Nursing Perspective: Theory in Use and Espoused Theory

This article explores the theory in use and espoused theory in nursing practice, specifically focusing on Orem's self-care deficit theory. It discusses how this theory influences the practice of medical-surgical nurses and promotes patient-centered care. The article highlights the importance of incorporating family members in the care process and creating a positive environment for patients.

Running head: NURSING PERSPECTIVE
Name of the Student
Name of the University
Author Note

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Introduction:
Being front line health care professionals, nurses are identified as one of the crucial
pillars of the health care sector in providing patient-centered care (Bulkley & McCotter, 2018).
As a nurse, there are certain theories nurses are required to follow in order to provide patient-
centered care and promote the wellbeing of the patient. According to the theory of action
frame, espoused theory is the reasons we give for our actions (Visser & Van der Togt, 2016).
On the other hand, according to the theory of action frame, people behave and care is
influenced by knowledge and understanding, goals and values. This is defined as the theory in
use (Reed & Shearer, 2006). It was often observed that the espoused theory is different from the
theory in use. While espoused theory defines the mindset of a nurse regarding what she wants to
do, theory in use highlights what a nurse actually does (Greenwood, 2000). The espoused theory
and theory in use are the result of the collaborative research of Argyris and Schön (Bulkley &
McCotter, 2018). The theory gap in practice is defined as the gap between the scientific
knowledge and theory used in the common practice. This termed as the gap between published
theory of nursing and practice of nursing (Jarvis, 2015). The purpose of the paper is to provide
the espoused theory and theory in use of Orem's self-care deficit and reflect on the nursing values
and beliefs which are influencing the practice. This paper will provide espoused theories and
theory in use of one of the major theories and impact of the theory in nursing practice in the
following paragraphs.
Discussion:
The espoused theory and theory in action are the collaborative research of Argyris and
Schön (Greenwood, 2000). They together postulated that human being is an idealistic creature

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and have a sense of determining right and wrong. They have a perceived concept and idea of
goodness they are capable of and because of this concept, they claim to hold certain values and
beliefs that guide their practice is called espoused theory (Greenwood, 2000). In short, espoused
theory reflects what nurses want to do such as providing the best possible care to each patient,
treating them with dignity and respect so that they feel empowered and confident. As a medical-
surgical nurse, these theories potentially influence the behavior of a nurse in the practice. In the
current context, Orem’s theory of self-care deficit is identified as one of the major nursing
theories in medical surgery (Shah, Abdullah & Khan, 2015). Orem‘s theory of self-care deficit
is proposed by Dorothea Orem who was working towards her goal of improving the quality of
nursing in general hospital. The theory is comprised of three major parts such as the theory of
self-care, the theory of self-care deficit and theory of nursing system (Karimi et al., 2016). By
implementing the theory, nurses want to provide best possible care to the patients so that they are
able to manage their health without clinical assistance. The Orem’s self-care nursing theory
provides medical nursing practitioner a direction to provide care in the ambulatory surgery
setting (Karimi et al., 2016). The theory is applied by nurses to assess clients and teaching,
guiding, supporting them for recovery. The theory is applied in nursing because as discussed by
Zarandi, Raiesifa and Ebadi (2016), self-care deficit in patient is observed during the surgery
and anesthesia when patients is unable to take care of themselves and require the assistance to
perform daily activities. Considerate numbers of patients require clinical assistance during their
postoperative period in activities such as sitting, walking, and standing (Blok, 2017). Therefore,
to support the client in their recovery journey this theory is applied by surgical nurses so that
client can be discharged faster from the ambulatory setting. This theory further helps patients to
meet the self-care needs (de la Borbolla-Martinez et al., 2016). The theory influenced the

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nursing practice in a different way because after gaining the understanding of the theory,
medical-surgical nurses are able to educate and engage the patients and their family members in
the self-care and guide them in such a way that patients initiate and perform own daily activities
to maintain the wellbeing and the life experiences using the resources (Saeidzadeh et al., 2017).
The theory also influenced surgical nurses in prioritizing the patients and their family members
and engage them in the decision making to support physical as well as mental wellbeing of the
patients (Bennett et al., 2017).
Orem’s theory of self-care deficit is defined by the theorist Dorothea Orem's who
believed that people should be self-reliant and responsible for their own care. The major
assumption of the theory is that a person’ knowledge of health problem is one of the crucial
components which promotes the concept of self-care and the self-care behavior of a person is
developed from sociocultural environment of that person (Abotalebidariasari et al., 2017).
Considering the first component, nursing is a form of art or actions selected by nurses to help
individuals in the postoperative surgery ward by changing the condition and maintaining
optimistic conditions (Urpí‐Fernández et al., 2017). The domain encompasses the perspective of
the patients about their health conditions along with the perspective of physician and nurse to
promote the self-care. In this case, as a medical-surgical nurse, I believe that every individual has
a right to live independently despite the presence of physical disabilities they might have. In this
case, the goal of surgical nursing is to make the patient or family members of patient capable of
meeting the requirements of self-care (Sharifi et al., 2016). This concept further influenced me
as a surgical nurse to assess the health condition of the patients, prioritizing the concern of the
patient and family members to regain the normal state of health of a patient and minimize the
effect of health disability. Considering the second domain, health is a crucial component of a

