combined and informed by my
doctoral studies in educational-clinical and social psychology. It
was my initial attempt to bring meaning and focus to nursing as an
emerging discipline and distinct health profession with its own
unique values, knowledge and practices, with its own ethic and
mission to society. The work also was influenced by my
involvement with an integrated academic nursing curriculum and
efforts to find common meaning and order to nursing that
transcended settings, populations, specialty, subspecialty areas, and so forth. From my
emerging perspective, I tried to make explicit nursing's values, knowledge, and practices of
human caring that are geared toward subjective inner healing processes and the life world of the
experiencing person, requiring unique caring-healing arts and a framework called "carative
factors," which complemented conventional medicine, but stood in stark contrast to "curative
factors." At the same time, this emerging philosophy and theory of human caring sought to
balance the cure orientation of medicine, giving nursing its unique disciplinary, scientific, and
professional standing with itself and its public.
Person: According to Watson, a person has three dimensions of mind, body and soul, and is in
fact an embodied soul on its way to becoming. Therefore, the spiritual dimension of a person has
a higher value in the Human Caring Theory. A person is a being whose wholeness is valuable
and deserves respect, assistance and care

Health: Watson defines health as harmony of the body, mind and soul; as a high level of
physical, mental and social performance; and absence of or an attempt to eliminate diseases.

Nursing: Watson interestingly applies a mystical meaning to the spiritual linkage of two persons
(a nurse and a patient) engaging in a caring experience.

Environment: In Watson’s Theory, there is great emphasis on a caring and healing environment,
which can be provided by a nurse according to the existing literature. The internal and external
factors that can help a person actualize his or her inner power of self-healing are called the
environment.

Application:

The patient’s condition would affect his capabilities in doing activities of daily living. With the
minimal movement he can do and the symptoms he is currently experiencing, assistance from the
group was highly needed by the patient. In addition, with the current situation of the patient he is
not experiencing the harmony of his body mind and soul that is essential and was highlighted in
Human Caring Theory of Watson.
Lydia E. Hall: Care, Core, Cure

Lydia E. Hall received her basic nursing education at York

Hospital School of Nursing in Pennsylvania. Both her BS in Public
Health Nursing and MA in teaching Natural Sciences are from
Teachers College, Columbia University, New York. Lydia Hall
was the first director of the Loeb Center for Nursing and
Rehabilitation and continued in that position until her death in
1969.

Lydia Hall’s theory involves three interlocking circles that

represents one aspect of nursing. The first circle is the care aspect.
The care aspect represents intimate bodily care of the patient. The second circle is the core
aspect. This aspect illustrates the innermost feelings and motivations of the patient. Finally, the
last circle is the cure aspect. This aspect deals with how the nurse aid the patient and family
through medical facets of care. The main tool the nurse uses to help the patient realize his or her
motivations and grow self-awareness is that of reflection.

Hall’s theory defines Nursing as the “participation in care, core and cure aspects of patient care,
where CARE is the sole function of nurses, whereas the CORE and CURE are shared with other
members of the health team.” The major purpose of care is to achieve an interpersonal
relationship with the individual that will facilitate the development of the core (Hall, 1964).
Person: The individual human who is 16 years of age or older and past the acute stage of a long-
term illness is the focus of nursing care in Hall’s work. The source of energy and motivation for
healing is the individual care recipient, not the health care provider. Hall emphasizes the
importance of the individual as unique, capable of growth and learning, and requiring a total
person approach.

Health: Health can be inferred to be a state of self-awareness with conscious selection of

behaviors that are optimal for that individual. Hall stresses the need to help the person explore
the meaning of his or her behavior to identify and overcome problems through developing self-
identity and maturity.

Nursing: Nursing is defined as the function necessary to carry out care, core, cure. The aspect of
Care is the sole function of nurses. Core and Cure are shared with other medical members of the
health care team. Nursing is identified as consisting of participation in the care, core, and cure
aspects of patient care.

Environment: The concept of society or environment is dealt with in relation to the individual.
Hall is credited with developing the concept of Loeb Center because she assumed that the
hospital environment during treatment of acute illness creates a difficult psychological
experience for the ill individual. Loeb Center focuses on providing an environment that is
conducive to self-development. The focus of the action of the nurses is the individual, so that any
actions taken in relation to society or environment are for assisting the individual in attaining a
personal goal.

Application

The application of this theory lies heavily on the Care aspect of nursing. The Care used by the
group focused on providing comfort, care, and health education to the patient. Moreover, the
group also included educating the patient regarding diet, lifestyle, and the importance of his
maintenance of well-being. Using the Core factor of the theory, the group together with the
patient aided him in setting a goal for himself regarding the improvement of his condition.
Though this proved to be difficult because the patient showed certain resistance, the group
focused on the social, emotional, and intellectual needs of the client in relation to his condition to
understand and empathize where his resistance is coming from. Finally, the application of this
theory also used the Cure aspect of the Care, Core, Cure. The student nurse assigned to the
patient is the one who administered health teachings. The aspect however is shared with other
health professionals so the focus on the Cure aspect was less compared to the Cure.