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Introduction

Asthma is a chronic respiratory condition characterized by persistent inflammation of the airways. It leads to reversible airway obstruction, heightened bronchial sensitivity, and structural changes over time, contributing to disease progression. Genetic factors and environmental triggers activate the immune system, leading to airway inflammation.

Exposure to allergens stimulates T-helper 2 (Th2) cells to release interleukins (IL-4, IL-5, and IL-13). IL-4 promotes immunoglobulin E (IgE) production by B cells, sensitizing mast cells to allergens. Upon re-exposure, mast cells release histamine, prostaglandins, and leukotrienes, causing bronchoconstriction and mucus secretion (De Pietro Crt, 2024). This results in airway narrowing, increased airflow resistance, and bronchospasms (Sinyor & Perez, 2023). IL-5 recruits eosinophils, worsening inflammation, while IL-13 increases mucus production, contributing to long-term airway damage. Chronic inflammation eventually leads to permanent structural airway changes, making breathing progressively more difficult. Symptoms like wheezing, coughing, and breathlessness are common in acute exacerbations. If frequent use of a rescue inhaler provides no relief, systemic corticosteroids may be necessary to manage inflammation and prevent further episodes (Ramirez et al., 2007).

The asthma cycle involves exposure to triggers, immune activation, inflammation, airway narrowing, and breathing difficulty. If untreated, this cycle may lead to irreversible airway damage.

Types of Asthma

Asthma is classified based on symptom severity, frequency, airway obstruction, and medication requirements..

Persistent Asthma

Persistent asthma, more severe than intermittent asthma, is categorized as mild, moderate, or severe (Crna, 2019b). Symptoms occur more than once or twice a week but not daily. Treatment typically involves long-term medications, including inhaled corticosteroids and bronchodilators. Regular lung function monitoring is crucial to adjust treatment as needed.

Asthma Incidence and Prevalence in the United States and Canada

United States

Asthma significantly affects the U.S. population, with approximately 25 million individuals (7.7%) affected. Its prevalence has risen since 2001 (National Center for Environmental Health et al., 2021). Environmental factors, lack of awareness, gender, socioeconomic status, obesity, and smoking contribute to its persistence. Children and low-income populations show higher prevalence rates.

Canada

Over 3.8 million Canadians (10.8% of the population) have asthma, with prevalence increasing by 67% from 2000-2001 to 2011-12 (Public Health Agency of Canada, 2018; Asthma Canada et al., 2021). It is especially common among young individuals and is a leading cause of school absenteeism and hospitalizations. New cases are frequently diagnosed in childhood and early adulthood, with environmental factors playing a significant role.

Diagnosis: History and Physical Examination Findings

Patient History

The patient’s worsening shortness of breath, wheezing, sore eyes, and persistent coughing over three weeks suggest poor asthma control (Ortega & Izquierdo, 2022). Frequent exacerbations, including two in the past year and one four months ago, indicate chronic inflammation. Increased reliance on a rescue inhaler, with diminishing effectiveness, further supports a diagnosis of poorly controlled asthma requiring additional treatment interventions.

Physical Examination

The patient’s respiratory rate is 18, and oxygen saturation is 95% on room air, suggesting mild respiratory distress (Ortega & Izquierdo, 2022b). Expiratory wheezing and prolonged expiratory phase indicate airway obstruction, consistent with asthma (Ortega & Izquierdo, 2022c). Despite respiratory complaints, the patient is alert, ambulatory, and not in acute distress, suggesting suitability for outpatient management. However, findings confirm an acute exacerbation.

Asthma Management Strategies

Asthma Action Plan

A structured plan helps patients manage symptoms, adhere to medications, recognize worsening conditions, and seek timely medical intervention (Rance, 2011). Regular updates ensure optimal disease control and reduced hospitalizations.

Patient Education and Inhaler Training

Proper inhaler technique is crucial for effective treatment. Patients should receive training on metered-dose inhalers (MDIs) and spacer use, along with medication action and potential side effects.

Prognosis and Long-Term Care

Prognosis

With appropriate management, asthma control is achievable, allowing patients to maintain normal lung function and minimal symptoms (Porpodis et al., 2009). However, poorly controlled asthma may lead to long-term lung impairment (Lee et al., 2021).

Long-Term Care Options

• Regular Monitoring: Follow-ups every 1-3 months for uncontrolled asthma and every 6-12 months for stable cases are recommended (Kabra & Lodha, 2003).

• Pharmacotherapy: Long-term medications such as inhaled corticosteroids and long-acting beta-agonists are crucial for symptom control.

• Lifestyle Changes: Avoidance of triggers like allergens and smoke, along with a healthy lifestyle, improves asthma management (Website, 2024).

By incorporating these measures, individuals with asthma can lead active lives with controlled symptoms.

Introduction: The objective of this exploration is to investigate and assess how Dorothea Orem's Self-Care Deficit Theory can serve as an effective framework for enhancing medication adherence among elderly individuals suffering from hypertension. The implications of this research could greatly enhance the quality of life for these individuals. Often labeled a silent killer, hypertension is responsible for millions of fatalities annually. This condition leads to serious complications such as strokes, heart disease, and renal failure. Despite the existence of antihypertensive medications, elderly patients grappling with hypertension struggle with adherence to their medication schedules due to cognitive decline, physical limitations, and the aging process. The present circumstances necessitate urgent attention and effective strategies focusing on early detection and preventive measures, given the numerous complications associated with the condition. Tackling the issues surrounding medication adherence in elderly patients with hypertension demands a structured and patient-centered methodology. This methodology, in line with the principles of Dorothea Orem's Self-Care Deficit Theory, is not only advantageous but essential. The Self-Care Deficit Theory emphasizes the capacity of individuals to fulfill their self-care requirements. The theory posits that when patients face a self-care deficit—indicating they are unable to care for themselves due to injury, illness, or age—nurses must provide support to help them regain and enhance their health. Orem categorizes nursing systems into three types according to the patient’s self-care capability. The theory consists of three interconnected components: the theory of self-care, the theory of self-care deficit, and the theory of nursing systems (Dorothea Orem). This paper presents Dorothea Orem and her theory, delineating the key concepts, definitions, assumptions, and propositions. The research then illustrates how the theory aligns with the project’s aim of enhancing medication adherence in elderly patients with hypertension. As outlined in Orem's writings, the four meta-paradigm concepts are also examined to formulate operational definitions pertinent to elderly patients living with hypertension.

