The nursing profession has experienced a mushrooming of theory development over the past three decades. One of the more significant of the nursing theories to emerge from this activity is Dorothea Orem's conceptual framework of nursing, which is most often referred to as the self care nursing model. I am going to review the development, structure, application, and evaluation of the self care model.
As nursing consultant to the Indiana State Board of Health from 1949 to 1957, Orem was exposed to the broad range of nursing activities and responsibilities. This exposure provided her with the experiences and observations which, in turn, led to the development of the initial ideas which were eventually synthesized into her self care nursing model.
As early as 1956, Orem recognized that patients are often limited in their capacity to provide self care, or to participate intelligently in their own care, and that the process of nursing, to a great extent, involves dealing with problems stemming from these conditions. Thus, in the persuit of solutions to these problems, she sought answers to such questions what do nurses do? why do nurses do what they do? what should nurses do? what are the outcomes of what nurses do?
In 1959, Orem introduced the elements of her self care conceptual framework. At that time, she stated that nursing involved both a mode of thinking and a mode of communication, and that nursing requirements are modified and eventually eliminated, as an individual becomes more proficient in self care. Over the following 20 years, she continued to modify and refine her conceptual framework of nursing. During this period, Orem developed the idea that the art of nursing is creative, in that it requires the development on the part of the nurse of an ability to envision valid modes of helping in relation to outcomes which are appropriate. She added that the art of nursing is expressed by the individual nurse thro...