ing factors studied is health state. Several studies
designed to determine the nature of the influence of
variations in health state on self-care abilities are re-
ported in the research literature. Research suggests
that this relationship is particularly salient in prac-
tice situations in which persons are experiencing
chronic health problems. The work of selected in-
vestigators is presented here to exemplify this line of
inquiry. The influence of change in health state on
the self-care abilities of persons with coronary
artery disease has been studied with both American
and Dutch adult patient populations (Isenberg,
1991; Isenberg, Evers, & Brouns, 1987). Across these
studies, changes in health state were found to be
critical determinants of the quality of the self-care
abilities of this patient population. As the health
state of patients improved, so did their capabili-
ties for self-care. Conversely, self-care capabilities
tended to decline as patients experienced recur-
rence of pain and declining health. The findings re-
vealed a positive relationship between health state
and self-care agency in patients with cardiac disease.
In addition to the study of variation in health
state due to pathophysiology, the conditioning in-
fluence of health state on self-care agency has also
been explored in situations in which the variation
in health state is due to psychopathology. West
(1993) investigated the influence of clinical varia-
tions in the level of depression, conceptualized as a
health-state factor, on the self-care abilities of
young American women. West (1993) reported that
of the basic conditioning factors studied, the level of
depression (health state) was the dominant predic-
tor of the quality of the self-care abilities of her
sample. In a study with Dutch psychiatric patients,
Brouns (1991) also reported that variations in men-
tal health state significantly influenced patients’
self-care capabilities. In both studies a positive rela-
tionship between health state and self-care agency
was revealed. Higher levels of mental health were
correlated with higher self-care agency scores.
These findings verified the conditioning influence
of health state on the self-care agency of patients’
experience variations in physical and mental health.
Moreover, the research findings clarified the nature
of the influence of health state on self-care agency.
The conditioning influence of other basic fac-
tors on the self-care abilities of clinical and non-
clinical populations has been the focus of inquiry
of several nurse scholars. For example, Brugge
(1981) studied the influence of family as a social
support system on the self-care agency of adults
with diabetes mellitus. Vannoy (1989) explored the
influence of basic conditioning factors on the self-
care agency of persons enrolled in a weight-loss
program. Schott-Baer (1989) studied the influence
of family variables and caregiver variables on the
self-care abilities of the spouses of patients with a
cancer diagnosis. Baker (1991) explored the predic-
tive effect of basic conditioning factors on the self-
care agency and self-care in adolescents with cystic
fibrosis. McQuiston (1993) investigated the influ-
ence of basic conditioning factors on the self-care
capabilities of unmarried women at risk for sexu-
ally transmitted disease. Horsburgh (1994) concep-
tualized personality as a basic conditioning factor
and tested the model with a healthy population and
a comparative clinical population with chronic
renal disease. O’Connor (1995) studied the influ-
ence of basic conditioning factors on the self-care
abilities of a healthy and clinical adult population
enrolled in a nurse-managed primary care clinic.
Baiardi (1997) explored the influence of health
state and caregiving factors on the self-care agency
of the caregivers of cognitively impaired elders.
Artinian, Magnan, Sloan, and Lange (2002) exam-
ined the influence of personal and environmental
factors on the self-care behaviors among patients
with congestive heart failure.THEORY VERIFICATION AND
SPECIFIC CLINICAL POPULATIONS
Opportunities to test elements of the Self-Care
Deficit Nursing Theory have been greatly enhanced
by the measurement work with self-care concepts
that has transpired over the past 20 years. It is im-
portant to note that the theory-testing studies cited
above were made possible by the development and
psychometric testing of instruments to measure the
theoretical concepts. Instruments are currently
available to measure the self-care agency of adoles-
cent populations (Denyes, 1982), adult populations
(Evers, Isenberg, Philipsen, Senten, & Brouns, 1993;
Geden & Taylor, 1991; Hanson & Bickel, 1985), and
elderly populations (Biggs, 1990). The availability
of valid and reliable measures of self-care agency
has been vital to the advancement of the theoretical
component of self-care nursing science.
In addition to the theory verification line ofCHAPTER 12 Applications of Dorothea Orem’s Self-Care Deficit Nursing Theory 151