Rio D. Domalaon

Nursing theories is very essential for us (nurses) in our daily work. It provides us with a sound basis to describe, explain, and predict factors that influence nursing care. In nursing, caring is the core of nursing practice. As a profession, we need to develop theoretical knowledge based on research findings to form the foundation of nursing practice. Therefore, development and validation of nursing theory will help in strengthening nursing practice. It is also a source of professional autonomy and power, and it guides in nursing education, research and practice and differentiates nursing practice from other disciplines.





Nursing theory should, in general, have a significant impact on clinical practice. Patient care situations can usually be viewed within the context of some theoretical framework. Dorothea Orem's general theory of nursing provides one such framework. The theory essentially defines the need for nursing care. This need occurs whenever a person experiences some limitation or deficit which interferes with their ability to maintain self-care. Further, the theory delineates the various interactions which should occur between a nurse and a patient.




Dorothea Orem's general theory of nursing describes nursing as a complex form of deliberate interpersonal action that ultimately provides a helping human health service. She chose the name ‘deficit’ as it describes and explain a relationship between abilities of individual, their children or adults for whom they care. The notion ‘deficit” does not refer to a specific
type of limitation, but to the relationship between the capabilities of the individual and the need for action.




Working outside your home country is a great challenge; you will encounter a diverse culture wherein the acceptance of the plan of care varies to each individual. In my experience, especially here in the gulf region it is very difficult to apply in a clinical setting the theory of Orem because of several factors most likely with their health beliefs, culture, and perception towards their recovery. Like for example, a Middle Eastern patient complaint a minor cut injury on the distal toe but hemodynamically stable, majority of their basic ADL will be dependents to the nurses. Like for instance, he/she will ask to drink water even if it is within his/her reach and he/she is able to manage still they will call the nurse to spoon feed them like a small baby in diapers. In addition to that, even if the nurses will explain the importance of being independent and the theory of Orem will takes place in this case. However, they will not accept what you will tell them, instead you will be bad forever until they discharge. Their mentality is different, if they are sick they are really sick and you have to serve them like majesty.

Marlon Pandeling

Thinking about nursing is as important as doing nursing. The conceptual structure of the discipline of nursing must be known by those nurses who practice nursing and those who teach nursing. Nurses in practice must be able to identify the phenomena that are of concern to them, and must have a framework for reflecting on their practice. It is very important for us nurses to know the different theories in relation to nursing. Such theory is the self-care deficit theory by Dorothea Orem.

The focus of Orem's model of nursing is to enhance the patient's ability for self-care and extend this ability to care for their dependents .A person's self-care deficits is a result of their environment. Three systems exist within the professional nursing model: the compensatory system, in which the nurse provides total care; the partial compensatory system, in which the nurse and the patients share responsibilities for care; and the educative-development system, in which the patient has the primary responsibility for personal health, with the nurse acting as a consultant. The basic premise of Orem's model is that individuals can take responsibility for their health and the health of others, and in a general sense, individuals have the capacity to care for themselves and their dependents.

In application to my present job, the theory of Dorothea Orem is a very useful tool. It serves as a guideline to maintain my composure as a nurse. At present, I am assigned in a medical-surgical ward, a total care is very much more important in rendering nursing care to my patients.

Erlie Bobadilla

I have been in the Nursing Profession for two and half decades now and I can say that I am a living witness that the Theory of Self Care by Dorothea Orem became one of the foundations of Nursing Practice across all settings. Orem’s Theory can be applied to nursing assessment and evaluation of the nursing process where the emphasis is on the importance of how one’s ownself is important for maintaining life,health development and well-being.Nurse can easily make her assessments only where there is direct contact between her, the client, and the client’s family.

We all know that the nurses’ role wherever we are, is to help client sick or well to maintain or achieve level of optimal health and wellness of all our patients.We nurses must act as teacher,support person,friend,creating a conducive and therapeutic environment to all clients.

