See

discussions, stats, and author profiles for this publication at: [Link]

Self-care: Orems theoretical contribution to

the Nursing discipline and profession

Article in Revista de Enfermagem Referncia December 2014

DOI: 10.12707/RIV14081

CITATIONS READS

2 5,483

3 authors:

Paulo Queirs Telma Vidinha

Escola Superior de Enfermagem de Coimbra Escola Superior de Enfermagem de Coimbra
141 PUBLICATIONS 74 CITATIONS 8 PUBLICATIONS 7 CITATIONS

SEE PROFILE SEE PROFILE

Antonio Jos de Almeida Filho

Federal University of Rio de Janeiro
85 PUBLICATIONS 92 CITATIONS

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Histria e Epistemologia da Sade e Enfermagem View project

Edital Universal CNPq 14/2011 (482064/2011-0) - Polticas Pblicas e interveno de enfermagem na

promoo sade do adolescente no cenrio escolar. View project

All content following this page was uploaded by Paulo Queirs on 11 December 2014.

The user has requested enhancement of the downloaded file.

 ISSNe: 2182.2883 | ISSNp: 0874.0283
Disponvel em: [Link]
THEORETICAL PAPER/ESSAY

Self-care: Orems theoretical contribution

to the Nursing discipline and profession
Autocuidado: o contributo terico de Orem para a disciplina e profisso de Enfermagem
Autocuidado: la contribucin terica de Orem para la disciplina y profesin
de Enfermera
Paulo Joaquim Pina Queirs*; Telma Sofia dos Santos Vidinha**; Antnio Jos de Almeida Filho***

Abstract
Background: As a practical human science, Nursing creates and uses an exclusive body of knowledge, affirming itself
as a scientific discipline with its own characteristics. Theoretical thinking has evolved in a journey of major conceptual
richness, thus generating theories and concepts with interpretative value of nurses performance. One of the most often
cited theories is the Self-Care Deficit Nursing Theory (SCDNT) of Dorothea Orem, which was developed between 1959
and 1985 and incorporated the nursing model proposed by the author.
Objective: To critically address the SCDNT through a theoretical study, which implied the reading, analysis and discussion
of different bibliographic materials.
Main topics under analysis: The SCDNT and associated conceptual terms.
Conclusion: As a particular combination of conceptual properties common to all nursing circumstances, the SCDNT is
relevant to guide nursing knowledge, clinical practice, education and management, as well as create structures from which
other theories and concepts are developed.

Keywords: Nursing Theory; self-care; nursing science.

