- Orem self-care intervention significantly increased self-esteem and resilience in hospitalised patients with major depressive disorder compared with standard care.
- Randomised controlled trial of 60 patients, five supportive-educative sessions, showed robust time-group effects (P < 0.001 self-esteem; P = 0.002 resilience).
- Model is structured, low-cost and empowering, suitable for integration into routine psychiatric nursing to promote autonomy and sustain gains at one-month follow-up.
BMC Nurs. 2026 Jul 15. doi: 10.1186/s12912-026-05046-4. Online ahead of print.
ABSTRACT
BACKGROUND: Major Depressive Disorder (MDD) is a debilitating psychiatric condition that severely impairs patients’ self-care capabilities, self-esteem, and resilience. Dorothea Orem’s Self-Care Deficit Theory offers a systematic nursing framework to transition patients from passive care recipients to active self-managers. This study aimed to evaluate the effects of a nursing intervention based on Orem’s self-care model on self-esteem and resilience among hospitalized patients with MDD.
METHODS: This randomized controlled trial was conducted from February to May 2026 among 60 patients diagnosed with MDD who were hospitalized in the psychiatric ward of Shahid Madani Hospital in Khoy, Iran. Patients were selected via convenience sampling and randomly assigned to either the intervention group (n = 30) or the control group (n = 30) using block randomization. The intervention group received 5 sessions of a tailored self-care program based on Orem’s supportive-educative system, alongside routine clinical care. The control group received only standard hospital care. Data were collected at baseline (pre-test), immediately post-intervention (post-test), and at a one-month follow-up using the Rosenberg Self-Esteem Scale (RSES) and the Connor-Davidson Resilience Scale (CD-RISC). Data were analyzed using SPSS software via descriptive statistics and Repeated Measures ANOVA.
RESULTS: Baseline demographic and clinical characteristics were homogeneous between the two groups (P > 0.05). Mauchly’s test confirmed sphericity for both self-esteem (W = 0.992, P = 0.788) and resilience (W = 0.953, P = 0.252) variables. The Repeated Measures ANOVA demonstrated a significant time-group interaction effect for both self-esteem (F = 10.11, P < 0.001, Partial Eta Squared = 0.15) and resilience (F = 6.59, P = 0.002, Partial Eta Squared = 0.10). At post-test, the intervention group exhibited significantly higher self-esteem (Mean = 18.33, 95% CI: [17.08, 19.58]) and resilience (Mean = 55.70, 95% CI: [52.00, 59.40]) compared to the control group (Self-esteem Mean = 12.03, 95% CI: [10.78, 13.28]; Resilience Mean = 42.07, 95% CI: [38.37, 45.77]) (P < 0.001), which remained stable at the one-month follow-up.
CONCLUSION: Psychiatric nurses can integrate this structured, low-cost, and empowering model into routine clinical practice to foster autonomy and reinforce essential psychological capacities-specifically self-esteem and resilience-in hospitalized psychiatric patients.
TRIAL REGISTRATION: Iranian Registry of Clinical Trials, IRCT20250723066609N3. Registered on February 6, 2026.
PMID:42458470 | DOI:10.1186/s12912-026-05046-4
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