Nursing is the act of caring,nurturing and healing but as always it goes beyond simply caring for the patient with illnesses and diseases,it’s also caring for the person inorder for him/her achieve the optimal health and wellness both in body and spirit.

Sad to say,at present ,this is not really happening.Nursing now becomes a job not a vocation.Some people took nursing only to go abroad and earn money,to be able to provide their families with the material needs they want,to be able to give comfort to their families if working overseas,if working in the Philippines,their goal is to gain experience so they can work abroad.They are not really there for their patients.Most of them are task- oriented rather than patient-oriented.

Abroad we have all the latest technologies,computerize machines that we can use in rendering  and delivering care to all our patients,we connect them to monitors but we often forget that by simply touching our patients could make them feel well and even better. So I am calling all nurses,we have to act as advocate for our patients and let them feel that we are here for them to support and assist them till they achieve full recovery as guided by D.Orem’s theory. We have to let them know also that machines can help them for the diagnosis of their disease but we have to let them feel that we are always around 24/7 for them.

                             

Catherine Gemora

Being a nurse is no easy feat. One must wake up early in the morning or early in the evening to prepare for work come good or bad weather. Before going to the workplace, the nurse must make sure that her paraphernalias are complete, her uniform well pressed, her hair neat and tidy and most of all, her smile well plastered on her face.  Four years in college is never enough to be prepared for the experiences one earns on nursing practice. I, myself is a living witness on how challenging it really is.

I am a pediatric nurse in one of the government hospitals in my province. Five days a week, I face the gruesome reality that whether I like it or not, I’m going to take care of 15-20 patients in a ward. How could I render quality nursing care to my patients without compromising their health and mine? That is the question I ask myself every time. The reality discouraged me so greatly at first that I kept on doubting if indeed it is my vocation to enter the profession that I have chosen until I met a particular patient. Let’s call her X. X, a preterm baby, was admitted at the neonates ward for acute respiratory distress syndrome. She was intubated, with orogastric tube for feeding and on very close monitoring. Naturally as a healthcare giver, I assisted her on her daily basic needs. I gave her feeding, checked her oxygenation status frequently, aided her during elimination and comforted her significant others. Unconsciously, I was using Orem’s self care deficit theory, particularly that of the wholly compensatory mechanisms. After a month from admission, X’s status improved. She was weaned and was extubated successfully. Gradually she was able to tolerate breastfeeding. Nearly two months in the hospital, X’s condition greatly improved and was discharged. Having witnessed X’s fight to survive made me realize how fullfilling it is to be able to help the sick. Honestly, I have never expected that she will make it through. Because of her, I learned to love my profession. She unknowingly encouraged me to become the kind of nurse that I am now.

Orem’s theory is constantly applied in my nursing practice. Understanding the concepts on the significance of balance between the person’s self-care abilities and his or her universal self care needs helped me serve my clients in the most humane, compassionate and competent way possible. 

Ada Jamora

Dorothea Orem’s theory speaks about the Self Care Model. Self care deficit is the primary key to her theory because it identifies how much a patient needs a nurse. Nursing care is needed in order for a patient to reach his optimum health.

For me, the theory of nursing systems is very much important because this gives us a picture of the form of nursing and the relationship between patient and the nurse. This model consists of three components: First is the wholly compensatory mechanism where the nurse does everything for the patient. As a nurse in the gynecology ward for almost 16 months now, I’ve had patients who totally depend on nurses for their survival. An example of which is the patient who is intubated. The nurse does everything from turning the patient to sides, giving ample oxygen, suctioning secretions and giving medications.

The second component is the partly compensatory. Here both the nurse and patient perform measures to reach the maximum health of the patient. A patient coming from the PACU after how many hours when the anesthesia wears off, we nurses usually encourage patients to ambulate in order to prevent the postoperative complications. Here, assistance is needed in order for the patient to achieve this task.