Resumo Resumen
Enquadramento: A enfermagem, enquanto cincia humana Contexto: La enfermera, como ciencia humana prctica, crea
prtica, cria e utiliza um corpo de conhecimento exclusivo, y utiliza un cuerpo de conocimiento exclusivo, afirmndose
afirmando-se como uma disciplina cientfica com caractersticas como una disciplina cientfica con caractersticas propias.
prprias. O pensamento terico tem evoludo num percurso de El pensamiento terico ha evolucionado en un trayecto de
grande riqueza conceptual, gerando teorias e conceitos com valor
interpretativo daquilo que os enfermeiros fazem. Uma das teorias
gran riqueza conceptual, generando teoras y conceptos con
mais citadas a Teoria do Dfice de Autocuidado de Enfermagem valor interpretativo de aquello que los enfermeros realizan.
de Dorothea de Orem (TDAE), desenvolvida entre 1959 e 1985, Una de las teoras ms citadas es la Teora del Dficit de
que incorpora o modelo de enfermagem proposto pela mesma. Autocuidado de Enfermera de Dorothea de Orem (TDAE),
Objetivo: Abordar criticamente a TDAE atravs de um estudo de desarrollada entre 1959 y 1985, que incorpora el modelo de
natureza terica, que para a sua execuo exigiu a leitura, anlise enfermera propuesto por la misma.
e reflexo de diferentes materiais bibliogrficos. Objetivo: Abordar crticamente la TDAE a travs de un
Principais tpicos em anlise: A TDAE e os termos conceptuais estudio de naturaleza terica, que para su ejecucin exigi
que lhe esto associados. la lectura, el anlisis y la reflexin de diferentes materiales
Concluso: A TDAE, sendo uma combinao particular de bibliogrficos.
propriedades conceptuais comuns a todas as circunstncias de
enfermagem, revela-se pertinente na orientao do conhecimento Principales temas en anlisis: La TDAE y los trminos
e na prtica clnica, ensino e gesto de enfermagem, assim como conceptuales que se le asocian.
na criao de estruturas a partir das quais se desenvolvem outras Conclusin: La TDAE, al ser una combinacin particular de
teorias e conceito propiedades conceptuales comunes a todas las circunstancias
de enfermera, resulta pertinente en la orientacin del
Palavras-chave: Teoria de Enfermagem; autocuidado; conocimiento y en la prctica clnica, enseanza y gestin de
cincia de enfermagem. enfermera, as como en la creacin de estructuras a partir de
las cuales se desarrollan otras teoras y conceptos.
* Post-doctoral student at the ICBAS-UP. Ph.D. in Psychological Development and Intervention.
Master in Occupational Health. Bachelor in History and in Rehabilitation Nursing. Coordinating Palabras clave: Teora de Enfermera; autocuidado; ciencia
Professor, Nursing School of Coimbra, Department of Nursing, 3046-851, Coimbra, Portugal
[pauloqueiros@[Link]]. Address for correspondence: Rua do Aude, n. 150, Quinta da Maina, de enfermera.
3000-435 Coimbra, Portugal.
** RN., Researcher, UICISA: E, Health Sciences Research Unit of Coimbra, Nursing School of
Coimbra, 3046-851, Coimbra, Portugal [telmavidinha@[Link]].
*** Ph.D., Professor/Researcher, Nursing School Anna Nery, Federal University of Rio de Janeiro, Received for publication: 18.02.14
21941-901, Rio de Janeiro, Brasil [ajafilhos@[Link]]. Accepted for publication: 03.10.14

