Sample Essay on Application of Orem’s Theory to Nursing Leadership


Nursing leadership is an essential professional area in nursing as it involves several aspects. Nursing leaders influence other nurses in the healthcare sector through their actions and/ or inactions. In recent times, the demands on nursing leaders have increased immensely, especially with the acute shortage of nurses and other healthcare professionals. As such, it is the mandate of nursing leaders to find ways through which they can improve the healthcare system as well as through which they can help the other nurses experience growth in the sector. One of the ways is through the use of medical extensivism which is an emerging concept in nursing leadership. Nursing leaders use this to address the needs of patients in various contexts, particularly where the patients are in need of help due to acute or chronic conditions. In most cases, patients with chronic conditions have treatment and care extended from the hospital set up to their homes. Consequently, it is crucial for them to find a way through which collaboration can be achieved between the primary health care providers and the hospital staff. This is where medical extensivism comes into play.

To perform effectively in medical extensivism, one important theory that can be applied is Dorothea Orem’s self care deficit theory. The self deficit theory was developed in 1959 as a grand nursing theory. It is thus applicable in a wide range of medical contexts and can be used effectively by nursing leaders to improve service delivery in health care. The self care deficit nursing theory is founded on the philosophy that it is the wish of all patients to be able to care for themselves (Bhanji, 2012). The measure of this ability is based on the premise that self care deficit can be categorized as either developmental, universal or health deviation deficits. In order to help patients fully take care of themselves, it is crucial for the caregivers to identify specific areas of self care requisites and then find ways through which they can help the patients to attain growth in these specific areas. The self care deficit theory can help nurse leaders, from hospitals to home care systems to understand the needs of patients and thus help them to address these needs effectively. According to Green (2012), Orem’s theory has been found to be effective especially where constant care is desired and the nurse leaders have to train the kin of the patients on how to take care of their patients better. In addition to this, the theory is applicable in alternative therapy procedures since it helps to achieve wholesome improvement as far as nursing is concerned.

This essay discusses the concept of medical extensivism in details. The main objective is to highlight how Orem’s self care deficit theory can be applied by medical extensivists to boost their intervention outcomes as well as to reduce treatment costs. The paper consists of four key sections. The second section of the paper discusses the details of the medical extensivist practice while the third section entails the application of Orem’s theory to the medical extensivist practice. The final section is a conclusion that offers a recap to the entire paper. It is believed that from this essay, one will be able to understand the concept of medical extensivism and that nursing leaders will be able to use this paper as a blue print for the application of Orem’s theory to medical extensivism.

Description of Nursing Issue

According to Sherman and Pross (2010), nursing leadership is often faced with several challenges. Some of the challenges associated with nursing leadership include: need for communication, a collaborative work culture, absence of an adequate number of qualified nursing professionals and difficulty in achieving patient transition from facility to home care systems. These challenges result in increased costs of nursing practice as well as other side effects. The absence of an adequate number of professionals results in negative impacts such as lack of collaboration between the hospital nursing staff and the home care individuals. In addition to this, the inadequacy leads to unwarranted hospitalizations, difficulty in transition from the hospital setting to homes and repeat testing and medications.  Because of this, there is need for healthcare systems to find ways through which these challenges can be addressed. The traditional nursing leadership practice system does not have provisions for catering for these needs and challenges. As such, healthcare facilities in the modern times are increasingly incorporating medical extensivists into practice. Through these personnel, the challenges associated with transition in acute illness cases can be addressed. Medical extensivism is thus an emerging trend in nursing leadership, currently embraced by only a few facilities depending on the availability of an adequate number of staff. While it is reported that hospital staff are in limited numbers, it is also argued that in most cases, nurse leaders in hospitals are free of duty and can therefore have the time to engage in the provision of extensivist services (Sherman& Pross, 2010).

Medical extensivists are nursing leaders who provide healthcare services both internally and externally. They extend their services to homes from the hospital settings. In most cases, they are available to assist patients with acute and chronic conditions who are unable to take care of themselves effectively. As an emerging field `in nursing leadership, medical extensivism involves mainly the provision of hospital related services at home. The professionals are tasked with helping to ease transition from the hospital to the homes. Freeman (2016) describes the key difference between a primary physician and a medical extensivist. In his argument, he suggests that while the medical extensivist is involved with the specific patient in a hospital as well as at home, the primary physician only helps the patient at home. From this definition, it can be argued that the primary physician cannot be up to date with patient information and records from the hospital. On the other hand, the medical extensivist has been with the patient in hospital and only extends the services back home (Freeman, 2016). The medical extensivist can therefore give the desired information to the primary physician.

