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July 31, 2013

Essay on Dorothea Orem

                                                           Dorothea Orem

 Dorothea Orem, born in Baltimore in 1914, is considered to be the foremost proponent of a groundbreaking nursing theory known as self-care deficit theory. Her theory is still recognized as one of the most widely used and recognized one. During her time, nursing was merely based on the conceptualized models derived from medicine, psychology and sociology. She started her career as a staff nurse in different clinical settings. While serving at Detroit hospital, she recounted that she did not possess substantial knowledge regarding the conceptualization of nursing.
  During her tenure at Indiana University, she realized the need for quality nursing in general hospitals across the state. She observed that nurses generally had difficulty in addressing the issues such as length of stay of patients, scheduling admissions, and discharges. These factors allowed her to view nursing in a completely new perspective.
    At this point, she set out seek answers of basic questions related to nursing such as what is nursing? What are the parameters of nursing as a field of knowledge and practice? Is nursing an art or completely a matter of science? Eventually, she located complete disarray in nursing education and practice mainly due to lack of proper framework.

       During her time, nursing was seen as less respectable plus the mass media did not play a significant role to burnish the image of profession. Unfortunately, it tarnished its already distorted image instead. In the early 1960s, nurses in films and popular culture were portrayed as being subordinate to Physicians with the exception of one TV show that was aired in 1962. Films such as Dr Kildare and Ben Casey are some pretty good examples of portraying nursing in less respectful terms. Precisely put, nurses were shown to be inferior to doctors and physicians. (Hartweg, 1997)
  On the whole, the media in Orem’s era ran amuck with the sex lives of nurses who were depicted as tall, thin blondes and as a symbol of desire for men. All in all, they were portrayed as promiscuous characters. The role of a nurse was reduced to mere pornography to say the least. The movies with titles like “Night call nurses” and “Deep Throat” made their way into the popular media. Orem strongly denounced such a portrayal of women as nurses. She called for the accurate portrayal of nurses strongly advocating equal rights for women.

      However, the only TV show that came out with an objective to put the role of nursing in a positive light did its job well. It served to propagate the positive nursing by showing nurses as identifying and addressing the problems instead of completely relying on the physicians.   Having to reflect upon all the questions that preoccupied her for a long time, the answer came to her as “flash of insight, and understanding of the reasons why self-care limitations in nursing prevented from receiving maximum care from this noble profession. She redefined nursing practices an art necessary to help ailing patients. The reliance on the scientific and technological aspects of nursing was less stressed.
      Nursing difficulties in Orem’s time were further compounded with gender politics that dominated the mid-nineteenth century. The predicament of nurses was marked by their struggle to find and enjoy an equal status at American hospitals. Naturally, it was much difficult for female nurses to cope with the fact the nursing was demeaned as women’s province.( Anne, 1997)
     The initial impetus for public articulation of the foundations and essential elements of the self-care deficit theory was the need to upgrade curriculums for practical nursing programs. In her own words, the self-care deficit theory was proposed as a solution to the problems of lack of conceptualization of rudimentary elements in nursing, isolation of nursing specific problems and the organization of knowledge accruing from research in problem areas.(Nursing Development Conference Group, 1973)   
      Self-care deficit nursing which Orem proposed was meant for rehabilitation and primary care in settings where the independence of a patient was strongly acknowledged. According to her self-care deficit takes place just when an individual is unable to deal with their own self-care requisites. In such a case, it is incumbent upon nurses to spot those deficits and define ways to support their patients. Orem’s theory is based on the principle of caring for person until he achieves optimum level of health and wellness.
      The cornerstone of Orem’s theory was her willingness to shift the focus from preventive health care to knowing exactly what nursing is in order to deepen and enlarge its meaning. In order to address the concept of health, Orem believed that the terms health and healthy are used to define living things and being healthy is a state of physical, mental and social wellbeing, not merely the absence of disease or infirmity.(Kalisch, 1987)
     She sees nursing as an art which is used to give expert assistance to suffering individuals. This is the most important principle for health care practitioners in order to address the regular and irregular needs of the patients.
       For her, environment plays a vital role in self-care. It includes biological and socio-economic factors such as atmosphere, pollutants, and weather conditions. While socioeconomic features of the environment relate to gender roles, age factor, cultural roles and responsibilities. She conditions the development of an individual by the tacit contribution of environment.
      She chalked out self-care requisites such as universal self-care requisites---the universal needs of human beings, developmental self-care requisites refer to maturational process or progress toward higher level of maturation. Situational requisites imply prevention of development related deleterious effects. Lastly, health deviation requisites are the needs that appear due to the condition of patient.
     Through this theory, her purpose to develop the self care framework was not to find the basic meaning of nursing but to develop a body of research-based nursing knowledge. She herself once stated that her work on theoretical foundations of nursing was an attempt to conceptualize nursing profession and practices which hitherto had not been discovered. The very idea to transform nursing into a structured discipline of knowledge lies at the heart of Orem’s theory.

Hartweg, D.L (1995) Dorthea Orem: Self-Care deficit theory. In C.M
Kalisch, P.A. Kalisch, B.J (1987), The Changing Image of Nurse, Menlo Park, Addison-Wesley Publishing Company.
Anne Marie Rafferty (1997) Nursing history and the politics of welfare, Routledge 283 pages
Dorothea, Elizabeth, Orem(1979) Concept formalization in nursing: process and product University of Michigan



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