Dorothea Orem and the Self-Care Deficit Theory:
Nursing Theorist:

Dorothea Elizabeth Orem (1914-2007) was a renowned American nursing theorist, educator, and author. Orem has published several works, including her book Nursing: Concepts of Practice, which is considered a foundational anchor in nursing education. She has received honorary doctorates from Georgetown University, Incarnate Word College, Illinois Wesleyan University, and the University of Missouri-Columbia. She is best known for developing the Self-Care Deficit Nursing Theory and has been awarded multiple times.
She has received the Catholic University of America Alumni Achievement Award for Nursing Theory (1980), the Linda Richards Award from the National League for Nursing (1991), was made an Honorary Fellow of the American Academy of Nursing (1992), and received the Sigma Theta Tau Edith Moore Copeland Founders Award (1997) ((Nursing Theories: The Base for Professional Nursing Practice).

Major Concepts:

Dorothea Orem’s Self-Care Deficit Theory is built upon the fundamental concept of self-care, which is the practice of activities that individuals initiate and perform on their behalf to maintain life, health, and well-being. The framework puts great emphasis on the role of an individual in maintaining his own life (Dorothea Orem).
Another key concept is the self-care requisites, which are the needs of the individuals that must be met to regulate their functioning and development. Orem categorized them into three groups- universal self-care requisites, developmental self-care requisites, and health deviation self-care requisites.
Another key concept of the theory is the self-care deficit, which occurs when an individual's ability to perform self-care is hampered. The nursing system is also one of the significant concepts of the theory. Orem has identified three types of nursing systems- wholly compensatory, partially compensatory, and supportive-educative (Dorothea Orem).

Definitions:

Self-care is the practice of activities that maturing and mature persons initiate and perform, within the time frames, on their behalf in the interest of maintaining life, continuing personal development, and maintaining well-being or recovering from disease or injury. According to her, self-care is the purposeful action to regulate one's functioning and development.
Self-care agency is the individual's ability to perform self-care activities, influenced by knowledge, skills, motivation, and physical capabilities. Therapeutic self-care demand, conversely, represents the totality of self-care actions required to meet known self-care requisites. These are categorized as universal, developmental, and health deviation requisites.
According to her, self-care deficit occurs when an individual's self-care agency is unable or partially able to meet the self-care needs of the individual.

Assumptions:

Dorothea Orem's Self-care Deficit Theory rests on the fundamental assumption that humans possess an inherent capacity for self-care: optimal functioning and well-being (Nursing Theories). When a self-care deficit occurs, which requires nursing interventions, it is also assumed that individuals actively participate in their health interventions and are capable enough to make informed decisions about their social and physical environments (Orem et al., 1995).
The interaction allows individuals to make judgments based on their surroundings and allows humans to engage in deliberate self-care actions. It is also assumed that care is often provided within structured social relationships.

Propositions:

The self-care deficit theory is particularly relevant to medication adherence in elderly patients with hypertension. Patients with hypertension often experience challenges with cognitive decline, physical limitations, and complex medication regimens. Such challenges can create self-care deficits.
Through the application of Dorothea Orem's theory, the study aims to measure the ability of patients to manage these interventions through targeted interventions. For instance, an elderly patient may have memory deficits, causing them to forget to take their medications (MacLaughlin et al., 2005). By applying self-care deficit theory, nurses can implement a partially compensatory system and teach patients to use specified interventions, such as pill boxes or medication reminders.

Metaparadigm concepts:

The Metaparadigm concepts of Dorothea's self-care deficit theory outline the dynamism of nursing care, specifically as applied to elderly individuals with hypertension and medication adherence challenges.

Person:

Orem views a person as a holistic being with the capacity for self-care. She highlights the concept of self-care agency, which is defined as the individual's ability to engage in self-care activities to maintain life, health, and well-being (Orem et al., 1995). The agency is influenced by knowledge, skill, motivation, and physical capabilities (Dorothea Orem).
In this context, the definition narrows the focus to a specific population: elderly patients with a chronic condition (hypertension) and a prescribed treatment (antihypertensive medication). The person may or may not exhibit adequate medication adherence. When applied to elderly patients with hypertension, the definition assesses their self-care agency related to medication management. The operational definition necessitates a nuanced assessment that extends beyond simple adherence rates. The definition necessitates a comprehensive assessment of the person's self-care agency, comprising cognitive function, physical limitations, health literacy, psychological factors, and medication beliefs. The detailed evaluation allows for a personalized self-care plan that addresses each patient's unique needs.

Health:

Orem views health as not merely the absence of the disease but a state characterized by soundness or wholeness of developed human structures and bodily and mental functioning (Dorothea Orem).In the context of elderly hypertensive patients, a state of health translates to a focus on both blood pressure control and the prevention of hypertension-related complications in elderly patients (Schutte et al., 2022).
In this context, "health" is operationalized as the patient's blood pressure control, measured by consistent readings within the target range and the absence of hypertension-related complications.
Orem's perspective requires a more comprehensive understanding of health in a broader perspective. Since Orem views health as a dynamic process and not a static endpoint, the study also includes quality of life, symptom management, monitoring laboratory values indicative of organ function, and evaluating adherence to lifestyle modifications under the umbrella of health.

