NURSE PRACTICE & ORGANIZATIONAL CHANGE THEORIES 2Nurse Practice and Organizational Change Management Theories: Orem’s Self-Care Deficit Theory and the Systems Theory

Introduction

At the doctoral level, nurses must possess advanced doctoral-level competencies to
practice at a higher level. These include scientific underpinnings to nursing practice, leadership
and organizational leadership skills for quality improvement, analytical and clinical scholarship
techniques for EBP (evidence-based practice), knowledge of technology/information systems,
and patient healthcare technology for transformation and improvement (Gonzalo, 2021).
Additional competencies include interprofessional collaboration to enhance population and
patient health outcomes, knowledge about health care policies to advocate for patients, nurses,
and the nursing profession, and proficiencies in population health and clinical prevention to
improve public health at the local, state, and federal levels. Most importantly, DNP nurses must
be informed of the theoretical foundations that underpin nursing practice and apply them to
improve the profession.
In this research paper, I will address four things. Firstly, I will examine the key concepts
underpinning the Systems Theory and Orem’s Self-Care Deficit Theory, including their shared
aspects. Secondly, I will identify a gap in practice and explain how the two theories can
influence practice change to address the gap. Next, I will explore how the chosen theories impact
health care at the national and global levels. Finally, I will examine how change happens in the
current organization I work for, whether it occurs according to a known theoretical framework or
not, and what guides the difference if it exists.
Orem’s Self-Care Deficit Theory and the McKinsey 7S Organizational Change Model
I. Orem’s Self-Care Deficit Theory

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Self-care is a concept that broadly refers to ‘the practice of events that people or
communities initiate and undertake on their ‘own’ behalf in sustaining wellbeing, happiness,
health, and life to cope with stress, physical injury, disability, disease, or any debilitating
condition. Nurse theorist Dorothea Orem coined Orem’s Self-Care Deficit Nursing model to help
patients control their “own” self-care initiatives and interventions (Gonzalo, 2021). The paradigm
primarily focuses on encouraging and empowering people to leverage their knowledge,
aptitudes, and abilities to self-care and self-therapy.
The scope of self-care activities includes self-medication, disease control, prevention,
health promotion, rehabilitative and palliative care, seeking specialist/hospital care, and
considering dependent individuals. The foundation of self-care is anchored on the reasoning that
the “individual” holds the key to respond to symptoms, shake off a disease, achieve happiness, or
preserve health by acting or not acting. Self-care entails various factors, including
socioeconomic, self-medication, environmental, lifestyle, nutrition, and hygiene. Some of the
fundamental principles of self-care are self-efficacy, personal responsibility, autonomy,
empowerment, and self-reliance (Khademian, Ara, & Gholamzadeh, 2020).
Therefore, Orem’s theory holds five presumptions. Firstly, humans must endlessly
connect and communicate with each other and the environment to remain functional and healthy.
Secondly, people must leverage their inherent authority to “act deliberately” to pinpoint gaps in
their “own” health and wellbeing and then take actions or make personal judgments. Thirdly,
human beings encounter adversity and hardship in caring for themselves or others, especially
when making function-regulating or life-sustaining actions. The theory also assumes that “human
agency” is only exercised when people, authorities, or communities discover, develop, and
transmit to others means and ways to determine their “own” needs and those of others and take

