Orem's self-care deficit nursing theory: its philosophic foundation and the state of the science.
There is a preponderance of descriptive studies, ranging from those using a simple descriptive correlational approach to multivariate approaches. Only one study is clearly identified as an experimental study (Moore, 1987) and two clearly identified as replication studies (Lenatsch, 1999; Schott-Baer, Fisher, & Gregory, 1995). Fewer than half make clear links between the variables being examined and situations of nursing practice; that is, they examine elements of the theory of self-care without making the link to nursing practice an explicit part of the study. While this work is increasing our knowledge about self-care (Stage II), further work needs to be done to put the results of these in the context of nursing practice as in Stages III, IV, or V. Most of the studies reviewed are Stage II and provide an enhanced or broader description of an element or component of the theory, empirically describing the relationships between or among age, gender, self-care actions, disease, and so forth. These studies add to our understanding of existing and known or proposed relationships within the extant theory. The majority of studies examine self-care and/or self-care deficits. There are many studies but little evidence that sustained research programs are developing and expanding the theory. The bricks are piling up around the framework, but only a few scholars are working on building the walls. These programs of research are occurring in universities where a critical mass of interested scholars and students can be found. The use of theoretical language is sometimes imprecise and at other times inaccurate. Valid new terms are introduced but the relationship to existing theoretical constructs is not always explicit. There is little critical review of research in the literature. Ongoing dialog among scholars is minimal. There is a need for nurse scholars to come together and to engage in such a dialogue to enhance the work. Given the relatively short history of nursing research and, more importantly, the conduct of nursing theory-based research, the number and quality of the work being conducted is quite remarkable. There has been a substantial amount of work produced and the quality of it has improved over time. Orem has provided nurse researchers with a theoretical system comprising an ontological structure, related epistemology, and numerous models that give direction to scholarly efforts. Scholars using this theoretical system would be well-advised to use these in conceptualizing and interpreting their work.