Environment

Orem views the environment as all the external factors that influence a person's ability to engage in self-care. According to her, the environment includes the physical, chemical, biological, and social contexts in which humans exist (Dorothea Orem).
For the project, "environment" is contextualized as a patient's home setting, social support network, and access to healthcare resources. Operationally, the study defines environment as encompassing all these factors, which can influence their ability to adhere to medication regimens. The facts identify the need to assess the safety and suitability of the home environment for medication storage and administration, evaluate the availability of social support to assist with medication management and ensure access to healthcare providers and pharmacies (Denyes et al., 2001).
Orem's theory outlines that environmental changes can positively or negatively impact self-care agency. For instance, limited financial resources or cultural beliefs can significantly impact medication adherence. In such cases, nurses are required to address these factors within their interventions. 

Nursing:

Orem observes nursing as assisting individuals with self-care needs when they exhibit deficit patterns. According to Orem, a nurse must intervene and assist individuals in meeting their self-care needs when they cannot do so themselves (Dorothea Orem).
Within the scope of the study, "nursing" involves assessing the elderly patient's self-care agency, identifying self-care deficit patterns, and defining necessary interventions to promote medication adherence in elderly patients with hypertension. Operationally, nursing involves a systematic process of assessment, diagnosis, and intervention measures required to support patient self-care behaviors. Nurses utilize Orem's wholly compensatory, partially compensatory, or supportive-educative nursing systems to tailor interventions to the patient's needs (Nursing Theories).
Orem's theory also views nurses as facilitators who empower individuals to regain or maintain their self-care agency. By applying Orem's Self-Care Deficit Theory, nurses can provide comprehensive and effective care to elderly individuals with hypertension, promoting medication adherence and improving their health outcomes.

Conclusion and Analysis:

The Self-care deficit theory offers a systematic framework for assisting elderly patients suffering from hypertension. The theory addresses medication adherence challenges by recognizing patients' inherent capacity for self-care and acknowledging the limitations that arise due to aging, cognitive decline, and the complex medication schedule. By applying the identified theory, the study enables nurses to implement customized interventions for the identified patient group that support their patient autonomy and health maintenance.
The theory follows a structured approach to identify self-care deficits and categorize nursing interventions into three systems: wholly compensatory, partially compensatory, and supportive-educative. Each of these interventions is defined to cater to different stages of self-care deficit in patients, ranging from direct assistance in medication administration to patient education through reminder tools or the creation of personalized medication management plans.
A key strength of Orem's theory in this context is its comprehensive integration of four meta-paradigm concepts- person, health, environment, and nursing. In analyzing the application of self-care deficit theory to medication adherence, it is evident that a personalized, patient-centric approach is required. Elderly hypertensive patients face multiple barriers to medication adherence, which requires individual interventions based on their specific deficits and capabilities.
Furthermore, the study highlights the need for continuous assessment and adaptation of nursing strategies to ensure sustained adherence. As the patient’s adherence to the self-care behaviors involved, so should the designed interventions to support them. Orem’s theory offers a dynamic model to accommodate the varying self-care needs of patients, allowing nurses to deliver targeted and patient-centric care.

References

Denyes, M. J., Orem, D. E., & Bekel, G. (2001). Self-Care: A Foundational Science. Nursing Science Quarterly, 14(1), 48–54. https://doi.org/10.1177/089431840101400113
Dorothea Orem. (2025). Google Books. https://books.google.com/books?hl=en&lr=&id=jFMiCgAAQBAJ&oi=fnd&pg=PP1&dq=self+care+deficit+theory&ots=i-7c0n3blQ&sig=aMYXDpJ0eg0_OEMk2_bn6y5VChM
MacLaughlin, E. J., Raehl, C. L., Treadway, A. K., Sterling, T. L., Zoller, D. P., & Bond, C. A. (2005). Assessing Medication Adherence in the Elderly. Drugs & Aging, 22(3), 231–255. https://doi.org/10.2165/00002512-200522030-00005
Nursing Theories. (2025). Google Books. https://books.google.com/books?hl=en&lr=&id=sd0-BAAAQBAJ&oi=fnd&pg=PA153&dq=self+care+deficit+theory&ots=4qFzr7_WH-&sig=XQFG2onbmSNjsWhm3PH-dGdJaoY
Nursing Theories: The Base for Professional Nursing Practice, 6/e. (2025). Google Books. https://books.google.com/books?hl=en&lr=&id=ENFbsUFcGrMC&oi=fnd&pg=PA113&dq=She+has+received+the+Catholic+University+of+America+Alumni+Achievement+Award+for+Nursing+Theory+(1980)

Significance of the theory: The theory of human caring was first introduced in 1979 ((Illuminations, 2025)). However, even after four decades, the theory remains profoundly significant in contemporary society and nursing practice ((Human Caring Theory: Expansion and Explication - ProQuest, 2025)). In today’s advanced technological and often depersonalized healthcare environment, Mrs. Watson's emphasis on building genuine connections with humans resonates deeply. The theory addresses the central theme of nursing- human caring ((Watson & Smith, 2002)).

The theory introduces the concept of "Caritas Processes", which identifies ten elements essential to the human caring experience. Watson's work challenges nurses to move beyond a biomedical model and embrace a humanistic approach. The theory urges nurses to build transpersonal caring relationships with their patients and engage in intentional acts of caring. ((Kim & Kim, 2021))

Caring, the central theme of nursing, is the cornerstone of Jean Watson's theory. Unlike conventional medical models that focus solely on physical health, Watson's theory offers a unique perspective for improving the overall health of patients by instilling love, compassion, and care in healthcare. This theory not only guides nursing students in shaping their professional identity but also provides a practical framework for compassionate and holistic care in their daily practice.

Jean Watson's theory of human caring has significantly influenced nursing education, administration, and practice. The theory is integrated into nursing curricula and has been proven to enhance the caring ability of students compared to those who did not study the theory. Furthermore, research on healthcare system restructuring showed that when administrators prioritized caring principles, there was a 15% improvement in staff satisfaction and a reduction in turnover rates. The theory also guides administrative practices during critical times, such as the COVID-19 pandemic, to ensure that caring remains the core component of nursing ((Patient Centered Care, 2025)).

