The Theory of Nursing


Healthcare in the twenty-first century is facing demands that are not only financially restrictive but also greatly influenced by intervening variables such as increased lifespan, an awareness of advanced treatment programming, and better quality of life. Unfortunately, however, with better health care there exists a void in the availability of trained professionals who are qualified to provide the necessary medical service, specially trained nursing professionals who are trained in, and receptive to, patient interaction in healthcare. In fact, according to Buerhaus (2000) by the year 2020, there will be a 40% shortage of required nursing professionals. Being a nurse in the twenty-first century will undoubtedly become more complex and demanding than in preceding decades. With the advent of even greater technology, higher medical costs, and other better paying professional careers available, the nursing community requires an immediate infusion of interest, compassion, understanding, and acknowledgment for the services their profession provides. The remainder of this paper will examine the structure and purpose of one nursing theory applied to a particular cultural group and one specific problem of that group, namely, the elderly and depression. Both of these situations have been identified as being more relevant than evaluating the nursing theory from a broad-based point of view. The report will pay particular attention to the Orem self-care theory and its usability in dealing with elderly patients.

  Orem Self Care Theory.

Growing old in America is not generally thought of as a gentle process, rather one fraught with higher medical costs, rising inflation, and familial separation and loneliness. Unfortunately, the elders in our society are oftentimes forgotten, seldom revered, and generally not appreciated. As a result, depression is rampant amongst the elderly. According to Orem (1995) self-care in dealing with patients is pivotal to the health and well being of the individual being treated – both on a preventative and long-term basis. Unlike the physician-centered model the Orem self-care deficit model stresses patient participation in all phases of wellness. The end result is, of course, the development of a healthy lifestyle – one that is self-motivating (Steiger & Lipson, 1985). Further, self-care regimens, according to authors such as Padula (1992) and Resnick and Daly (1998), are self-initiating, purposeful, and planned. The remainder of this report will, therefore, center around Orem’s self-care deficit model wherein the focus is on a patient’s continued independence and proactive involvement in self-care.

According to Orem (1995, 2003) an individual’s health and well-being is a function of one’s ability to meet one’s health and developmental needs; and because everyone is responsible for their own life, all individuals are capable of fulfilling their goals and ambitions. Unfortunately, however, a web of influences can disrupt the positive flow of individual wellness. Such influencing factors are a professional lack of awareness by nurses of a patient’s health beliefs, a lack of appreciation for a patient’s cultural diversity, and the inability to listen to a patient’s problems (physical and psychological), goals, desires, beliefs, practices, and worldviews.

Although Orem is point specific with reference to health-promoting behavior she fell short of including a significant nursing characteristic that is vital in the facilitation of an elderly patient’s self-care program, namely reflective thinking. Without reflective thinking, a self-care program for the elderly can be fraught with unwanted influences and result in an elderly patient becoming depressive. Therefore, prior to a discussion on preventing depression amongst the elderly visa via self-care programming, it is necessary to have a clear idea as to what constitutes reflective thinking and its relationship to self-care.

With the ability to reflect, and armed with an appreciation and understanding of what constitutes self-care for the elderly, nurses can then begin to correct healthcare delivery systems that all too often promote and reinforce depression amongst the elderly.

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