Analyze and evaluate a middle range theory. You will select a middle range theory and identify application of nursing theories into clinical practice-Discuss the major concepts of the theory Philosophical basis or worldview change, advancing health Structural aspects of the theory

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Subject: Nursing

The application of nursing theories in clinical practice is a fundamental aspect of modern healthcare. These theories provide a structured framework for nurses to understand, assess, and implement care strategies for patients. One such theory that has significantly influenced nursing practice is the “Self-Care Deficit Nursing Theory” developed by Dorothea Orem.

Historical Development

Before delving further into the analysis and evaluation of this theory, it’s essential to understand its historical development. Dorothea Orem, a prominent nursing theorist, developed this theory in the 1950s and 1960s as a response to the changing landscape of healthcare. During this period, there was a growing recognition of the need to empower patients to take an active role in their care, particularly as healthcare settings were transitioning from a more paternalistic approach to a patient-centered one.

Components of the Theory

The Self-Care Deficit Nursing Theory comprises three interrelated theories, each with its own set of major concepts. These theories are:

  1. Theory of Self-Care: This component emphasizes the individual’s capacity to engage in self-care activities. Self-care is defined as the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being (Orem, 1995). The theory of self-care outlines the importance of assessing an individual’s self-care abilities and identifying areas where assistance may be required.
  2. Theory of Self-Care Deficit: This theory recognizes that there are instances when individuals cannot meet their self-care needs independently due to various factors such as illness, injury, or developmental limitations (Taylor & Renpenning, 2019). The theory of self-care deficit highlights the role of nursing in providing care and support when there is a deficit in an individual’s ability to perform self-care activities.
  3. Theory of Nursing Systems: The third component of Orem’s theory, the theory of nursing systems, defines the various methods and strategies that nurses employ to meet the self-care needs of individuals (Orem, 2001). It involves the systematic assessment of a patient’s self-care requisites and the development of a plan to address these requisites through nursing interventions.

Philosophical Basis and Worldview Change

At the core of the Self-Care Deficit Nursing Theory is a humanistic and pragmatic worldview. This philosophical basis recognizes the inherent dignity and worth of each individual and emphasizes their capacity to engage in self-care (Sitzman & Eichelberger, 2017). This perspective aligns with the evolving paradigm shift in healthcare towards patient-centered care.

The theory encourages a significant shift in how healthcare is delivered. It promotes a transition from a model where patients are largely passive recipients of care to one where they are active participants in their own health and well-being. This shift is particularly relevant in today’s healthcare landscape, where patient autonomy and empowerment are highly valued.

Structural Aspects of the Theory

The structural aspects of the Self-Care Deficit Nursing Theory encompass the three major components mentioned earlier. These components work in tandem to guide nursing practice.

  1. Self-Care Agency: Self-care agency refers to an individual’s ability and motivation to engage in self-care activities (Orem, 1995). It encompasses their knowledge, skills, motivation, and confidence in managing their own care. Nurses play a crucial role in assessing and enhancing a patient’s self-care agency.
  2. Self-Care Requisites: Self-care requisites are the specific actions and behaviors required for maintaining health and well-being (Taylor & Renpenning, 2019). These requisites are determined through a comprehensive assessment of the patient’s physical, emotional, and social needs. Nurses use this information to identify areas where support and intervention are needed.
  3. Nursing Systems: Nursing systems represent the strategies and methods employed by nurses to meet the self-care needs of individuals (Orem, 2001). This includes the planning and implementation of care, education and guidance provided to patients, and ongoing evaluation of the effectiveness of nursing interventions.

Application in Clinical Practice

One of the critical aspects of evaluating a nursing theory is assessing its practical applicability in clinical settings. In the case of the Self-Care Deficit Nursing Theory, its application is particularly relevant in the care of patients with chronic illnesses such as diabetes.

Diabetes is a complex chronic condition that requires ongoing self-care management. Patients with diabetes must monitor their blood glucose levels, administer insulin or other medications, follow dietary restrictions, and engage in regular physical activity. Orem’s theory can be instrumental in addressing the self-care deficits that individuals with diabetes may experience.

In this context, nurses can assess the patient’s self-care agency by evaluating their knowledge of diabetes management, their motivation to adhere to treatment regimens, and their confidence in managing their condition (Hartweg, 2019). Self-care requisites specific to diabetes care can be identified through a comprehensive assessment, taking into account factors such as dietary preferences, cultural considerations, and access to healthcare resources. Nursing systems can then be tailored to provide the necessary support and education to empower patients in self-care management.

Strengths and Weaknesses of the Theory

Like any nursing theory, the Self-Care Deficit Nursing Theory has its strengths and weaknesses. One of its primary strengths is its patient-centered approach, which aligns with modern healthcare trends (Smith, 2018). This approach recognizes the unique needs and preferences of each patient and encourages nurses to collaborate with patients in setting self-care goals and developing strategies to achieve them.

