Dorothea Orem

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Dorothea Orem

• Self-Care Deficit theory

Prepared by
Prof. Dr. Nefissa A. El-Kader
Vice Dean of Education and Student
Affairs Faculty of Nursing-Cairo University
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Outlines

• Overview about Orems theory-
• Orem's CV
• Origins Purpose
• Philosophy and world view
• Metaparadigm Concepts
• Assumptions and Propositions
• Theories included in the Self-Care Deficit theory
  
• Orems Theory and Nursing process

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Time oriented Peplau
Published at 1952.Orem Published at
1959.Roy Published at 1960.Rogers
Published at 1970.King Published at
1971Newman Published at 1989
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Dorothea OremC.V.

• 1939 BSN completed
• 1945 - MS in nursing education
• 1958 - consultant to the Office of Education
  where she began working on her SELF-CARE THEORY
• 1959 - first published her theory in Guides for
  Developing Curricula for the Education of
  Practical Nurses (a government publication)

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Dorothea OremC.V.

• 1976 - honorary Doctorate of Science from
  Georgetown University
• 1980 Award for nursing theory from catholic
  university of America.
• 1999 - last edition of her theory was published

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Publications

• 1959 Guidelines For Developing Curricula For The
  Education Of Practical Nurse
• 1962 The Hope Of Nursing
• 1971 Nursing Concept And Practices 6th edition
  in (1999).
• 1972 Concept Formalization In Nursing Process
  And Product.
• 1979 Levels of nursing education and practice

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Origin

• While Orem was working in the Department of
  Health Education and Welfare (HEW) as a
  curriculum consultant she worked to upgrade
  practical nursing training.
• That stimulated the need to address the question

What is the subject matter of nursing? (Curriculum
)
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Origin contd.

• Orems book of guidelines for developing
  curricula for the education of practical nursing
  was the seed for her work (Orem,1959 in Fawcett
  1995) and (Meleis, 1998).
• To conceptualize a curriculum for a diploma
  program by isolating and specifying nursing
  action.

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Origin contd.

• Ideas that helped to shape the self-care
  framework were formulated as Orem experienced a
  period of intensive exposure to nurses and their
  endeavors from 1949 to 1957 (Fawcett, 1995).

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Philosophical view

• Orem has identified her philosophical view based
  on the action theory, from the perspective of the
  person as a deliberate actor or agent.

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Philosophical view contd.

• Orem model is based upon the philosophy that all
  patients wish to care for themselves and its
  purpose was to define the following
• Nursing concern is on the mans needs for
  self-care action and the provision and management
  of it on a continues basis in order to sustain
  life and health, recover from disease or injury
  and cope with their effect.
• Nursing goal is overcoming human limitations (
  Berbelgia, 2002).

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World View

• World view referred to the physiologic
  assumptions about the nature of person
  environment relationship.
• Orem adopted the organicism rather than
  mechaniscism as world view, she proclaimed that
  man include internal physical, psychological and
  social nature with the change rather than
  stability.

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World View contd.

• She stated that man and environment interact as a
  self-care system.
• A change in either the system of man and the
  system of the environment will affect the
  self-care system.
• Orem states Man functioning is linked to his
  environment and together man and environment form
  an integrated whole system.
• Keywords that support this view change, whole,
  interaction, man and environment.

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Conceptual Models

• Nursing models are categorized according to the
  discipline or anthropology from which they were
  derived.
• It is clear in Orems theory that she used
  developmental model (Montgomery,2004). Also,
  Meleis (1998) viewed that Orems theory could be
  categorized as an interaction model.

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Theory Development Strategy

• The theory development strategy used by Orem was
  induction from practice.
• Induction from practice is clearly evident in
  Orems detailed accounts of how concepts in the
  theory were determined and defined based on
  experience in concrete nursing practice
  situations or results of analysis of nursing care
  materials (Orem,1991)

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Theory Development Strategy contd.

• Orem did however read widely and identified some
  of major influences on her thinking, suggests
  that there was an element of deduction in her
  work (Montgomery,2004).
• Sources of influences include ideas about
  deliberate human actions and motivation.

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Theory Development Strategy contd.