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person which installs humanity in person and assists to live the best possible life (LeBlanc &
Jacelon, 2018). Health can be improved by collaboration of the physiological and psychological
mechanism and interaction with other human beings. As a surgical nurse, I believe that health is
the key product of the social, physiological, emotional and cultural environment and to live the
best possible life, an individual requires good health. This concept influenced me as a surgical
nurse to incorporate my core values such as honesty and dignity and respect in the practice while
assessing the patient’s health and provide care to the post-operative patients so that they meet the
needs of self-care. Considering the concept of person or human being, a person has the capacity
to reflect based on their perspective (Griffiths et al., 2018). From the nursing perspective, a
person can be defined as the recipient of nursing care which may include the family members of
the patient and friends of the patient who will support the wellbeing of the person along with
nurses (Griffiths et al., 2018). I believe that it is a human right to receive best possible care
irrespective of gender, race, and ethnicity. Therefore, the theory influenced me as a surgical
nurse to provide best possible care by incorporating family members while assessing the patient
in the post-surgical ward, prioritizing the decision making of the family members so that they
able to perform best possible life. Considering the fourth domain, the environment encompasses
ethnographic factors and elements which possibly influenced the wellbeing of a person. As
discussed by Bennett et al. (2017), a person’s wellbeing is determined by the environment where
they live and the environment plays a crucial role in meeting the needs of the self-care. As a
surgical nurse, I believe that it is crucial to assess the environment of the patient and creating a
positive environment of the patient so that individual feels empowered and confident to take the
initiatives for perming the daily activities which support the wellbeing of the patient. This theory
influenced me as a surgical nurse to consider the environment of the patient while assessing the

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health of the patient and teaching and supporting the patient by creating a safe environment.
This can be created by the collaboration with the family members which will facilitate the
emotional, psychological, physical and spiritual wellbeing (Griffiths et al., 2018).
In the current context, I would like to say that my personal theory-in-use developed
from different experiences which further potentially influenced my practice and quality of care.
While I was placed as a medical-surgical nurse in the surgical department for providing care, I
assisted the post-operative patients who were unable to perform the daily activities and require
the assistance in their self-care in order to live an independent life. Being a surgical nurse, I
gained the understanding that while healthy individuals are able to perform the self-care and
daily activities without assistance, the post-operative patients are vulnerable to perform these
daily activities and seek the clinical assistance to perform these activities. The Orem's theory of
self-care deficit highlighted four crucial concepts discussed above which are used by my
coworkers and my supervisor their practice while providing the care to the patient who requires
the clinical assistance in walking, setting, toileting, and bathing. I have observed that my
coworkers and supervisor engage in the therapeutic communication with patient to gain the
understanding of the concern of the patient, sharing experiences with post-operative patients so
that they feel empowered, confident about their life which further enhances their resilience. This
attributes not only influenced me as a nurse to support patients for their spiritual, social,
emotional and physical wellbeing. From this observation, I have developed my theory in use to
provide the best possible person centered care by showing respect, dignity, and honesty,
prioritizing their decision making and teaching them in performing self-care on their own. After
developing the theory in use from my work experiences, as a surgical nurse, I become more
empathetic towards the situation of the patient and aware of my surgical nursing practice. To

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assist the patients in performing the daily activities, I assess the patient’s health considering the
environment and incorporate the framework of activity of daily living in my practice. I
incorporate family members in the care process to facilitate the recovery process, ensure proper
respiration, feeding and hydration for the patient between the activity and rest. The theory in use
influenced my practice by providing it a better direction and reducing the gap in my nursing
practice. After gaining the understanding of the theory, I engaged my patients in the therapeutic
communication; provided education and knowledge regarding the process of the self-care,
engage patients in the social interactions, spiritual activities that they feel empowered and gain
the perspective of living a hopeful life. This is the way to ensure the best health condition of the
patients and stabilize the health status of the patients and remove all possible harms which can
deteriorate the health condition of the patient.
Conclusion:
Thus it can be concluded that while espoused theory reflects the mindset of the nurse in
the nursing practice the theory in use highlight the what nurses actually do which is influenced
by the nursing core values and practices of the peers. This paper explored one of the major
theory such as Orem’s theory of self-care deficit which is proposed by Dorothea E. Orem who
was working towards her goal of improving the quality of nursing in general hospital. The theory
is applied in nursing because the self-care deficit in the patients is observed during the surgery
and anesthesia when the patients are unable to take care of themselves and requires the assistance
to perform daily activities. The theory influence the nursing practice in a different way because
after gaining the understanding of the theory, medical-surgical nurses are able to educate and
engage the patient and their family members in the self-care and guide them so that patient
initiates and performs own daily activities to maintain the wellbeing and the life experiences

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using the resources. This information further influenced me as a nurse to provide the best quality
of care and acquire skills of care which I would integrate into my future practice.

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