However, a potential weakness of the theory lies in its complexity. The comprehensive assessment and planning required by the theory may make it challenging to implement in fast-paced clinical settings where time and resources are limited. Additionally, while the theory acknowledges the importance of individual autonomy in self-care, it may not fully account for the sociocultural and economic factors that can influence an individual’s ability to engage in self-care (Lubin, 2020).

Use of Theory in Clinical Practice

The use of the Self-Care Deficit Nursing Theory in clinical practice has been widely documented in nursing literature (Walker & Avant, 2019). Nurses have successfully applied this theory in various healthcare settings, particularly in the context of chronic disease management.

One of the key challenges in applying this theory is the need for comprehensive patient assessments to determine self-care deficits accurately. This requires skilled and knowledgeable nurses who can thoroughly evaluate a patient’s self-care agency and requisites. Additionally, the application of the theory may require a shift in the traditional nurse-patient relationship, where nurses act more as facilitators of self-care rather than direct caregivers (Hartweg, 2019).

To make this theory more usable and applicable to practice, healthcare organizations can invest in training and education for nurses. This includes enhancing their assessment and coaching skills related to self-care. Furthermore, integrating technology and telehealth solutions can help bridge the gap in supporting patients’ self-care activities remotely, providing ongoing guidance and monitoring.

Evaluation of Theory

In evaluating the Self-Care Deficit Nursing Theory, it’s important to consider whether the theory is used effectively to understand and apply into practice (Smith, 2019). The extensive literature on the theory’s application suggests that it has indeed been employed successfully, particularly in the context of chronic disease management.

However, some difficulties in its application exist. One challenge is the need for additional training and resources to support patients effectively in their self-care efforts. This may include patient education materials, access to healthcare professionals for guidance, and ongoing monitoring of self-care activities.

Furthermore, the implementation of this theory may require a cultural shift within healthcare institutions. It involves moving from a traditional model of care delivery to one that empowers patients to take a more active role in managing their health. This cultural shift can be met with resistance from both healthcare providers and patients.

In conclusion, middle range nursing theories like the Self-Care Deficit Nursing Theory provide a valuable framework for enhancing clinical practice (Jones & Johnson, 2020). While they may have their strengths and weaknesses, these theories offer a patient-centered approach that aligns with modern healthcare paradigms (Sitzman & Eichelberger, 2017). Through ongoing research and adaptation, these theories can continue to evolve and contribute to improved patient outcomes and nursing practice.


Hartweg, D. L. (2019). Middle Range Theories for Nursing. Routledge.

Jones, P. S., & Johnson, K. L. (2020). Middle-Range Theory Development Using Kings Theory of Goal Attainment: A Conceptual Framework for Nursing Practice. Nursing science quarterly, 33(3), 254-259.

Lubin, S. (2020). Application of Middle-Range Theory in Nursing Research and Practice: A Review of the Literature. Journal of Nursing Education and Practice, 10(12), 24-28.

Orem, D. E. (1995). Nursing: Concepts of practice. Mosby.

Sitzman, K. L., & Eichelberger, L. W. (2017). Understanding the work of nurse theorists: A creative beginning. Jones & Bartlett Learning.

Smith, M. C. (2018). Middle-Range Theory for Nursing. Springer Publishing Company.

Taylor, S. G., & Renpenning, K. M. (2019). Nursing theory: Utilization & application. Mosby.

Walker, L. O., & Avant, K. C. (2019). Strategies for theory construction in nursing. Pearson.

Frequently Asked Questions (FAQs)

FAQ 1: What is the Self-Care Deficit Nursing Theory, and who developed it?

Answer: The Self-Care Deficit Nursing Theory was developed by Dorothea Orem, a prominent nursing theorist, in the 1950s and 1960s. It is a framework that emphasizes an individual’s capacity for self-care and the role of nursing in providing care when self-care deficits exist.

FAQ 2: How does the Self-Care Deficit Nursing Theory align with modern healthcare trends?

Answer: The theory aligns with modern healthcare trends by promoting a patient-centered approach and emphasizing patient autonomy and empowerment. It encourages a shift from a traditional model of healthcare to one where patients are active participants in their own care.

FAQ 3: In which clinical settings is the Self-Care Deficit Nursing Theory commonly applied?

Answer: The theory has been widely applied in various healthcare settings, particularly in the context of chronic disease management. It is relevant in settings where patients require ongoing self-care support and guidance.

FAQ 4: What are the strengths of the Self-Care Deficit Nursing Theory in clinical practice?

Answer: One of the strengths is its patient-centered approach, which allows for individualized care plans. It also promotes collaboration between nurses and patients in setting self-care goals and strategies.

FAQ 5: What challenges may healthcare organizations encounter when implementing this theory in practice?

Answer: Implementing the Self-Care Deficit Nursing Theory may require additional resources for patient education, support, and monitoring. Additionally, it may necessitate a cultural shift within healthcare institutions to embrace a more patient-centered approach to care delivery.

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