theory, “self-care” is described as learned behavior,
and the activities of self-care are learned according
to the beliefs and practices that characterize the
cultural way of life of the group to which the indi-
vidual belongs (Orem, 2001). The individual first
learns about cultural standards within the family.
Thus, the self-care practices that individuals em-
ploy should be understood and examined by nurses
within the cultural context of social groups and
within the health-care systems of societal groups.
The theory provides a means to study the types of
self-care needs identified by specific cultural groups
and the acceptable cultural self-care practices to
meet the needs (Meleis, Isenberg, Koerner, Lacey, &
Stern, 1995).
In contrast to these studies that are focused on
clinical populations experiencing health-deviation
self-care requisites, Hartweg’s research centers on
health promotion and has been extended cross-
culturally. Hartweg (1990) conceptualized health
promotion self-care within Orem’s Self-Care
Deficit Nursing Theory and went on to explore
through a descriptive study the self-care actions
performed by healthy middle-aged women to pro-
mote well-being. The women studied were able to
identify over 8,000 diverse self-care actions, the ma-
jority of which were related to the universal self-
care requisites (Hartweg, 1993). The interview
guide used with this American population has
recently been validated with healthy, middle-aged
Mexican American women in a comparative study
(Hartweg & Berbiglia, 1996). Whetstone (1987)
and Whetstone and Hansson (1989) also con-
ducted cross-cultural comparative studies using
self-care concepts. They compared the meanings
of self-care among Americans, German, and
Swedish populations.
In addition to the cross-cultural comparative re-
search, the Self-Care Deficit Nursing Theory is
being applied in studies with specific cultural
groups. In an ethnographic study based on con-
cepts within Orem’s theory, Villarruel (1995) ex-
plored the cultural meanings, expressions, self-care,
and dependent care actions related to pain with a
Mexican American population and commented on
the theory’s use with this population. Dashiff
(1992) applied Orem’s theory in her description of
the self-care capabilities of young African American
women prior to menarche.
Nurse scientists beyond our national borders
are currently using the Self-Care Deficit Nursing
Theory as a basis for their research. Professor
Georges Evers at the Catholic University of Leuven
in Belgium has developed an extensive program of
research based on the theory. His program includes
descriptive and explanatory studies of the self-care
requisites and self-care capabilities of diverse clini-
cal populations, the development and psychomet-
ric testing of instruments to measure self-care
concepts, and the testing of interventions to en-
hance self-care performance (Evers, 1998).
Orem’s theory is also being applied by Jaarsma
and colleagues as a basis for an ongoing program of
research with cardiac patients in the Netherlands.
Using a questionnaire derived from the self-care
requisites described in the Self-Care Deficit
Nursing Theory, Jaarsma, Kastermans, Dassen, and
Philipsen (1995) identified problems frequently en-
countered by cardiac patients in the early recovery
phase from coronary artery bypass surgery or my-
ocardial infarction. With a population of patients
with advanced heart failure, Jaarsma, Halfens,
Senten, Saad, and Dracup (1998) identified the
therapeutic self-care demand of this population
and then developed a supportive-educative pro-
gram designed to enhance their self-care abilities.
The global nature of this theory is apparent. The
book Nursing: Concepts of Practice(Orem, 1985)
has been translated into Dutch, French, German,
Italian, Spanish, and Japanese. Records cited in a
CINAHL index search of the nursing literature in-
cluded publications describing the application of
the Self-Care Deficit Nursing Theory in nursing sit-
uations in Australia, Belgium, Denmark, Finland,
Germany, the Netherlands, Norway, Portugal,
Sweden, Switzerland, the United Kingdom, Hong
Kong, Taiwan, Thailand, Turkey, Canada, Mexico,
the United States, and Puerto Rico.
Moreover, over the past 15 years, the author has
been privileged to be a part of an international net-
work of nurse scholars and scientists focused on the
development of disciplinary knowledge derived
from the Self-Care Deficit Nursing Theory. Our
collaborative work began in 1983 when the author
was invited as a consultant to the faculty of health
sciences at the University of Maastricht in the
Netherlands to assist faculty and students in devel-
oping programs of nursing theory–based research.
Initially, our work focused primarily on the teach-
ing of nursing science seminars for nurses through-
out the Netherlands. In 1986, we extended the
seminars to include nurses from all parts of Europe.CHAPTER 12 Applications of Dorothea Orem’s Self-Care Deficit Nursing Theory 153