Revista de Enfermagem Referncia Srie IV - n. 3 - nov./dez. 2014

pp.157-163
Introduction the act of caring and results from combining empirical
knowledge with the knowledge drawn by nurses
The nursing theory has been a dominant topic from practice; conceptual knowledgeis abstract and
in nursing literature over the past 40 years, thus generalised, and goes beyond personal experience,
contributing to nursing development as a profession. allowing to explain all patterns manifested in multiple
The era of theory, together with the awareness of care experiences and articulate them with the various
nursing asa profession and academic discipline, models and theories (Schultz & Meleis, 1998).
emerged from the debates and discussions occurred in As a whole, these patterns of knowing constitute
the 1960s. The transition from vocation to profession the ontological and epistemological foundations
in the 1970s was decisive for nursing as it questioned of the nursing discipline. Therefore, Fawcett,
the discipline on which it should be based, the answer Watson, Betty, Walker and Fitzpatrick (2001) argue
being nursing science (Tomey & Alligood, 2002). that the integration of all patterns is essential for the
According to Meleis (2011), this progress in nursing practice of professional nursing and that none can
theory is a significant aspect of the scholarly evolution be [Link] to most disciplines,
and the cornerstone of the nursing discipline. especially those that exist only if they are associated
Compared to other sciences, the nursing science is in with a given professional practice, nursing is endowed
the early stagesof its development. It is considered with both scientific knowledge and conventional
a body of knowledge specific to the discipline of knowledge, that is, knowledge that was not empirically
nursing, which focuses on the human-universe-health tested (McEwen & Wills, 2009).
process integrated into the nursing structures and This notion that the nursing discipline is composed
theories. Its goal is to represent the nature of nursing of patterns of knowing that go beyond the empirical
and use it for the benefit of humanity (Barrett, pattern allows us to rethink nursing as a science and
2002). To think philosophically about nursing an art (Queirs, 2013). According to Meleis (2011), the
science helps to establish the meaning of science art of nursing may be used as a synonym for caring,
through the analysis and understanding of nursing which, for Johnson, mentioned by the same author,
concepts, theoriesand goals as theyrelate to care is only possible when nurses are able to grasp the
practice (Tomey & Alligood, 2002). For knowledge meaning of the encounter with the patients and when
and its evolutionto be addressed, it is necessary to they conduct their practice based on moral criteria.
take into accountits ontology, epistemology and Thus, nursing cannot be considered an exact science,
methodology. Ontology refers to what exists and but rather a science that fits into the disciplinary
its nature; epistemology relates to the forms of group of human sciences, more specifically into the
knowledge; and methodology refers to the mean(s) group of practical human sciences (Queirs, 2013). As
used for the acquisition of knowledge (Tomey & a scientific discipline, nursing should outline its nature
Alligood, 2002).More specifically, theepistemology of as a practical human science, distinguishing itself
nursing may be defined as the study of the origins of from not only the natural and social sciences, but also
its knowledge, its structure and methods, the patterns the human sciences (Kim, 2010). Nursing knowledge
ofknowingcreated and used by its members,and the is then a knowledge that creates, structures and
criteriafor validating its knowledge claims (Schultz & restructures itself in a dialogical dynamics between
Meleis, 1988). conception (theory) and action (caring), ina constant
Carper (2006) first identified four fundamental to-and-fro translational movement (Queirs, 2013).
patterns of knowing in nursing: empiric, aesthetic, Scientific disciplines have their own communication
ethical, and personal. The author later added structure expressed by concepts and terms. Due
reflective knowing and socio-political [Link] to their interpretative, explanatory and symbolic
authors proposed new patterns or suggested power, some concepts become critical to define the
reformulations, namely: experiential, intuitive and nature of a discipline and identify its conceptual
interpersonal knowing (Moch, 1990); context (White, matrix (Queirs, 2014). According to Fourez (2008),
2006); procedural, cultural and tacit patterns (Abreu, a scientific discipline is what is called in philosophy
2008); andclinical and conceptual patterns (Schultz of science a disciplinary matrix or paradigm, that is,
& Meleis, 1998). Clinical knowledge is manifested in a mental structure, whether conscious or not, that

Revista de Enfermagem Referncia - IV - n. 3 - 2014 Self-care Orems theoretical contribution to the Nursing discipline and profession