The third component which is the supportive-educative system is very much appreciated in our ward. An example of which is the patients who gave birth outside of the hospital. Breastfeeding lectures and immunization schedules are included in the health education for them to give the optimal health the baby deserves.

Indeed, Dorothea Orem’s theory is very practical and is very much applicable not only in the hospital setting but also at home. We give care not only to our patients but primarily to our family as well. As a nurse, one must keep in his heart and mind the principles that this theory upholds.

Mohammad Yousaf

There exist many nursing theories. From Florence Nightingale’s “Notes on Nursing” in mid nineteenth century till now many nursing theorists has worked on different theoretical models for nursing practice, knowledge and research. Despite there differences and similarities, strengths and limitations the focus of all these nursing theories was to improve the patient care in different situations and different areas of clinical nursing practice. These provide a foundation for best possible nursing, teachings and nursing research. But there elapsed almost a century between Nightingale’s very primitive concepts to modern developed nursing theories.

Off course all these theories have some limitations and strengths, some are easy to understand and more practicable, while some are still in practice in limited fields of vast areas of nursing practice. Previously I had a very limited knowledge about the nursing theories, and only after having started this course and after my BScN program, I was able to understand and to know some about the nursing theories and how these were developed, After having gone through all the theories stated in this course, I came to conclude that the best out of existing nursing theories is the Orem’s Theoretical Model of self care deficit. I also impressed much from Leininger’s theory of culture care which is very much practicable in modern nursing while caring the multicultural clients. No doubt the basic needs of human being and the demand of better earning sources have forced the human to migrate from one area to another and other vital factor in migration of people from one place to another is the political upsets in different countries. It changed most of the societies to multicultural societies, developing some new norms and needs for adjusting in new societies. But still some basic cultural values remained unchanged within the specific group of people. Advances in the technology of communication, means of traveling, have made the whole world a global village. From its creation, human nature always sought of socialization, a very few groups of people or societies have remained isolated otherwise no place is left where multicultural people cannot be seen. Keeping all this in view Leininger’s culture care theory can be considered the best but this is not the only criteria to award it with the title of best nursing theory. We have to see which one theory is most commonly being utilized in nursing practice, for research and teaching purposes. Utilization of a theory in practical field is more important than having many theories in the body of knowledge of a particular discipline, from this point of view I see the Orem’ model more practicable providing better guidance for nursing practice, curriculums and research leading to an evidence based practice rather than an experience and observational based practice.

Dorothy Orem’s nursing theory was first published in 1971 and soon it gained popularity and acceptance among the nursing professionals (Kozier, ERB, Blais & Wilkinson 1998). According to Kozier et al, (1998), it stresses over the achievement of maximum individual’s self care so he could be able to achieve and maintain an optimal state of health. Orem defined individual as an integral whole, health a state of wholeness. She considered environment an external element to an individual. Man and environment, the both to her are the part of an integrated system which cannot be separated. Nursing to her is a service, an art and technology which helps an individual or a group of individuals or the whole community to fulfill its deficits whether these are physical, spiritual or psychosocial or relates to his lack of knowledge or information.

It is a client centered theory while the best nursing practice and goals are also considered client centered. The clients require nursing intervention most often are deficit of some physical ability, knowledge regarding it or some lack of information and/or motivation. It describes 3-dimentional aspects of individual life when he is able to perform his/her self care alone without assistance, when he/she is unable to do so and nursing interventions and in a condition where he is partially handicapped to fulfill the demands of self care. It helps nurses to set client oriented goals and provides a theoretical model to attain these goals.

It is very helpful in my area of clinical practice as oncology specialist nurse. The cancer patients in reality require more holistic nursing care , apart from their physical problems they face psychosocial and financial problems. They do not need only physical care but psychological support more than it. As cancer treatment is costly and prolonged, they face financial issues frequently. They lack knowledge about Chemotherapy and its side effects, Radiation therapy and its complications and management at home. So they need nursing intervention wholly and partly, they need education and support to maintain their optimal state of health. I think Orem's model addresses all these very well and utilized in practice here by our oncology nurse.