Context of the theory development

Mrs. Jean Watson is a distinguished nurse theorist, educator, and scholar. She received her bachelor's degree in nursing, her master's degree in psychiatric-mental health nursing, and her doctorate in educational psychology and counseling. Mrs. Watson has been awarded the Visionary Award for Caring Science Leadership, the highest honor of the American Academy of Nursing ((Watson, 2015)). Her background in mental health has contributed significantly to her strong emphasis on the psychological and emotional aspects of nursing. As a nurse, she recognized the limitations of a purely biomedical approach to care. She observed the profound impact of emotional, spiritual, and relational factors on patient well-being.

The theory mainly draws significant theoretical influence from humanism, existentialism, and phenomenology ((Létourneau, et al., 2017)), (Human Caring Science, 2025). The theory of humanism defines the inherent worth and dignity of each individual; existentialism explores the meaning of human existence and the importance of personal choices; and phenomenology emphasizes the lived experience of a person ((Existentialism Is a Humanism BRIEF BIOGRAPHY of JEAN-PAUL SARTRE, n.d.)). The amalgamation of these theories is evident in Watson's work, which solely focuses on the patient's subjective experience of health and illness.

The research shows that external forces, such as the human potential movement of the 1960s and 1970s, have influenced the theory. The movement, which stressed self-actualization and personal growth, aligns with the theory's emphasis on the subjective experience of health and illness. This influence is evident in the theory's focus on the individual's potential for growth and healing. The same themes are also evident in Mrs. Watson's work. The theory has also drawn reference from a growing shift from task-oriented healthcare to a patient-centric nursing approach.

Internal consistency of the theory

Watson's theory is paramount in the nursing domain and is widely adopted. However, critics argue that some key themes of the theory, such as "caring", "transpersonal caring," and "Caritas Processes," are open to individual interpretation. For example, the concept of "caring" in the theory goes beyond generic, day-to-day tasks performed for patients; however, what specific behaviors are included in the "caring" concept are somewhat subjective ((Perkins, 2021)). The research has also identified hindrances in the theory's interpretation due to a lack of universally agreed-upon definitions for some key concepts.

The concepts within Watson's theory are interconnected, although the nature of these linkages could be more explicit in some cases. The Caritas Processes guide the Carative factors, while transpersonal caring relationships are tied to the caring moment (Human Caring Science, 2025). However, the interdependent relationship of these two factors is not always clearly stated. For example, how nurses' intentional caring (Caritas Process) translates into specific actions (Carative Factors) and builds a transpersonal caring relationship with patients needs a more precise explanation of how these components fit together.

While the core concept of Jean Watson's theory of human caring remains unchanged, the terminology of the theory has evolved. The Carative Factors have evolved into the Caritas process. This evolution not only reflects the theory's adaptability but also its continued relevance in the dynamic field of nursing. However, different interpretations of key terms within nursing literature can lead to inconsistency in its interpretation. While a certain degree of articulation is expected and accepted in every complex theory, more significant inconsistency in the use of key terminologies requires a more detailed explanation.

Parsimony of the theory

Parsimony, the concept of using the fewest possible concepts and assumptions to explain a phenomenon, is one of the most desired characteristics of a theory. In the context of nursing theory, it refers to the simplicity and conciseness with which a theory can explain the complex and multifaceted nature of patient care. A highly parsimonious theory is often more accessible and easier to apply in practical nursing situations.

Watson's theory of human caring is not generally considered a highly parsimonious theory ((Morse et al., 1991)). The theory consists of a large number of concepts, including the Ten Carative factors (later known as the Caritas process), the transpersonal caring relationship, the caring moment, and the phenomenological field. While each concept is crucial to its overall understanding, their sheer number reduces the attractiveness and widespread adoption.

The theory brings a fresh perspective into the nature of caring but is sometimes criticized for shifting the focus toward specific actions of care rather than building a more profound understanding and connection with the patients that define true care. Certain aspects of theory, such as transpersonal and spirituality, while meaningful, can also make the theory feel abstract and distant from practical application ((Morse et al., 1991)). Research also suggests that ten Caritas Processes, while comprehensive, could be consolidated or synthesized for better parsimony.

Testability of the theory

Testability is the ability to examine the variables of a theory empirically. The testability of a theory is an important criterion for evaluating its scientific validity. The concept of human care is abstract, and its testability is debatable. The theory’s key concepts, such as ‘transpersonal caring’ and 'caring moment', are subjective concepts that are difficult to measure empirically. Academicians have always pondered upon how to measure the presence or absence of a transpersonal connection between patient and nurse or how can the impact of a 'caring moment' on a patient's health be measured mathematically ((Barker et al., 1995))

While the traditional empirical testing methods cannot be explicitly applied to the theory, researchers have attempted to test some aspects of the theory using different methodologies ((Mills, 2021)). Qualitative analysis, interviews, and narrative analysis have been used to capture the real-life experiences of nurses and patients to measure the actual impact of caring interventions on patient outcomes ((Morse et al., 1991)). These studies have proven that caring-based interventions, like active listening and empathy, have resulted in a 25% reduction in patient's anxiety levels and a 30% improvement in family satisfaction scores.

While some concepts, such as active listening and empathy, have still been measured and articulated, other key concepts, like Caritas Processes, remain distant from quantification. The Caritas Process is about the conscious intention and commitment of a nurse towards caring, which is an internal state and is not directly observable.

Attempts have been made to study the impact of caring interventions on patient outcomes and satisfaction levels ((Quality Caring in Nursing, 2025)).However, due to the difficulties in operationalizing and measuring the theory's core concepts, the empirical evidence supporting the theory remains limited.

Pragmatic adequacy of the theory

The Pragmatic adequacy of a theory is the measure of the usefulness and practicality of the theory's concepts in real-world practice. A theory with high pragmatic adequacy can be easily implemented and helps solve practical problems. Watson’s theory of human caring is highly pragmatic and is actively used in real-world nursing practices despite its challenging implementation. Nurses who are drawn to the theory's humanistic and holistic approach often find it resonates with their values and beliefs about patient care ((Létourneau, et al., 2017)). 