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actions to affect “own” self and others positively. Finally, groups or communities with structured
relationships allocate responsibilities and cluster tasks for delivering care to team members.
The Self-Care theory is classified into three interconnected models: the idea of self-care,
the theory of nursing systems, and the self-care deficit theory (Younas, 2017). The “Self-Care”
theory focuses on actions that people initiate and execute for their “own” health, wellbeing, and
life. Orem identified three categories of “self-care requisites” or necessities that guide “self-care”
actions or activities, including universal, developmental, and health deviation. Universal self-
care requirements are those requisites linked with life processes and preserving functioning
integrity and human structure. They include maintaining adequate food, water, and water;
sustaining a balance between rest and activity; balancing social interaction and solitude; and
preventing hazards and risks to human development and functioning. The second category of
requisites, “development,” is the specific expressions of “universal self-care” requirements that
have been tailored for only developmental purposes and processes. The last category of
requisites, health deviation, are critical conditions needed during disease and injury or may occur
due to medical interventions required to diagnose and treat an illness or injury (Younas, 2017).
Dorothea’s second theory, Self-Care Deficit, is often called into action when “nursing”
care is required, mainly if an adult is limited in or unable to deliver ongoing effective self-care to
the ‘self.’ Dorothea proposed a few techniques to assist such individuals, including providing
guidance, acting on their behalf, supporting them, creating an environment that promotes
personal growth, and teaching them. Finally, the “theory of nursing system” results from a range
of relationships between a healthcare provider (nurse) and a client or patient. This structural
arrangement arises when the patient’s therapy needs to override the existing “self-care”
machinery, resulting in nursing.

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II. The Systems Theory
The “Systems” theoretical approach looks at an organization as a “whole” structure
consisting of several synergistically interrelated and interacting factors (Wilkinson, Armstrong,
& Lounsbury, 2017). These variables include the environment, the physical setting, formal
structure, technology, and people. It emphasizes the need for managers not to tackle issues
separately but focus on their interactions. For that reason, the theory insists that the management
adjusts several factors to function correctly, survive, grow, maintain organizational integrity, and
outshine its competitors. The approach requires managers to view their institutions as “open
systems” because neither plans nor objectives can potentially be created in a “closed” structure.
They must consider external factors (such as emerging technologies, competitors, government
regulations, markets, and their employees) and internal variables (like employees, inventory, and
production processes). Considering these factors entirely is the only way to ensure the company
operates effectively, efficiently, and successfully.
III. Similarities between the Theories
Although they are inherently unique, Orem’s model and the Systems approach share one
similarity: they propose looking at issues holistically and providing all-inclusive solutions.
Orem’s self-care requires nurses to empower their clients to care for themselves by considering a
broad range of individual and community factors, including socioeconomic, self-medication,
environmental, lifestyle, nutrition, and hygiene (Gonzalo, 2021). In the same measure, the
Systems theoretical approach requires that managers look at organizational issues “holistically,”
ranging from the environment, the physical setting, formal structure, technology to people. In
this case, people might include clients (customers), industry regulators, suppliers, employees,
and community members. According to Chikere & Nwoka (2015), these individual factors often

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work synergistically to ensure the “whole” organization or “system” functions effectively, and
defects in any part can lead to malfunctions or inefficiencies.
A Gap in Nursing Practice

Quality of care is among the few critical patient-related outcomes affecting the nursing
practice. Quality of care is a concept that refers to the extent to which health processes and
services for populations or individuals enhance the potential of achieving anticipated health
outcomes. Health care is equitable, efficient, timely, patient-centered, integrated, people-
centered, effective, and safe. Despite being one of the fundamental determinants of health
services, evidence points to a society (national and global) that is constantly experiencing
disparities and gaps in health care quality. For example, statistics show that low-and middle-
income nations register about 15 percent (5.7-8.4 million) mortalities annually more than
developed countries due to poor-quality care. More so, approximately one in three individuals
report encountering negative experiences with their health care systems, including long waiting
times, short consultations, and disrespectful care (World Health Organization, n.d.).
There are specific ways in which Orem’s model and the Systems theory can initiate and
operationalize change: that is, improving the quality of care at the patient and community level.
Orem’s model will advocate identifying specific problems of affected individuals and
communities and implementing change from three theoretical perspectives: self-care, nursing
systems, and the self-care deficit. The “self-care” model will propose determining patient and
population “requisites” (self-care health deviation, developmental, and universal) and “deficits”
and implementing “self-based” interventions to address specific problems. These include
carrying out standard and evidence-based diagnostic tests, therapies, prevention, and