Basically Orem’s theory of Self-care Deficit is about the relationship between the nurse and the patient which became crucial in the process. The most interesting part is both parties have to do something in order to attain the stability of the patient.

As a Nurse, we are the first line of health care provider to attend the needs of the patient and expecting that we may experience several cases a day. Relating my own learning with Orem’s theory to clinical practical setting, supposing an unconscious patient was rushed into the hospital and a resident doctor found out t is stroke. A nurse should be oriented that the patient could no longer do certain activities for the moment and as Orem’s theory applies the nurse must act based on the three nursing system. 

Ailene Mangahas

Dorothea Orem’s self-care deficit theory can be applied to almost all settings, not just in the hospital, clinic, or nursing homes, but most especially at your own homes. The goal of the theory is to help person to perform self-care, irregardless of his age and developmental stage he/she is in. Assistance will only be needed if the individual is unable to meet his basic needs. At home, the mother is the primary caregiver just like a nurse in the clinical setting. She determines which among the fundamental needs are not met by her child from infancy to adulthood, what steps to take to enable her child to meet them, and how much self-care her child is able to perform. It is the mother’s goal to increase her child’s ability to independently satisfy these needs.

For me, child’s developmental milestones are part of childs’s premature awareness to self-care like learning to hold milk bottle with his own little hands, being toilet-trained, learning simple hygiene like handwashing, bathing, etc. At an early age, individual has learned about his universal self-care requisites and how to meet these needs for his survival like eating when hungry, drinking when thirsty, sleep during the night, rest when tired, get along with friends, and protect himself from injury. Having Orem’s theory of self-care in mind, as a mother and a nurse to my children, I must instill to them that these self-care practices they learned must be maintained in order to keep them healthy and will prevent them from being ill.

However, at certain points an individual experiences an inability to meet self-care needs and demands due to limitation like a presence of a disease or illness. Here comes the unique roleof the nurse to identify the self-care deficit, perform ways to compensate. The role of the nurse is not only limited to covering up the deficit but it also extends to educating the individual about the disease process including its causes, signs and symptoms, treatment regimen and its side effects, complications and how to prevent complications. A condition, like diabetes mellitus,is considered to be a lifetime condition. The goal of the treatment is not to cure the patient from being free of it but to keep the sugar as close to normal level as possible as to prevent its deadly complications.

My 69-year old mother-in-law, who is living with us, has been diabetic (insulin-dependent) and hypertensive for more than 20 years already. I am proud to share that being well-equipped with nursing knowledge,I have applied my supportive-educative role as a nurse to her care. I acted as her advocate, redirector, support person and teacher in the entire struggle for her condition. I help her revise many of her health practices and lifestyle. I taught her a lot of things about proper insulin administration like rotating sites of injection to avoid tissue atrophy (before she used to inject at 1 site only-the abdomen); single use of insulin needle/syringe to prevent infection; correct way of cleaning the site prior to injection-applying the principle of asepsis and antisepsis, cleaning from inner (the cleanest) to outer (the dirtiest); no rubbing after insulin injection to avoid abrupt absorption of insulin to the system that may lead to hypoglycemia; disinfecting the vial port with alcoholized cotton to prevent insulin from being contaminated. I also discussed with her the signs of hypoglycemia and to keep candies on hand if in case this happens or an intake of sweetened juice will also help reverse hypoglycemia. I explained to her the importance of adhering to antihypertensive maintenance drugs, to keep her blood pressure from shooting up. I also did counseling about diabetic and low salt low fat diet. Moreover, I encouraged her to have regular check-up with her endocrinologist and cardiologist and have her laboratory tests be routinely monitored. So far, her latest glycosylated hemoglobin indicates that her sugar is in good control, and her blood creatinine level is still within normallimits indicative of adequate renal functioning. She has now fully understood that it is not diabetes that will make her more ill but the complications the diabetes will bring her. So she has maintained self-care and promoted activities that that will keep health and well-being. She has taken full responsibility to care for herself despite the presence of a disease entity.