The theory is actively involved in shaping nursing philosophical models in healthcare institutions. The theory also finds application in building therapeutic relationships with patients ((Barker et al., 1995)).However, the extent to which the theory is fully and consistently implemented varies depending on the availability of resources.

Additionally, the application of Watson’s theory of Human Caring requires education and special skills training. Nurses also need to develop key interpersonal skills necessary to enact caring behaviors. The theory revolves around consciously caring for patients, which requires intentional effort and continuous self-reflection. Ethical decision-making is also required to navigate complex care situations.

Although the feasibility and implementation of a theory depend upon the type of healthcare setting and the resources available, research suggests that the implementation of Jean Watson's theory of human care is moderately feasible.

The feasibility is high in the case of smaller organizations or clinics that have a slow-paced environment. Theory implementation is also easy in areas with more extended patient interactions, such as in mental health and therapeutic sessions ((Morse et al., 1991)). On the other hand, the theory is difficult to implement in fast-paced settings where patient-nurse interaction time is minimal.

To integrate the theory into nursing practice, the ten Caritas Processes should be integrated into daily nursing practices. Nurses must actively listen to their patients, validate their feelings, build a calm and supportive environment, and show empathy. They must also practice self-care to maintain their well-being. The theory can also be utilized to encompass advocacy, leadership, and policy development.

References

• Barker, P. J., Reynolds, W., & Ward, T. (1995). The proper focus of nursing: a critique of the “caring” ideology. International Journal of Nursing Studies, 32(4), 386–397. https://doi.org/10.1016/0020-7489(95)00030-2
• Existentialism Is a Humanism BRIEF BIOGRAPHY OF JEAN-PAUL SARTRE. (n.d.). https://yang.nz/LitCharts/Existentialism-Is-a-Humanism-LitChart.pdf
•  Human Caring Theory: Expansion and Explication - ProQuest. (2025). Proquest.com. https://search.proquest.com/openview/fd15193ea478fdb9c720941fe09e086b/1?pq-origsite=gscholar&cbl=18750&diss=y
•  Illuminations. (2025). Google Books. https://books.google.com/books?hl=en&lr=&id=S1a1E0ABjAoC&oi=fnd&pg=PR11&dq=The+theory+of+human+caring+was+first+introduced+in+year+1979.+However
• Kim, J., & Kim, S. (2021).
• Kim, J., & Kim, S. (2021). Nurses’ Adaptations in Caring for COVID-19 Patients: a Grounded Theory Study. International Journal of Environmental Research and Public Health, 18(19), 10141. https://doi.org/10.3390/ijerph181910141
• Létourneau, D., Cara, C., & Goudreau, J. (2017). Humanizing Nursing Care: An Analysis of Caring Theories Through the Lens of Humanism. International Journal of Human Caring, 21(1), 32–40. https://doi.org/10.20467/1091-5710.21.1.32
• Mills, J. (2021). Theoretical foundations for self-care practice. Progress in Palliative Care, 29(4), 1–3. https://doi.org/10.1080/09699260.2021.1952415
• Morse, J. M., Bottorff, J., Neander, W., & Solberg, S. (1991). Comparative Analysis of Conceptualizations and Theories of Caring. Image: The Journal of Nursing Scholarship, 23(2), 119–126. https://doi.org/10.1111/j.1547-5069.1991.tb00655.x
• Patient-Centered Care. (2025). Google Books. https://books.google.com/books?hl=en&lr=&id=IKlLcYKV0poC&oi=fnd&pg=PR19&dq=research+on+healthcare+system+restructuring+showed+that+when+administrators+prioritized+caring+principles
• Perkins, J. B. (2021). Watson’s Ten Caritas Processes with the Lens of Unitary Human Caring Science. Nursing Science Quarterly, 34(2), 157–167. https://doi.org/10.1177/0894318420987176
• Quality Caring in Nursing. (2025). Google Books. https://books.google.com/books?hl=en&lr=&id=2rR_rggUPLwC&oi=fnd&pg=PR5&dq=The+theory+of+human+caring+was+first+introduced+in+year+1979.+However
•  Watson. (2015, October). Visionary Award for Caring Science Leadership - Watson Caring Science Institute. Watson Caring Science Institute. https://www.watsoncaringscience.org/visionary-award-for-caring-science-leadership/
• Watson, J., & Smith, M. C. (2002). Caring science and the science of unitary human beings: a trans-theoretical discourse for nursing knowledge development. Journal of Advanced Nursing, 37(5), 452–461. https://doi.org/10.1046/j.1365-2648.2002.02112.x

Introduction: Dorothea Orem’s Self-Care Deficit Theory of Nursing is one of the most influential frameworks in nursing domain. The theory emphasizes on the role of nurses in assisting individuals who are unable to meet their own self-care needs. The theory was developed in the mid-20th century, but still finds relevance in today’s nursing practices. Orem’s theory provides a structured approach to patient care by categorizing nursing interventions based on the levels of self-care.

 This critique aims to offer a comprehensive analysis of Orem’s Self-Care Deficit Theory by examining its foundational principles, strengths, and limitations. The paper will explore the theory’s relevance in contemporary nursing practice, particularly considering the increasingly complex healthcare needs of modern patient populations. As nursing continues to evolve with a greater focus on patient autonomy, collaborative care, and addressing diverse health conditions. Orem’s theory remains a valuable tool for understanding how nursing interventions can promote self-care and improve health outcomes. This critique will assess both the enduring impact of Orem's work and the challenges it faces in a rapidly changing healthcare landscape (Alligood, 2022; Fawcett, 2005; Smith & Parker, 2015).

The significance of the Dorothea: Orem’s Self-Care Deficit Nursing Theory lies in its structured approach to patient care. The theory emphasizes on patient autonomy, individualized care, and on the role of nurses in bridging the gaps in self-care. The theory is widely applied in nursing education, research, and practice due to its relevance in various healthcare settings. The theory encourages self-care promotion and aims to restore a patient's ability to care for themselves. The theory also help nurses to develop interventions that empower patients rather than create dependency.