• Factors influencing development
• Practical nursing curriculum development
• Womens movement
• Nursing theory conferences

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Basic Elements in the Model

• The structure and components of the self-care
  framework have undergone various interpretations
  overtime.
• Orem (1991) explained all of the conceptual
  elements of the self-care framework were
  formalized and validated as static concepts by
  1970.
• Since then, some refinements of expression and
  further development of substantive structure and
  continued validation have occurred and changes
  have been made (Fawcett,1995).

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Structurally, each theory is presented as a set
of assumptions, and a set of propositions.
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Model Metaparadigm- Nursing
Orem viewed nursing as A community service, an
art and a technology. Community ( is a group of
individuals and families who share not only a
common geographic area but common Interest. As
a health service in the community It is an
interpersonal process that requires the social
encounter of a nurse with a patient (transaction
process) based on the values of that community.
Art As an art, it is the ability to assist
others in the design, provision and management
of systems of self-care to improve or to
maintain human functioning at some level of
effectiveness
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Model Metaparadigm- Nursing
Technology techniques of practice 1-
Communicating with persons in states of health
and disease. 2- Maintaining interpersonal,
intragroup, and intergroups relationships
for cooperative efforts. 3-Giving human
assistance adapted to specific human needs
limitations. 4- Maintaining and controlling the
positions and movements of persons in
physical environment for therapeutic
purposes. 5- Promoting process of human growth
and development including self or ego
development. 6-Sustaining and maintaining life
process. 7- Appraising, changing and controlling
psycho-physical modes of human functioning
in health and disease. 8- Maintaining therapeutic
relations based on psychosocial modes of human
functioning in health disease.
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Model MetaparadigmNursing
Nursing

• It is the ability to assist others in design,
  provision and management of self-care to improve
  or maintain human function at some level of
  effectiveness.

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Methods of Nursing Help

• Acting or doing for
• Guiding directing another
• Teaching another
• Providing psychological and physical support.
• Providing a supportive environment to promote the
  patients ability to meet current or future
  demands.

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Model MetaparadigmHealth
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Model MetaparadigmHealth
Health

• Not only a bodily state but also to how one
  functions in everyday living and
• progressive development that is movement toward
  higher and higher level of integration and
  functioning.

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Model Metaparadigm- ENVIRONMENT

• Person and environment are a functional unit in
  which exchange are reciprocal and influence is
  mutual.
• Persons are viewed as existing in their
  environments and never isolated from them.
• 4 environmental features (physical, chemical,
  biologic and social) have an impact on the health
  and well- benign the person and the family.

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Model Metaparadigm - PERSON
Person

• The recipient of nursing care
• A being who functions biologically, symbolically,
  and socially
• Has the potential for learning development
• Is subject to the forces of nature
• Has a capacity for self-knowledge
• Can engage in deliberate actions, interpret
  experiences, and perform beneficial actions
• Can learn to meet self-care needs (requisites)

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Model Metaparadigm - PERSON
Person

• Human beings are distinguished from other living
  beings by their capacity to
• Reflect upon themselves and their environment
• Use symbolic creations (ideas, words) in
  thinking, communicating, and guiding efforts to
  make things that are beneficial for themselves
  and/or for others
• Man and environment form an integrated system . A
  change in either component may affect the
  self-care system.

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Orems Self-care Theory

• Based on the concepts of
• SELF-CARE
• SELF-CARE AGENCY
• SELF-CARE REQUISITES
• THERAPEUTIC SELF-CARE DEMAND

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Self-care Definition

• Self-care
• The practice of activities that mature person
  initiates and performs independently within time
  frame, to promote and maintain personal
  well-being, healthful functioning and continuing
  development throughout life.

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Orems Self-care Agency

• Definition the individuals ability to perform
  self-care activities (capabilities of the person)
• It is a complex acquired abilities to meet ones
  continuous requirement for care.
• Consists of TWO agents
• Self-care Agent - person who provides the
  self-care and has the power to do so
• Dependent Care Agent - person other than the
  individual who provides the care (such as a
  parent)

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Orems Self-care Requisites (also called
Self-care Needs)

• Definition the expressions of action to be
  performed by or for individuals for controlling
  human and environmental factors that affect human
  functioning and development
• Three types of self-care requisites constitute
  the therapeutic self- care demand
• Universal - requisites/needs that are common to
  all individuals.
• 1- Air, water and food
• 2- elimination and excrements

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Orems Self-care Requisites contd.