I mother three children, aged 10, 8 and 2 who have asthma, a condition that they inherited from their father. When they were younger, my role is partly compensatory in their adaptation to their condition. I have taught them ways to recognize the symptoms of an attack, and how to operate the nebulizer using the prescribed ratio of ventolin and saline solution, how to use the metered dose inhaler (but when they were a year old they used a special device called babyhaler), which steps to take when attack happens in school, the do’s and don’t’s to prevent it.The success of these interventions will be made possible if there is give and take actions between me and my client( my children, in this case). As their nurse, I perform, compensate for their limitation, assist them as needed. At the same time, their participation plays an integral part in the process. Like with the inhaler,after demonstrating to them its correct use , they must able to show me the proper way to do it with perfect timing for breathing/puffing in and holding breath for seconds after the pump.The condition is already given, they have to live with it and learn ways to adapt to it as part of their self-care so as to maintain their well-being. Now, my goal here is to be just a part of their supportive-educative system, that they will be participating and performing in most of their self-care, and I will just simply monitor and regulate their self-care.

In the clinical setting, such as in the operating room where I am assigned to work for more than a year now, Orem’s theory is not really that applicable since it is more appropriate in setting that requires long term care. However, post-operatively, the nurses act for the patient in the performance of therapeutic self-care especially those who were subjected under general anesthesia and spinal anesthesia.Immediately after the operation, the patient is transferred to post anesthesia care unit or recovery room, where the patient is continually evaluated until he/she becomes stable and fully awake. The immediate needs that the PACU nurse will give particular attention to the patient are: oxygenation, ventilation, circulation, level of consciousness and temperature. The patient is hooked to patient’s monitor to check oxygen saturation, blood pressure and pulse rates. Most of them are hooked to oxygen inhalation via nasal cannula mask if breathing mechanics has not yet fully recovered from effects of anesthetics and sedation. Respiratory rate and body temperature are also recorded every 15 minutes. It is the PACU nurses’ responsibility to help the patient maintain these needs since the patient is incapable of doing so because he/she is not fully awake, drowsy and disoriented brought by the anesthetics. Patients who had surgery under spinal anesthesia cannot move their legs and has decreased or no sensation from nipple line down to toes. Caregivers will help them get comfortable lying in bed. The sensation will go back 1-4 hours when the medication wears off. Oftentimes, post-surgery the patient experiences difficulty in urinating, then a straight catheter will be indicated to help them eliminate fluid. Thus, in the operating room, nurses’ role is wholly compensatory.

Therefore, I conclude that Dorothea’s self-care theory applies to many settings, not only in the execution of the nursing process in clinical areas, but also in our own home settings. Her theory is part of our daily living. Its application reflects how well we value our own lives, our own health and which steps are taking in order to keep one’s well-being especially our loved ones. I definitely agree with her proposal that each of us is responsible for our own self-care, and we, as nurses, are also accountable for health of the individual, family and community.

Frances Greg Bordon

Several years ago, I had this inkling that the reason why nurses (males and females, that is, and with exemptions to colored uniforms and scrub suits) don on white uniforms is to symbolize purity of heart and undying commitment to serve. I began to wonder if it is just the sole symbolism of the color or there might be others things that could be coined to it. After a long while during the course of my practice as a professional nurse, I realized something radical. It made me think of the reason why nurses wear the classic white uniform is to show the client we are there to get dirty just to make them clean. Quite ironic, because nurses embody cleanliness, but our uniforms are prone to stains because of bedside nursing care. I told myself it is ok to get a bit dirty, only a bit, while caring and nursing my clients for them to look clean, feel good and smell good. It is quite heartwarming to see clients looking good after you did something for them. That overrides the dirtiness of our uniforms. However, I guess this is where the creation of protective gowns started to function: to maintain cleanliness of BOTH the nurse and the client. It is therefore not a valid excuse for nurses to be poorly groomed and unhygienic simply because you nurse at the bedside. It is unsightly to be in a nursing unit where all the nurses look clean and smell good whereas their patients appear disheveled. I think of these nurses as professionals who may not have used the Theory of Self-Care Deficit.

