Access Type

Open Access Dissertation

Date of Award


Degree Type


Degree Name




First Advisor

Stephanie Myers Schim


The purpose of this study was to extend the theory of self-care deficit nursing by including specific constructs of religion, spirituality, and spiritual self-care practices within the structure suggested by Orem's self-care deficit nursing theory. Based on an extensive literature review, practice experience, and a discovery theory-building approach, a new mid-range theory called White's theory of spirituality and spiritual self-care (WTSSSC) was developed. To begin to test this mid-range theory, empirical indices of many of the main concepts were identified from prior studies and one new instrument (the Spiritual Self-Care Practice Scale) was developed. Hypothesized relationships among the main concepts of the mid-range theory were examined and tested in a sample of 142 urban African American outpatients who had been previously diagnosed with heart failure. The results of this study provided support that White's midrange theory of spirituality and spiritual self-care (WTSSSC) is a viable extension of Orem's self-care deficit nursing theory (SCDNT). The relations between QOL and spirituality, spiritual self-care practices, chronic illness self-care for heart failure, and physical and mental health were statistically significant and in the expected directions. The midrange theory can be used to incorporate spirituality and spirituality self-care practices which can mitigate the effects of chronic disease related to overall QOL for African Americans who have been diagnosed with heart failure. Results of this study have provided additional support for the use of spiritual self-care practices to assist in managing chronic illness, specifically heart failure. Nurses who work with patients diagnosed with heart failure should provide instruction on self-care practices specifically for heart failure (weight and diet management, medication compliance, sleep, etc.) and then encourage the use of spiritual self-care practices to enhance the well-being and QOL for these individuals. Nursing education needs to include spirituality and the importance of spiritual self-care practices as part of teaching Orem's theory of self-care to enhance patient health and QOL. This education could be presented in nursing education classes in colleges and universities; professional development programs; and presentations at state, regional, national and international conferences. Further research is needed to continue development of the WTSSSC.