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rehabilitation. The whole approach is ingrained in helping patients gain the necessary “self-care
agencies” or abilities to perform self-care.
On the contrary, the “Systems” approach will root for quality improvement by
considering the “complete” picture of the interrelated factors that might be contributing to poor
quality of care, including patients, healthcare workers, administration, nursing processes,
socioeconomic, environment, and regulatory functions, among others. The idea is to address
individual factors that affect the functioning of the entire healthcare system-specific variables
contributing to poor quality of care. For example, suppose the problem stems from a lack of
medication adherence. In that case, the Systems approach will advocate for awareness creation
and health promotion to enlighten patients to take their drugs at the right time and the prescribed
dosage.
How the Two Theories Influence Health Care at the National and Global Level
All theoretical concepts, including Orem’s model and the Systems approach, can impact
health care practice at different organizational levels, such as local, regional, national, and
global. For example, at the federal level, Orem’s theory advocates for nursing interventions to
assist patients and populations in meeting their self-care “deficits,” including hygiene, dressing,
feeding, toileting, and speech. For instance, nurses can help patients maintain their “own”
hygiene by motivating and prompting them through reminders to bathe and wash up. Nurses can
also campion changes that directly impact patients’ “self-care” abilities and efforts, including
socioeconomic, physical, and environmental. Nurses can achieve advocacy by joining national
associations like ANA. At the global stage, advocacy can be done through international
organizations like WHO and the UN. Orem’s theory would consider health outcomes of specific
countries and will propose tailored interventions to help these nations achieve “self-care.”

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Unlike Orem’s model that focuses on nursing practices and helping patients achieve self-
care, the Systems approach looks at solutions to healthcare problems from a broader perspective.
At the national level, the System model will consider all the “national” social determinants of
health that affect the wellbeing and health of individual citizens and various populations. These
variables include social support networks, healthcare system, employment, food, physical
environment, neighborhood, education, and socioeconomic status (Artiga & Hinton, 2018). For
instance, in the U.S., the Systems approach can consider factors like quality of care, nurse
cultural competency and linguistics, health coverage, and nurse-to-patient ratios across all states.
Globally, the Systems approach will look at the same social determinants of health but on an
international scale. It will consider the specific country-based or region-based elements and
networks that impact the planet’s functioning, health, and safety, such as conflicts, air travel, and
vaccine distribution.
How change Occurs occurs Organization I currently Work for and Whether the Change

Follows a Theoretical Framework.

Change is inevitable in today’s globalized, tech-dependent, and highly competitive
organizational settings, including the healthcare industry. At some point, every company or
institution will change or transition to remain competitive, profitable, or viable. Typically,
“change” is defined as the decisions or actions that prompt a firm to alter an essential ingredient
of its establishment, such as internal processes, infrastructure, underlying technologies, and
culture (Flovik, Knardahi, & Christensen, 2019). In my current workplace, change follows
Nudge’s theoretical framework. Typically, what happens is that the management makes indirect,
subtle, and evidence-based suggestions and then “nudges” or “pushes” employees to accept the
change it desires. The notion is that ‘nudging’ change is more effective compared to strictly

NURSE PRACTICE & ORGANIZATIONAL CHANGE THEORIES 9
enforcing it. Our firm follows Nudge’s theory seven steps: defining change, considering
employee perspectives, providing evidence to determine and justify the options selected,
presenting change as an option, listening to employee feedback, limiting choices, and solidifying
change with short-term achievements (Lofgren & Nordblom, 2020). Orem’s model centers on
encouraging and empowering people to leverage their knowledge, aptitudes, and abilities to carry
out self-care and self-therapy.

Conclusion

Orem’s Self-Care Deficit Nursing model and the “Systems” organizational model are two
fundamental approaches that can guide DNP-prepared nurses in making informed clinical and
management decisions. The “Systems” model looks at an organization as a “whole” structure
consisting of several synergistically interrelated and interacting factors. These theories can help
nurses identify gaps in practice (such as poor quality of care at the national and global level or
ineffective nursing leadership) and propose viable, evidence-based interventions.

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References

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Chikere, C. C., & Nwoka, J. (2015). The systems theory of management in modern-day
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care_deficit_theory
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