In what ways would these nurses are liable to negligence because of failure to use the theory? First possible reason is that there are nurses who fail to address FEEDING, BATHING/ HYGIENE, DRESSING/GROOMING, and TOILETING needs of their patients. For me, these are the BASIC and CORE bedside nursing considerations and other complicated/sophisticated procedures, medications, equipment, nursing techniques and skills would come only secondary. If we can meet these properly, then we really are nurses and caregivers. Many nurses would instruct patients to do these tasks on their own even if they cannot perform it fully. Orem’s theory also advocates promotion of independence. However, nurses give clients full independence despite their actual failure to meet self care needs. Second reason might be that nurses are bombarded with several tasks in the unit (doing clerical works, poor nurse patient ratios, and the like) that their time to meet self care needs of patients is limited. Third perhaps is the attitude of nurses in general like laziness, disgust of patients’ excreta, aversion to touch and bedside nursing, and probably lack of interest to become a nurse per se. All of these and other possible factors may lead to the downfall of the profession if Orem’s theory is not evidently used in health care settings.

I have worked in some public and private hospitals here at Iloilo City and Metro Manila. There I have seen how unfair nurses are to clients especially if they differ in socio- and economic factors. If clients are affluent, rich, and influential in the society, nurses tend be so submissive to all their requests. Every call of clients in the intercom is answered promptly. But nurses behave differently in front of low income patients. Their needs for diet, medications, bathing hygiene, referrals, etc are most of the time delayed.

In my experiences, I have seen myself doing the same things.

It is only now that I am an instructor I have realized I bypassed Caring Procedures to my previous patients. I was so engrossed before to gaining knowledge and skills that I forgot the basic function of the nurse and that is to meet client self-care needs primarily. Now I am applying the concepts of Orem’s theory in my work as a nurse and instructor. I see to it that all my students would care for their assigned patients like the way they care for a loved one. I make sure that all of my patients are properly fed, bathed, groomed, and toileted regardless of race, color, socioeconomic status, and religion. We support independence of clients and involve them in their own care. I do bedside nursing myself to demonstrate to students and family members how caring needs can be met. I always remind myself and my students that a simple touch therapeutically used goes a long way in caring and treating clients, and that the appearance of their clients greatly reflects the kind of nurses they have. I spend some time to actually supervise students in bedside nursing care. We make sure our clients are comfortable and feeling good throughout the shift. If we have established it, then we can proceed to other aspects of nursing care.

The concepts of Orem’s Theory continue to reverberate in the annals of nursing practice and history. If we utilize this theory in our practice, time will come no nursing client around the world will be displeased of nurses, no client will ever be smelly and dirty, no client will suffer from malnutrition and elimination related problems, and no client will be naked and exposed of unnecessarily. We have satisfied our clients and our God in their bodies and spirits.

God bless all nurses around the world. We will continue to care more and give unconditional love to all our clients.

Vincent Duncano

As a former critical care nurse assigned in the coronary care unit, I took care of patients whose usual diagnoses would be status-post coronary artery bypass graft, post cardiac arrest secondary to severe myocardial infarction, coronary artery disease, dyslipidemia, s/p thrombolytic therapy secondary to unstable angina/myocardial infarction, status-post percutaneous transluminal coronary angioplasty or PCI with stenting, congestive heart failure, etc. Patients, especially those who are admitted comatose, may have numerous contraptions on them such as but not limited to endotracheal tube/tracheostomy tube hooked to mechanical ventilation, Swan-ganz for hemodynamic monitoring, arterial line for BP monitoring, with central access for continuous renal replacement therapy or the conventional dialysis among others. These aside from the usual foley catheter, nasogastric tubes, chest tubes, and multiple parenteral lines, etc. We categorized patients as level III and level IV according to their dependency and to the number of hours required for nursing. Imagine that and for a novice nurse, I’m sure, that is enough reason not to report for duty, just like what happened to me on my first day.

