Over the subsequent five years, approximately 200
nurses from 12 European countries participated in
the seminars. The participants studied the Self-
Care Deficit Nursing Theory, research methodol-
ogy, and the interrelatedness of theory and
research. Each participant developed a self-care
theory-based research project that could be imple-
mented in his or her home settings.
Our first collaborative research project involved
the development of an instrument to measure
Orem’s theoretical concept of self-care agency. The
English and Dutch versions of the Appraisal of Self-
Care Agency (ASA) Scale were the products of this
endeavor. To date, the ASA Scale has been trans-
lated and validated for research use with popula-
tions in the following countries: Belgium,
Denmark, Finland, Canada (French-speaking),
Germany, Norway, Sweden, Switzerland (German-
speaking), Japan, Korea, Thailand, Turkey, and
Mexico.
This collaborative project provided the team
with the opportunity to identify universal nursing
knowledge and, by means of transnational compar-
isons, identify culture-specific knowledge. The
current shared programs of research focus on:
(1) influences of aging on the self-care abilities
of Americans (Jirovec & Kasno, 1990), Canadians
(Ward-Griffin & Bramwell, 1990), Danes (Loren-
sen, Holter, Evers, Isenberg, & Van Achterberg,
1993), Dutch (Evers, Isenberg, Philipsen, Senten, &
Brouns, 1993), Finns (Katainen, Merlainen, &
Isenberg, 1993), Norwegians (Van Achterberg et al.,
1991), and Swedes (Soderhamn, Evers, & Hamrin,
1996); and (2) influence of chronic health prob-
lems, such as coronary artery disease, on the self-
care abilities of Americans (Isenberg, 1987, 1993),
Canadians (Aish & Isenberg, 1996), and Dutch
clients (Isenberg, 1993; Isenberg, Evers, & Brouns,
1987; Senten, Evers, Isenberg, & Philipsen, 1991).
Using the Mexican version of the ASA Scale to
measure self-care agency, Professor Esther Gallegos
at the University of Nuevo Leon in Monterrey,
Mexico, recently completed a study of the influence
of social, family, and individual conditioning fac-
tors on the self-care abilities and practices of
Mexican women. The results of her study indicated
that health state was the predominant predictor
of women’s self-care agency and self-care perfor-
mance (Gallegos, 1997). The level of poverty
experienced by the Mexican women also had a sig-
nificant influence on their self-care performance.
One of the challenges of international collabora-
tive research deals with establishing sources for
funding to carry out the scientific work. The
research work cited above was funded in part by
a variety of agencies: the Netherlands Heart
Foundation, the Swiss National Fund, Fulbright
Scholarship, Finnish Academy of Science, and the
Kellogg Foundation. Our collaborative work was
further enhanced by the generous support that each
of us received from our respective institutions:
Wayne State University, United States; University of
Maastricht, the Netherlands; Catholic University of
Leuven, Belgium; University of Oslo, Norway;
University of Nuevo Leon, Mexico; St. Gallen
Hospital, Switzerland; and University of Kuopio,
Finland.
To this network of nurse scientists, international
collaboration has provided an opportunity and a
means to pursue a shared vision and address a
shared challenge. By means of shared ideas, re-
sources, research designs, and instruments, we are
advancing nursing science derived from the Self-
Care Deficit Nursing Theory. To date, specific
propositions of the theory have been tested in nine
countries. Through this theory testing program of
research, data are being accrued that will provide
answers to the question, “To what extent is the Self-
Care Deficit Nursing Theory relevant to the global
community?” The findings of the transnational
comparative studies are identifying universal ele-
ments of the theory and suggest that the translated
versions of the ASA Scale are cross-nationally valid.
Furthermore, the idea to organize a forum for
self-care scientists and scholars originated with this
group. In 1991, the International Orem Society for
Nursing Science and Scholarship was founded. The
society’s mission is to advance nursing science and
scholarship through the use of Dorothea E. Orem’s
nursing conceptualizations in nursing education,
practice, and research. The society cosponsors a
Biennial International Self-Care Conference with
the University of Columbia, Missouri, and pub-
lishes a quarterly newsletter, which has recently
been expanded to a journal.Practice
In this section, we focus on the ways in which the
Self-Care Deficit Nursing Theory is guiding nurs-
ing research because the theory’s utility to nursing
practice is well-documented in the literature.
Nonetheless, it would be remiss not to comment on154 SECTION III Nursing Theory in Nursing Practice, Education, Research, and Administration