158
is used to classify the world with the purpose of particular emphasis to Parsons structure of social
tackling it. action and von Bertalanffys system theory (McEwen
Theoretical thinking in nursing evolves and has & Wills, 2009).
evolved in a journey of great conceptual richness. Self-care is thecentral conceptof SCDNT. According to
This conceptual richness ought to be appropriately Orem (2001), self-care may be defined as the practice
adapted by nurses in a plural form (both theoretically of activities that individuals initiate and develop
and methodologically) (Queirs, 2014). within specific time frames, and whose objectivesare
To be useful, a theory ought to be meaningful, relevant to maintain life and personal well-being. Queirs
and, above all, understandable. Theory has been (2010) adds that self-care is universal by covering all
defined as the systematic explanation of a given event experiential aspects, not being restricted to basic and
in which components and concepts are identified, instrumental activities of daily living.
relationships are proposed and forecasts are made Orem considers that the SCDNT is a general theory
(Streubert-Speziale & Carpenter, 2003). Conceptual composed of three inter-related theories: 1) the
and theoretical models create mechanisms by Theory of Self-care, which describes why and how
which nurses may convey their own professional people care for themselves; 2) the Theory of Self-
convictions, provide a moral/ethic structure to Care Deficit, which describes and explains why
guide their actions, and promote a systematic way people can be helped through nursing; and 3) the
of thinking about nursing and its practice (Chinn & Theory of Nursing Systems, which describes and
Kramer, 2004). Young, Taylor and Renpenning (2001) explains relationships that must be brought about
argue that conceptual models or structures describe and maintained for nursing to be produced (Tomey
a network of concepts and their relationships, thus & Alligood, 2002).
explaining broad phenomena in nursing. In addition, The Theory of Self-Care includes the concepts of self-
nurses realise what they are doing and shall be able care, self-care activity and therapeuticself-care demand
to explain it to others. Therefore, the theory in (Tomey & Alligood, 2002). Self-care is a regulatory
nursing leads to professional autonomy,guiding human function that individuals deliberately perform
care, education and research practices within the for themselves orhave performed for them to maintain
profession (Tomey&Alligood, 2002). life, health, development and [Link] it is
One of the most often cited theories in nursing is deliberate, controlled, intentional and effective, thus
the Self-Care Deficit Nursing Theory (SCDNT) of achieving a realempowerment, it is designated as
Dorothea Orem, which was developed between self-care activity (Tomey & Alligood, 2002). According
1959 and 1985 and incorporated the nursing model to Soderhamn (2000), the ability to self-care is not in
proposed by the [Link] the assumption thatany itself a means to maintain, restore or improve health
theoryhas the capacityto expand the disciplineand and well-being, but rather the potential for self-care
science of nursing, the purpose of this study was to activity as an integral part of human beings. The
critically address the SCDNT. Theory of Self-care is the basis to understand the
This study is theoretical in nature which implied conditions and limitations of the actions of people
the reading of Orems SCDNT, using different who may benefit from nursing (Tomey & Alligood,
bibliographic sources, and further analysis and critical 2002), although a balance between excess and lackof
discussion of the most crucial components. Given the care is essentialfor individuals to be able to self-care.
emerging conceptual richness, whenever possible, The central idea of the Theory of Self-Care Deficit
concepts proposed by other theorists and authors isthat the need for nursing care is associated with
shall also be discussed. the subjectivity of peoples maturity in relation to
health-related or health care-related action limitations
(Tomey & Alligood, 2002). Thus, these limitations
Development render them completely or partially unable to care
for themselves or their dependents. This concept is
Orem deniedany kind of philosophical contribution the essence of the general theory of self-care deficit,
to the construction of the SCDNT and, though the considering that it determines the need for nursing
authorexpressed interestin several theories, she gave interventions when individuals demands for self-care

PAULO JOAQUIM PINA QUEIRS, et al. Revista de Enfermagem Referncia - IV - n. 3 - 2014