Having considered my profession as a vocation, I adhere to the principles and concepts postulated by Dorothea Orem on her self-care deficit theory. I took it to heart that every time I am on duty, my patients will have my utmost care in a very compassionate manner. I was their voice when they can’t speak, their hands when they can’t feed, their cane when they have hard time moving around, and their “yaya” when they can’t bath. They were always informed on what’s going to be done to them. I always have stored supplies of shampoo, soap, toothpaste and comb for those whose relatives forget to bring. On many occasions I also feed their spiritual needs by encouraging them to watch religious shows on TV. It takes patience, understanding, and compassion to serve those who can’t physically, emotionally, psychologically and spiritually take care of themselves. And it needs additional dedication to learn new ways to help such patients. 

Hay, those were the days… and now I miss working in such a tedious, “toxic” environment. And you ask why? The satisfaction you’ll get in helping people recover from their illness and seeing them move out of your unit in stable condition, with a big smile plastered on their face, and verbalizing unending praises of thanks, is really priceless. It compensates for the meager income you receive as a staff nurse.

And now that I am an educator, I try to impart to my students the value of respecting every person, regardless of his stature in life, age, gender, spiritual beliefs and health condition. I emphasize the importance of being a nurse, a member of the health team and co-equal of the doctor in dispensing care. I teach them that nurses should be patient advocates, giving utmost quality care in the most compassionate manner. And that nurses should not underestimate the importance of education, skills and attitude on patient care.

According to Orem, self-care is the “the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health and well-being” (Meleis, 2005). Care of self is not only an activity limited to that person but it can also be provided by his significant others, the community where he belongs or by nurses and other members of the health team. Such is true when the person is suddenly unable to perform self-care independently due to an illness. It is at this point of time that the services of the nurse are needed. It is required though that the nurse should possess the skills needed to perform activities and procedures, knowledge to comprehend the reason for the condition and for the actions to be taken, and the right attitude to deal with an entity that is by himself very dynamic in nature. The nurse is required to possess such characteristics so as to help/assist the client recover from his disease state without harm.

In Orem’s point of view, the nurse is the client’s partner, the personality who will act on behalf of the patient when needed. A nurse should be a patient advocate; advocate for the welfare of his patient. For her, the nurse should possess interpersonal and social processes and technologic-professional operations to be an effective self-care agent. And since nursing is an art based on science, the nurse, as a professional, should observe the nursing process of assessment, planning intervention, and evaluation to be effective and efficient in taking care of patients who are wholly or partly dependent on the health team for their recovery.

The concepts, principles and assumptions of Dorothea Orem’s Self-care deficit theory are very much applicable to the critical care unit setting. In this specialized nursing area, most of the clientele really are dependent on the nurses’ assistance for their nutritional, physiological, emotional, physical and spiritual needs. They need our help/services until such time they recover and perform those on their own.

It is for the above-stated reasons that some say this theory is applicable to all situations regardless of time, condition and place. Let me say this though. I do believe that other nursing theories are also applicable to the critical setting such Nightingale’s Note’s on Nursing, Maslow’s Hierarchy of Needs, Leininger’s Transcultural Nursing Theory, Orlando’s Dynamic Nurse-Patient Relationship, Abdellah’s Patient-Centered Approaches among other. It is only that as a critical care nurse, one can really experience the dependency of those who are critically ill and thus value the importance of a nurse in such a setting to the fullest.

Godspeed to us all!