Medical extensivists attend to patients with chronic and acute conditions in various ways. The patients helped by the medical extensivists often have multiple complex medical issues. The medical extensivists assist in stabilizing the patients back home before handing over to the primary caregivers (Reinhard & Hassmiller, 2012). During the process, they also provide co-ordination of extended care to the patients who were once under their care. This helps to reduce the frequency of issues such as repeat testing, double medication and inaccurate medical reporting among others (Newhouse et al., 2011). From this explanation, it can be understood therefore that the key stakeholders of medical extensivism are nursing leaders and the primary caregivers. Being an emerging field, it is important to note that the prevalence of practice is still low despite the benefits associated with the practice.

Application of Orem’s Theory to Medical Extensivism

Orem’s self care deficit theory can be said to be the most applicable in the medical extensivist practice. This is because medical extensivists work with people who are chronically or acutely ill and who in most cases need help in achieving self care requisites. Orem’s theory is founded on the identification of the key self care requisites in the universal, developmental and health deviation categories (Green, 2013). It can therefore be applied in this context to enhance the performance of the medical extensivists with respect to helping in patient transition from the hospital to the home setting. While applying this theory to medical extensivism, the strategy of choice would be repetitive evaluation of self care requisites and identification of deficit areas. This would be followed by laying down nursing intervention plans to be used to address the specific deficits faced by patients.

The use of the requisite identification strategy can be understood from the description given by Bhanji (2011). From this description, the theory application involves outlining all the self care requisites in tabular form. Each of the classes of requisites is highlighted with all the components associated with it. The table contains columns for evaluation and comments. In the evaluation column, an indication is made concerning the level of care that the patient can be able to achieve on their own. This means that a linkert scale could be used where perfect care is indicated as a 10 while inability to achieve any self care is indicated as a 0. From this, the medical extensivists can then give comments on their recommendations i.e. whether to offer total compensation, partial compensation or educational support to the patient. These are the key intervention strategies indicated in Orem’s theory (Green, 2012). The use of this strategy can be very effective in achieving the desired goal since the theory provides common understanding between the medical extensivist and the primary caregiver. Repetitive evaluation can be used to measure treatment progress and to determine the most favorable outcomes for the patient.

The ability to use this strategy from the perspective of the primary caregiver and the medical extensivist makes it an instrumental procedure through which treatment implementation can be achieved. Based on the outcomes from the evaluation, it is possible for the patients to be helped in achieving constant improvement. Although medical extensivism is increasingly being used in hospitals will outstanding results, it is clear that the area still needs great research. Currently, the information available about medical extensivism is limited, creating the perception of an under researched area in medical practice. It is therefore important that the area should be studied more intensely, especially on the key components and features of medical extensivism.


Nursing leadership is becoming increasingly more challenging. However, nursing theories can be applied to create greater common understanding between nursing leaders. Orem’s theory gives a foundation from which nursing leaders can evaluate their performance especially regarding the improvement of patient self care capacities. The most common trend in nursing leadership is medical extensivism. This trend involves extension of medical services from the hospitals to home settings. This is different from primary care giving in that the primary caregivers have not been in the hospital with the patients. As such, Orem’s theory can be used by medical extensivists to clearly evaluate their patients and so help in the transition from hospitals to homes before handing over to the primary caregivers. This can help to avoid issues such as repeat testing and inaccurate medical records among others.



Bhanji, S.M. (2012). Comparison and Contrast of Orem’s Self Care Theory and Roy’s Adaptation Model. Journal of Nursing, 1(1), 48-53.

Freeman, G. (2016). 5 Ways to Ensure Extensivists Improve Outcomes and Cut Costs. Health Leaders Media.

Green, R. (2012). “Application of the Self-Care Deficit Nursing Theory to the Care of Children with Special Health Care Needs in the School Setting” Self-Care, Dependent-Care & Nursing, 19(1).

Green, R. (2013). “Application of the Self Care Deficit Nursing Theory: The Community Context” Self-Care, Dependent-Care & Nursing, 20(1).

Newhouse, R., Stanik-Hutt, J., White, K.M. et al (2011) “Advanced Practice Nurse Outcomes 1990-2008: A Systematic Review” Nursing Economics, 29 (5).

Reinhard, S. and Hassmiller, S. (2012). The Future of Nursing: Transforming Healthcare. The AARP International Journal.

Sherman, R. and Pross, E. (2010) “Growing Future Nurse Leaders to Build and Sustain Healthy Work Environments at the Unit Level” OJIN: The Online Journal of Issues in Nursing, 15(1).