159
are greater than their ability to self-care. Although self- Universal requisites originate from what is known,
care deficit is an abstract concept, when expressed in validated or in the process of being validated, about
terms of action limitations, it helps us to understand human structural and functional integrity at various
the role of the individual in self-care and provides stages of the life cycle, i.e. they are common to
guides for the selection of nursing interventions all people. Examples of such requisites are the
(Tomey & Alligood, 2002). maintenance of a sufficient intake of water, air and
Queirs (2010) argues that an individual may present foodand the maintenance of balance between activity
different self-care needs, autonomous skills to satisfy and rest(Tomey & Alligood, 2002).
those needs and support needs in situations of Developmental requisites are all those which promote
transition, in which he/she cannot properly adapt processes of life and maturation and prevent harmful
himself/herself. According to Soderhamn (2010), conditionsthatmay hinder them(Tomey & Alligood,
the ability to acquire or restore self-care, either 2002), i.e., they are associated with a particular event
independently or with the help of third parties, such as a wedding or a new job.
occurs in three dependent phases. The first phase, Health-deviation requisites exist for people who are
known as estimative self-care, determines what ill or injured, have specific forms of pathological
should be done to restore self-care; the second situations or disorders, including defects or
phase, known as transitional self-care, recognises disabilities, and are undergoingmedical diagnosis or
the different options to restore self-care and selects treatment. The characteristics of health deviations,
the most favourable one; the third and final phase, as situations extending through time, determine the
known as productive self-care, shows the individuals care needs that individuals experience during the
true capacity for self-care. According to the same disease process(Tomey & Alligood, 2002).
author (2010), the self-care ability is only recognised The care needed to meet the self-care deviation
when the individual is able to perform the self-care requisites must be transformed into action
activity to maintain, restore or improve his/her components of the self-care systems. The complexity
health and well-being. This view brings us to the of these systems increases with the numberof health-
concept of transition proposed by Meleis, and cited deviationrequisites thatmustbe met in specific time
by Abreu (2008), which is defined as a significant frames (Taylor & Alligood, 2002), using therapeutic
change in the individual when he/she is exposed self-care agents. According to Orem, a therapeutic
to different stimuli and new knowledge. This may self-care agent is defined as a maturing adult, or an
generate a new behaviour or result in a different adult who accepts and fulfils the responsibility of
definition of the self within the social context. identifying and satisfying the therapeutic self-care
According to Sholssberg, who was cited byAbreu demands of dependent others, or even an adult
(2008), the individuals ability to determine and who accepts to regulate these individuals self-care
manage their needs and developadaptive responses performance. According to Queirs (2010), these
may be altered during a transition, thus an adaptation agents may be professionals or informal caregivers
or adjustment period is necessary. duly trained to provide care.
The Theory of Nursing Systems proposes that As regards professional care, Meleis, who was cited
nursing is a human action, because theseare action by Abreu (2008), believes that the most relevant
systems designed and produced by nurses through role in nursing practice consists of assisting people
the exercise of their practice while working with in transition processes as it facilitates these process
individuals who have self-care limitations (Tomey & and helps people achieve theirwell-being. Kleinman,
Alligood, 2002). who was cited by Abreu (2008), reports that formal
Orem identified three types ofself-care requisites caregivers are endowed with professional skills
in the SCDNT: universal, developmental and health- and are socially recognised for the exercise of their
deviation. These may be defined as the goals to be role. Informal care is that in which the dependent
achieved through self-care actions carried out by the person is cared for, usually free of charge, in a
individual or a third party, i.e., they correspond to relationship of effective proximity which may be
the groups of needs identified in theory (Tomey & provided by a relative or a significant person(Abreu,
Alligood, 2002). 2008).

Revista de Enfermagem Referncia - IV - n. 3 - 2014 Self-care Orems theoretical contribution to the Nursing discipline and profession

160
Orem identified thethree types of practice of According to Orem, the nursing process is a system
nursing science in nursing systems: 1) fully that allows diagnosing the need for care, planning the
compensatory system, when nursing replaces right procedure, and intervening. The method for
individuals in self-care; 2) partially compensatory conducting this process meets the following criteria:
system, when individuals need nursing only to identification of self-care requisites; identification of
help them carry out what they are not able to do self-care skills; identification of therapeutic demands;
on their own; and 3) supportive-educative system, mobilisation of nurses skills;and planning of assistance
when individuals are able to perform self-care, in nursing systems (Tomey & Alligood, 2002).
althoughthey need nurses to teach and supervise According to Meleis and Trangenstein, who were cited
them while performing it (Tomey & Alligood, 2002). by Abreu (2008), nurses care for patients, who are
The supportive-educative system is also relevant to integrated in a sociocultural context (environment),
informal caregivers. undergoing a transition (or anticipating it), with the
In this perspective, asequential series of actions help aim (nursing process) of promoting ones health and/
overcome or compensate the limitations associated or well-being through a set of actions (therapeutic
with peoples health to undertake the regulatory interventions). The belief that human beings
actions of their own functioning and development are constantly communicating and exchanging
or those of their dependants. In this sense, Orem information with one another and their surrounding
identified five methods that nurses mayuse, in environment in order to survive is a belief underlying
combination or isolated,when caring for patients: Orems theory (McEwen & Wills, 2009). According to
acting for and doing for others; guiding and directing the author, an integrated human functioning includes
them; providing physical and/orpsychological physical, psychological, interpersonal and social
support; providing and maintainingan environment aspects, as human beings are believed to distinguish
that supports their personal development; and themselves from othersby their potential for learning
teaching them (Tomey&Alligood, 2002). anddeveloping (Tomey & Alligood, 2002).