Dorothea Orem’s Self-Care Deficit Theory provides valuable insights into the role of nursing in supporting individuals' self-care. The theory introduces the concept of self-care deficits and highlights when individuals are unable to meet their own health needs and require nursing intervention (Orem, 2001). This perspective shifts the nursing focus from simply providing care to empowering patients and encouraging their autonomy and long-term health management. Orem’s framework also emphasizes the holistic nature of care, addressing physical, psychological, and social factors that influence self-care. It is particularly relevant in the context of chronic disease management and patient-centered care (Alligood, 2022; Fawcett, 2005).

Orem’s Self-Care Deficit Theory emphasizes the nurse's role not merely as a caregiver, but as a facilitator of patient autonomy to guide individuals toward greater independence in managing their health (Alligood, 2022). Orem's framework enables nurses to identify and address self-care deficits and foster a more collaborative approach to care. This theory has profoundly influenced the profession and help define nursing's professional identity particularly in its patient-centered and adaptable care planning. It underscores the importance of nurses in empowering patients to take an active role in their own health and reinforce the collaborative nature of modern healthcare (Alligood, 2022).

     Dorothea Orem’s Self-Care Deficit Theory has been widely utilized to guide nursing education, administration, and practice by providing a clear framework for understanding patient care needs. Nursing education is used to teach students how to assess and promote patient autonomy and emphasizes the importance of empowering individuals to manage their health (Alligood, 2022). The theory informs the development of care delivery systems and policies that prioritize patient-centered care and the role of nurses in supporting self-care. In clinical practice, Orem’s model helps nurses assess self-care capabilities and enables the design of individualized care plans that address self-care deficits and promote patient independence.

Context of the theory development

 Dorothea Orem was born in 1914 in Baltimore, Maryland and earned her nursing diploma in 1939 and later completed her bachelor’s and master’s degrees in nursing education. Orem’s diverse career included clinical practice, teaching, and nursing administration and during which she developed her influential Self-Care Deficit Theory. This theory was introduced in the 1950s and emphasizes the importance of self-care in maintaining health. It highlights the nurse's role in assisting patients who cannot meet their own care needs due to illness or other limitations (Orem, 2001). Orem believed that nursing should focus on promoting patient autonomy and empowering individuals to manage their health and it is significantly shaped nursing education and practice (Alligood, 2022). Her work remains a foundational framework in nursing and impacts how nurses assess, plan, and intervene in patient care. It continues to guide both contemporary nursing practice and research (Fawcett, 2005). Orem passed away in 2007, but her contributions to the profession continue to influence the nursing field today.
Dorothea Orem’s Self-Care Deficit Theory is influenced by several key theoretical foundations. Orem’s work is rooted in the belief that nursing is a practice aimed at helping individuals meet their self-care needs when they are unable to do so independently. The major theoretical influences include the works of Betty Neuman, whose emphasis on the holistic approach to health and encompass the physical, psychological, and social aspects of care. She was also influenced by the work of Florence Nightingale who highlighted the role of the environment in health. Orem was also influenced by the works of Virginia Henderson’s ideas on patient independence and the role of nurses in assisting individuals to achieve self-care. These diverse theoretical influences have contributed to the development of a comprehensive model that addresses both individual and nursing system needs in the pursuit of health and well-being.

 Dorothea Orem’s Self-Care Deficit Theory was shaped by several external influences including the evolving role of nursing, changes in healthcare delivery, and advancements in medical science. Orem’s nursing career was shifting from a task-oriented profession to one that emphasized patient autonomy and holistic care. It prompted her to develop a theory that clearly defined the nurse’s role in promoting self-care (Alligood, 2022). The rise of patient-centered care focuses on empowering individuals to manage their own health. Additionally, the growing prevalence of chronic illnesses and the need for long-term care influenced her framework. These external factors collectively shaped Orem's theory and ensure its relevance to the changing healthcare environment and its application in modern nursing practice.

The theory internally consistent

 Dorothea Orem’s Self-Care Deficit Theory is clearly defined and provides a structured framework for nursing practice. The theory consists of three interconnected concepts: self-care, self-care deficits, and nursing systems. Self-care refers to the activities individuals undertake to maintain their health. Self-care deficit occurs when individuals are unable to meet their own care needs and necessitates nursing intervention. Orem clearly outlines the role of nurses in addressing these deficits by either assisting patients directly or helping them regain or improve their self-care abilities (Orem, 2001). The theory’s clarity is further supported by its practical application in clinical settings. It remains relevant in nursing education, administration, and practice (Alligood, 2022).
The concepts of Dorothea Orem’s Self-Care Deficit Theory are clearly linked to form a cohesive and logically structured framework for nursing practice. The three primary concepts of self-care, self-care deficits, and nursing systems are interconnected in a way that allows for practical application. Orem’s theory links these deficits directly to the need for nursing care. Nurses either assist patients or teach them how to manage their own care (Orem, 2001). The nursing system is categorized into wholly compensatory, partially compensatory, and supportive-educative systems. This clear connection between the concepts ensures the theory provides a structured and comprehensive approach to nursing care and interventions (Alligood, 2022).

The terms and definitions of Dorothea Orem’s Self-Care Deficit Theory are consistently applied throughout discussions of the theory. Orem clearly defines key concepts as self-care, self-care deficits, and nursing systems. These definitions are maintained across various interpretations and applications of the theory. This consistency in terminology ensures that the theory remains clear, logical, and applicable in nursing education, practice, and research (Alligood, 2022).

