Orem's Self-Care Deficit Theory There are several grand theories of nursing, and among them is Orem's self-care deficit theory. This theory is predicated a set of assumptions, including that people are distinct individuals, that they should be self-reliant, that a person's knowledge of potential health problems is necessary for promoting self-care behaviors, and that nursing is a form of action. The movie Awakenings can be used as an example of how this can be applied even to the most difficult of nurse-patient interactions.

Orem's Self-Care Deficit Theory

Dorothea Orem was a staff nurse, and later moved onto educational positions within nursing. She developed her concept of self-care deficit theory to explain nursing in terms of a key interpersonal relationship between nurse and patient, where the nurse helps the patient to take care of him/herself. The underlying assumptions are that the patient is a distinct individual, and should be self-reliant. It is insufficient for a patient to simply rely on medical professionals for their health. The patient should have knowledge of his/her own health problems, and understand what they can do to address those. Understanding the issues helps the patient with self-care. Orem believed that self-care or dependent-care are learned behaviors, and that nurses can play a role in creating patients who are better able to take care of themselves. Prevention is a critical element of care in this theory.

Nursing, therefore, is a helping service. The goal of nursing is to "render the patient or members of his/her family capable of meeting the patient's self-care needs" (CurrentNursing.com, 2016). Ideally, this will help the patient to regain normal function following illness or injury, and to minimize the effects of the illness or injury. One of the roles that nurses play is to take patients who are incapable of caring for themselves and getting them to a state where they are capable of self-care. This occurs through deliberate, purposeful action on the part of the nurse, including educating the patient (CurrentNursing.com, 2016).

Staff Nurse

The staff nurse under Orem's theory should focus on educating the patient and the patient's family with respect to self-care. Health care in this theory has a strong preventative element, so the nurse must educate patients about how they can take care of themselves better, to avoid making trips to the medical system. The nurse would highlight ways to change diet, exercise, medications and other techniques to make the patient more independent. The more independent the patient, the better they will feel, and this should also have positive health impacts.

The staff nurse may be limited in the sense that they often do not specialize. Where a specialist nurse will be in a better position to offer condition-specific advise to patients, there is still a role that staff nurses can play in terms of more general information, and in assisting the clinical nurse specialists in helping the patients with certain elements of self-care education and training.

Nurse Manager

The nurse manager is responsible for ensuring that the resources are available to staff and advanced practice nurses to perform their educational roles. For example, nurses who educate patients under Orem's theory are going to spend a fair amount of time with each patient. As a result, the nurse manager needs to ensure that this time is available -- otherwise nurses will not be able to genuinely help patients if they are rushed and harried all the time. Moreover, the nurse manager must be responsible for whatever teaching materials are being used, for ensuring that nurses are properly trained so that they give good advice, and must conduct follow-up as well. The nurse manager therefore plays an important role in removing roadblocks and difficulties that can prevent nurses from educating patients effectively on self-care.

Advanced Practice Registered Nurse

The clinical nurse specialist will have a particular specialty, thus working with patients who have more or less the same condition....

This allows the nurse to build a strong body of knowledge with respect to self-care, and the different issues that patients face in building their independence. As such, the clinical nurse specialist is in a unique position of holding a very high level of knowledge and having access to the patient. This is a role that is very well suited to the application of Orem's theory because of the specialization aspect. A specialist may not be able to help with other conditions, but within his/her own speciality should be an exceptionally useful resource for patients and their families.
Discussion

Awakenings provides an interesting framework for this theory because the patients in the movie are initially catatonic. As such, they are not the autonomous beings capable of self-care that Orem assumes patients to be. Thus, during their catatonic state, there is only room for limited application of this nursing grand theory to such patients. The nurses do not attempt to apply Orem's theory because the patients are not conscious. However, the physician in the movie does apply the concept that each patient is a unique individual. The doctor tries a number of ways to reach the patients and in doing so finds different things that work for each patient. This is a positive application of one of the assumptions.

When the patients begin their awakenings, they first must adapt to the world. The role of the nurse is seen in different ways. For example, in one scene Miriam is running from a nurse who wants to take her blood pressure. This highlights the difficulties that a nurse can face when dealing with patients who are unable to look after themselves. The nurse in this situation can only help so much. Other patients also demonstrated challenging situations. Rose wanted make up and hair dye, or when Frances did not like the trees and wanted them pruned. The nurses served as caregivers in these scenes, working with the patients to the best of their abilities, in these instances to help the patients cope with the realities of waking up in this different world. The patients were struggling, and during this part of the movie the nurses had to not only care for these patients, but to help the patients to improve upon their ability to care for themselves. This was ultimately to prove futile as the patients reverted to catatonia, but prior to that point the nurses were taking the view that they had to prepare these patients for eventual re-integration into society.

The movie in that way highlights one of the challenges in Orem's theory, that patients sometimes are dependent. Rhodes et al. (1988) describe a scenario where patients report tiredness and weakness as the result of cancer treatment. These patients for the most part would like to be able to care for themselves, but they are unable to because of the fatigue associated with their treatment. The nurses worked with the patients, and their families, but ultimately there are limits to self-care. The movie highlights another situation where self-care deficit theory is only somewhat applicable, but when the patients are catatonic is not applicable.

Orem's theory holds mainly when the assumptions are met. While Orem assumed that patients are inherently independent, there are many situations where that condition simply does not hold. When people are not independent, they may not be able to care for themselves no matter how much effort the nurses make. That is the situation illustrated in the movie, and it occurs with a lot of very sick or very elderly individuals in the real world as well. At that point, motivating the families is an important element in self-care, because the families at least should contribute to this care.

Conclusion

Orem's Self-Care Deficit Theory is better applied to patients who are conscious, unlike the ones in the movie, who are mainly in a catatonic state. However, there are some lessons to be learned from Awakenings, in particular with respect to the ability of nurses to help people as they recover, and with respect to treating all patients as unique individuals. It is important to keep in mind that the self-care deficit theory is valuable for most patients to prevent chronic ailments and conditions, if people learn more about the things that they need to do to keep healthy and manage whatever conditions that they might have. For the patients that awakened, they often struggled with their situations, and were incapable of caring for themselves. The nurses sought to help them in this regard, and by doing so were to influence their quality of life, demonstrating the validity of Orem's Self-Care Deficit Theory.

Empowering patients lies at the center of this philosophy, and while it cannot always be applied, there is enough evidence to suggest that such preventative measures can be quite powerful. Nurses following this theory benefit from specialization, so that they know a lot about dealing with particular conditions, can educate patients suffering multiple conditions. Nurse managers need to provide a high level of support and leave nurses with enough time to work with patients under this theory; nurses who are too rushed will not be able to effectively help patients learn about self-care. Self-care philosophy…