Figure 1. Self-Care Deficit Nursing Theory. Source: Orem, D. (2001).

Nursing: Concepts of practice (6th ed). St. Louis: Mosby.

PAULO JOAQUIM PINA QUEIRS, et al. Revista de Enfermagem Referncia - IV - n. 3 - 2014

161
Critical Analysis development of guidelines for nursing management/
administration (Tomey& Alligood, 2002).
Orems views about nursing science as a practical We believe that the contribution of Orem to
science are essential to understand how empirical theory, specific nursing knowledge and nursing
evidence is gathered and interpreted. Orem identified science is explained by the creation of a theory
two groups of nursing sciences: 1) nursing practice that is comprehensive enough to frame and convey
sciences, which included wholly compensatory disciplinary meaning to the professional activity. This
nursing science, partially compensatory nursing allowsfor the development of explanatory narratives
science and supportive-educative nursing science; of what is done by nurses, the patterns of knowing
and 2) foundational nursing sciences, which used by them and those which they, simultaneously,
included the science of self-care, self-care activity create and enrich when they need to find answers to
and human assistance (Tomey & Alligood, 2002). The problems related to the health, disease and well-being
concept of self-care may have different meanings in of the individuals and populations whom they must
other disciplines; nevertheless, Orem defined and assist. On the other hand, through the SCDNT,Orem
structured it in a unique way (Tomey & Alligood, contributed to building a specific disciplinary
2002). The authors theory is expressed through language,by bringing concepts to nursing (migratory
a limited number of terms, which are clear and concepts) which are then recreated and acquire
congruent among [Link] SCDNT comprises three specific features, such as the major concept of self-
inter-related theories: self-care; self-care deficit; and care. This concept is central to the nursing discipline
nursing systems. This theory is a synthesis of the given its ability to clarify a purpose for it (to promote
knowledge on self-care (and dependent-care), self- or restore the individuals ability to self-care) and the
care activities (and dependent care), therapeutic explanatory power of an action (the acquisition of
self-care demands, self-care deficit and nursing skills to achieve autonomy and self-determination).
action (Orem, 2001). According to Orem, this The germinating power of this concept should also be
theory is not an explanation of a given situation/ emphasised, as it allows for thedevelopmentof other
individuality specific to nursing practice, but rather concepts, such as estimative self-care, transitional
a particular combinationof conceptual properties or self-care and productive self-care. These acquire
characteristics common to all nursing circumstances. operational power and may be used to describe
As a general theory, it may be appropriate for nurses what we do and identify the stage where our actions
involved in nursing clinical practice, the development beneficiaries find themselves.
and validation of nursing knowledge, and the teaching
and learning of nursing (Orem, 2001).
In research, the SCDNT has been at the basis Conclusion
ofseveral studies (both qualitative and quantitative),
which may be divided into two groups: 1) studies The value of any nursing theory, particularly the
to developinstruments for measuringconceptual grand theories,is explained by its ability to expand
elements; and 2) studies to test the concepts in nursing as a practical human science. Understanding
specific [Link] the fact that they the nature of human beings, their interaction with
are well-defined and capable of being assessed, all the environment and the impact of such interaction
necessary tools have not yet been created to assess on peoples health helps to plan clinical practice
every theoretical entity. This is in addition to the fact and define the interventions that improve the
that the various entities differ from population to individuals health and well-being. The improvement
population (Tomey & Alligood, 2002). of careshould bethe main focus of a grand theory in
The relevance of Orems theory is in its scope, nursing.
complexity and clinical usefulness,as well as its The SCDNT has been very useful to guide clinical
ability to generatehypotheses andaddknowledge to practice, education and management, as well as to
the nursing body of knowledge. It has proven to be promote structures from which other more accurate
equally useful in both the design of curricula to train and testable concepts derived. Although this theory
nurses in several colleges and universities and the has only been used sparingly due to its complexity