Parsimony of the theory

 Dorothea Orem’s Self-Care Deficit Theory is relatively concise in its core concepts. It could be considered more complex due to the depth and breadth of its framework. The theory includes detailed descriptions of self-care, self-care deficits, and nursing systems with clear categorizations of the different levels of nursing intervention. These concepts are thoroughly explained to provide clarity for nursing practice and contribute to its length and complexity (Orem, 2001). However, for a theory to be practical and applicable across various clinical settings, some level of detail is necessary to ensure comprehensive understanding and guidance. The theory is not overly verbose. It balances conciseness with the need for specificity in its definitions and applications and makes it suitable for guiding nursing care (Alligood, 2022). Thus, although it could be streamlined for simplicity, the theory’s level of detail is essential for its effectiveness in practice and education.
Dorothea Orem’s Self-Care Deficit Theory strikes a balance between simplicity and thoroughness. It provides clear and direct explanations of the key concepts involved in nursing care as self-care, self-care deficits, and nursing systems without being overly complicated or convoluted. The theory articulates a straightforward relationship between these concepts and explains how individuals perform self-care to maintain their health and how nursing intervention is necessary when a person is unable to care for themselves due to illness, injury, or other limitations (Orem, 2001).

Orem's framework is organized around three distinct yet interrelated parts. The concept of self-care is simple and universally understood. The identification of self-care deficits requires nursing intervention. The nursing system responds to these deficits. The categorization of nursing systems as wholly compensatory, partially compensatory, and supportive-educative is clear and concise. It provides nurses with a practical guide for determining the appropriate level of intervention (Alligood, 2022). The theory focuses on core concepts that are both understandable and applicable in clinical practice. Orem’s theory meets the standard of parsimony because it offers a structured, easy-to-understand framework without extraneous details by clarifying the roles of both the nurse and the patient in promoting health.
Orem’s Self-Care Deficit Theory incorporates several layers of complexity and maintains parsimony by ensuring that its statements are direct, relevant, and facilitate a clear understanding of the phenomena of interest. Its simplicity does not undermine its depth. It enhances the theory’s practical application in guiding nursing practice, education, and research.

Testability of the theory

 Dorothea Orem’s Self-Care Deficit Theory has been widely applied in nursing research to assess its validity and applicability. The theory’s focus on self-care, self-care deficits, and nursing interventions provides clear, measurable concepts that lend themselves well to empirical investigation. Researchers can test various aspects of the theory, such as the relationship between patients' self-care abilities and the need for nursing interventions, or the effectiveness of different types of nursing systems in helping patients meet their self-care needs (Orem, 2001). Orem’s theory often involves observational or experimental studies. Researchers measure patient outcomes related to self-care abilities and assess how different nursing interventions impact these outcomes. Studies might focus on how nursing interventions in chronic illness management to reduce self-care deficits or improve patients' ability to engage in self-care activities. Several studies have explored the application of Orem's theory in various clinical settings and examine the effectiveness of self-care interventions and providing evidence that supports the practical utility of the theory in improving patient health outcomes (Alligood, 2022). The theory’s adaptability and practical relevance to a wide range of healthcare contexts make it conducive to ongoing empirical testing and confirm its robustness as a foundational framework in nursing.

 The core concepts of self-care, self-care deficits, and nursing systems are all measurable through various methods and tools. Self-care refers to the activities an individual engages in to maintain their health and well-being and it can be assessed by evaluating a patient's ability to perform basic health-related tasks such as feeding, bathing, dressing, and managing medications. Tools like self-report questionnaires, observational assessments, and standardized scales such as the Self-Care Inventory (SCI) are used to measure self-care (Alligood, 2022). Self-care deficits arise when individuals are unable to perform these tasks due to health conditions or other limitations. These deficits can be measured by assessing the gap between a person’s independent capabilities and their need for assistance, with tools like the Self-Care Deficit Screening Scale helping to identify specific deficits and determine necessary interventions (Orem, 2001). Orem's nursing systems categorize interventions into wholly compensatory, partially compensatory, and supportive-educative types and it can be assessed based on the level of support a nurse provides relative to the patient’s self-care deficit. The effectiveness of these interventions is evaluated through clinical outcomes, patient feedback, and observational data to ensure that nursing interventions are appropriate and successful in improving the patient’s self-care abilities (Alligood, 2022).

Pragmatic adequacy of the theory

  Dorothea Orem’s Self-Care Deficit Theory is widely used in nursing practice, education, and research. Nurses apply the theory to assess patients' self-care abilities in clinical settings and identify any deficits that require intervention. For example, nurses evaluate a patient’s ability to manage their health and intervene accordingly for diabetes or heart failure patients through education, direct assistance, or full care. It is depending on the severity of the self-care deficit (Orem, 2001). The theory’s structured approach also guides nursing students in clinical practice to help them assess patient needs, plan interventions, and evaluate outcomes (Alligood, 2022). Furthermore, Orem’s theory continues to be validated in research to demonstrate its effectiveness in improving patient outcomes and guiding evidence-based practice.

     Education and specialized skill training are required to effectively apply Dorothea Orem’s Self-Care Deficit Theory in nursing practice. Nurses must have a solid understanding of the theory’s core concepts to assess and address patients' needs accurately. This requires formal education in nursing theory. It is typically integrated into nursing curricula to ensure students understand the importance of self-care and how to evaluate and intervene when deficits occur (Alligood, 2022). In addition to theoretical knowledge, nurses must develop critical assessment skills to identify self-care deficits and determine the appropriate level of intervention. Special training is also necessary for applying the theory in diverse clinical settings, such as chronic disease management or geriatric care because patients' ability to perform self-care may vary significantly. Nurses must be equipped with both theoretical understanding and practical skills to implement Orem’s theory effectively and provide comprehensive care that supports patient autonomy and health outcomes (Orem, 2001).

It is feasible to implement Dorothea Orem’s Self-Care Deficit Theory in nursing practice because it provides a clear, practical framework that can be applied across a wide range of clinical settings. The theory’s focus on assessing self-care abilities and addressing self-care deficits is highly relevant to everyday nursing tasks. Nurses can easily incorporate Orem's three nursing systems which are wholly compensatory, partially compensatory, and supportive-educative into patient care plans to determine the appropriate level of intervention based on the patient's needs (Orem, 2001). The theory is flexible enough to be adapted for different patient populations and healthcare environments from acute care to home health nursing. Additionally, its emphasis on patient autonomy and education aligns with current trends in patient-centered care to make it not only feasible but also highly beneficial in promoting effective, individualized care (Alligood, 2022).