Revista de Enfermagem Referncia - IV - n. 3 - 2014 Self-care Orems theoretical contribution to the Nursing discipline and profession

162
and lack of validation, it has proven to be useful and Moch, S. D. (1990). Personal knowing: Evolving research in
valuable to expand nursing science. It results from nursing. Scholarly Inquiry for Nursing Practice, 4(2), 155-
163.
a particular combination of conceptual properties
common to all nursing circumstances, thus it should Orem, D. E. (2001). Nursing: Concepts of practice (6th ed.). St.
Louis, MO: Mosby.
be used by everyone involved in the nursing discipline
and profession. Queirs, P. J. (2010). Autocuidado, transies e bem-estar. Revista
Investigao em Enfermagem, 21, 5-7.
Queirs, P. J. (2013). O que os enfermeiros pensam da
References enfermagem? Dados de um grupo de informantes. Revista
Investigao em Enfermagem, 2(5), 57-65.
Abreu, W. C. (2008). Transies e contextos multiculturais.
Coimbra, Portugal: Formasau. Queirs, P. J. (2014). Conceitos disciplinares em uso por
estudantes de licenciatura e de mestrado em enfermagem.
Barrett, E. A. M. (2002). What is nursing science? Nursing Science Revista de Enfermagem Referncia, 4(2), 29-40. doi:
Quarterly, 15(1), 51-60. doi: 10.1177/089431840201500109 10.12707/RIII13120
Carper, B. (2006). Fundamental patterns of knowing in nursing. Schutz, P. R., & Meleis, A. (1988). Nursing epistemology: Traditions,
In L. C. Andrist, P. K. Nicholas, & K. A. Wolf (Eds.), A history insights, questions. Journal of Nursing Scholarship, 20(4),
of nursing ideas (pp. 129-137). Sudbury, Canada: Jones and 217-221. doi: 10.1111/j.1547-5069.1988.tb00080
Bartlett Publishers.
Sderhamn, O. (2000). Self-care activity as a structure:
Chinn, P. L., & Kramer, M. K. (2004). Theory and nursing: A phenomenological approach. Scandinavian
Integrated knowledge development (6th ed.). St. Louis, MO: Journal of Occupational Therapy, 7(4), 183-189. doi:
Mosby. 10.1080/110381200300008724
Fawcett, J., Watson, J., Betty, N., Walker, P., & Fitzpatrick, J. Streubert-Speziale, H. J., & Carpenter, D. R. (2003). Qualitative
(2001). On nursing theories and evidence. Journal of research in nursing: Advancing the humanistic imperative
Nursing Scholarship, 33(2), 115-119. doi: 10.1111/j.1547- (3rd ed). Philadelphia, PA: Lippincott Williams & Wilkins.
5069.2001.00115.x
Tomey, A. M., & Alligood, M. R. (2002). Tericas de enfermagem e
Fourez, G. (2008). A construo das cincias. As lgicas das a sua obra (5 ed.). Loures, Portugal: Lusocincia.
invenes cientficas. Lisboa, Portugal: Instituto Piaget.
White, J. (2006). Patterns of knowing: Review, critique, and
Kim, H. S. (2010). The nature of theoretical thinking in nursing update. In L. C. Andrist, P. K. Nicholas & K. A. Wolf (Eds.),
(3rd ed.). New York, NY: Springer Publishing Company. A history of nursing ideas (pp. 139-150). Sudbury, Canada:
McEwen, M., & Wills, E. (2009). Bases tericas para enfermagem Jones and Bartlett Publishers.
(2 ed.). So Paulo, Brasil: Artmed. Young, A., Taylor, S. G., & Renpenning, K. M. (2001). Connection:
Meleis, A. I. (2011). Theoretical nursing: Development & progress Nursing research, theory and practice. St. Louis, MO:
(5th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Mosby.

PAULO JOAQUIM PINA QUEIRS, et al. Revista de Enfermagem Referncia - IV - n. 3 - 2014

163
View publication stats