I can apply Dorothea Orem's Self-Care Deficit Theory by assessing patients' ability to perform self-care activities and identifying any deficits that require intervention. I would begin by evaluating each patient's capacity to manage their own health and daily activities and consider factors such as their physical, cognitive, and emotional abilities. When I manage the patients post of surgeries, I would assess their ability to follow treatment regimens, pain management, and activities restrictions. If a self-care deficit is identified, I would apply Orem's framework to determine the most appropriate level of nursing intervention depending on the severity of the deficit. In situations where patients are unable to fully manage their self-care, I would provide direct assistance or support and educate them on how to manage their condition more independently. Additionally, I would work with patients to empower them to take an active role in their care by providing the necessary resources, guidance, and support to reduce their self-care deficits over time. Orem’s theory emphasizes patient autonomy and education to align with my goal to promote self-management and improve health outcomes.

Conclusion

Dorothea Orem’s Self-Care Deficit Theory is a foundational and highly applicable framework in nursing. It offers valuable insights into the role of the nurse in promoting patient independence and well-being. The theory’s clarity in defining key concepts as self-care, self-care deficits, and nursing systems. It enables nurses to assess and address patient needs effectively and ensures that interventions are tailored to the individual's capacity for self-care (Orem, 2001). Orem’s emphasis on patient autonomy and the importance of education and support aligns well with contemporary trends in healthcare such as patient-centered care and the promotion of self-management in chronic disease management (Alligood, 2022).
The theory is empirically testable with measurable concepts that allow for practical application and research validation to further enhance its utility in clinical practice (Orem, 2001). Education and skill training are necessary to implement the theory effectively. Its structured approach makes it feasible and adaptable in various healthcare settings. Moreover, the theory's consistent definitions and well-linked concepts provide a solid foundation for guiding nursing practice, education, and research (Alligood, 2022). Overall, Orem’s Self-Care Deficit Theory remains a relevant and effective tool in nursing. It is facilitating improved patient outcomes and contributing to the ongoing evolution of nursing as a discipline dedicated to promoting health and well-being. Its application in clinical practice supports the development of individualized care plans that empower patients to take an active role in their health and reinforce the critical relationship between nurses and patients in achieving optimal health outcomes.

Reference

Alligood, M.R. (2022). Nursing theorists and their work (10th ed.). Elsevier.
Fawcett, J. (2005). Analysis and evaluation of contemporary nursing knowledge: Nursing models and theories. F. A. Davis Company.
Orem, D. E. (2001). Nursing: Concepts of practice (6th ed.). Mosby.
Smith, M. C., & Parker, M. E. (2015). Nursing theories and nursing practice (4th ed.). F. A. Davis Company.
World Health Organization (WHO). (2021). Noncommunicable diseases. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases

No matter their field or specialty, all nurses use the same nursing procedures; A scientific method developed to deliver the best in patient care through five simple steps.

Assessment - Nurses evaluate patients on a thorough physical, economic, social, and lifestyle basis.
Diagnosis - By carefully considering physical symptoms and patient behavior, the nurse builds the diagnosis.
Outcome/Plan - The nurse uses her expertise to set realistic goals for recovery. These objectives are then closely monitored.

Introduction: Evidence-based practice (EBP) is a fundamental aspect of modern nursing, integrating clinical expertise, patient values, and the best available research evidence to improve patient care outcomes. EBP ensures that nursing interventions are backed by scientific research, leading to enhanced patient safety, efficiency, and effectiveness in healthcare delivery. Despite its benefits, implementing EBP in clinical settings presents significant challenges. This essay critically evaluates the role of EBP, examines barriers to its adoption, and suggests strategies to facilitate its integration into nursing practice.

The Importance of Evidence-Based Practice in Nursing: EBP is grounded in several nursing theories, including Florence Nightingale’s Environmental Theory, which emphasizes the role of scientific evidence in improving patient health outcomes. The Iowa Model of Evidence-Based Practice provides a structured framework for integrating research into clinical decision-making, ensuring that nursing interventions are data-driven and patient-centered.

By implementing EBP, nurses contribute to reducing medical errors, enhancing patient satisfaction, and improving recovery rates. A notable example of EBP in action is the use of early mobility programs in Intensive Care Units (ICUs). Research has demonstrated that mobilizing critically ill patients reduces hospital-acquired infections and accelerates recovery, reinforcing the significance of applying research findings to clinical practice.

Barriers to Implementing Evidence-Based Practice: Despite its advantages, several barriers hinder the adoption of EBP in healthcare settings. One major challenge is resistance to change among healthcare professionals, often due to a lack of awareness or misconceptions about EBP. Additionally, time constraints and heavy workloads make it difficult for nurses to stay updated with the latest research. Limited access to high-quality research articles and inadequate institutional support further exacerbate the problem.

Strategies to Overcome Challenges: To successfully integrate EBP into nursing practice, healthcare institutions must foster a culture that values continuous learning and professional development. Providing nurses with access to research databases, organizing workshops on critical appraisal skills, and implementing mentorship programs can enhance EBP adoption. Leadership support is also crucial—nurse managers and policymakers must advocate for EBP by incorporating it into hospital policies and clinical guidelines.

Conclusion: Evidence-Based Practice is a cornerstone of modern nursing, ensuring that patient care decisions are informed by the latest scientific research. While barriers to EBP implementation exist, proactive strategies such as education, mentorship, and leadership support can facilitate its integration into clinical settings. By embracing EBP, nurses can enhance healthcare quality, improve patient safety, and contribute to the ongoing advancement of the nursing profession.

References

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice.
Nightingale, F. (1860). Notes on Nursing: What It Is and What It Is Not.
Titler, M. G. (2010). The Iowa Model of Evidence-Based Practice to Promote Quality Care.