• 3- activity/rest
• 4- solitude (aloneness) /social interaction
• 5-prevention of hazards to life and well-being
  (physical , social psychological hazards).
• 6-promotion of function and development within
  social group based on group norms.

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Orems Self-care Requisites (also called
Self-care Needs)

• Developmental Actions that need to be performed
  in relation to human developmental processes ,
  conditions and events and relation to events that
  adversely affect development.
• Health Deviation exists for persons who are ill
  or injured have specific forms of pathologic
  conditions (including defects and disabilities
  who are under medical diagnosis and treatment..
• Needs resulting from illness, injury disease or
  its treatment

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Self-Care Deficit

• The relationship between self-care agency
  (ability to perform self-care) and the
  therapeutic self-care demand in which self care
  agency is not sufficient to meet ones
  therapeutic self-care demands.
• Dependent- care deficit exists when the persons
  ability to perform dependent-care (i.e.,
  dependent- care agency) is not sufficient to meet
  the socially dependent persons therapeutic self
  care demand).
• Deficit can be complete or partially and as such
  indicate whether wholly or compensatory system.

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Therapeutic Self-care Demands

• The sum of self-care measures/ actions, required
  to meet the specific self-care requisites of a
  person at a point in time.

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?Assumptions Propositions
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Assumptions (explicit)

• Nursing is a deliberate , purposeful helping
  service performed by nurses for the sake of
  others over a period of time.

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Assumptions (explicit)
For self

• Persons are capable and willing to perform
  self-care for self or for dependent members of
  the family.

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Assumptions (explicit)

• Self care is part of life that is necessary for
  health human development well-being.

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Assumptions (explicit)

• Education and culture influence individuals.

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Assumptions (explicit)

• Self-care is learned through human interaction
  and communication.

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Assumptions (explicit)

• Self-care includes deliberate and systematic
  actions performed to meet needs for care.

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Assumptions (implicit)

• People should be self- reliant and responsible
  for their own care needs as well as others in the
  family who are not able to care for themselves.

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Assumptions (implicit)

• People are individuals with entities that are
  distinct from others and from their environments.

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Propositions

• Person and nursing client
• Human beings have capabilities to provide their
  own self-care or care for dependents to meet
  universal, developmental and heath deviation
  self-care requisites.
• Self care abilities are influenced by age,
  developmental state experiences and sociocultural
  background.
• Self-care deficits are to balance between
  self-care demands and self-care capabilities and
  an indication of a state of social dependency..

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Propositions Cont

• Nursing Therapeutic
• Therapeutic self-care includes actions of nurses,
  patients, and others that regulate self care
  capabilities and meet self-care needs.
• Nurses assess the abilities of patients to meet
  their self-care needs.
• Nurses engage in selecting valid and reliable
  processes , or technologies or action for meeting
  self-care demands.
• Components of therapeutic self-care are wholly
  compensatory, partly compensatory and supportive
  educative.

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Orems General Theory of Nursing

• Consists of three related theories collectively
  referred to as Orems General Theory of
  Nursing
• Self-care Theory
• Self-care Deficit Theory
• Nursing Systems Theory

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Orems Self-care Theory

• Based on the concepts of
• SELF-CARE
• SELF-CARE AGENCY
• SELF-CARE REQUISITES
• THERAPEUTIC SELF-CARE DEMAND

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Self-care Definition

• Self-care comprises those activities performed
  independently by an individual to promote and
  maintain personal well-being throughout life.

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Orems Self-care Deficit Theory

• Is the central focus of Orems Grand Theory of
  Nursing
• Explains when nursing is needed
• Describes and explains how people can be helped
  through nursing
• Results when the Self-care Agency (patient) cant
  meet her/his self-care needs or administer
  self-care
• Nursing meets these self-care needs through five
  methods of help

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Orems Nursing Systems Theory Describes...

• Nursing responsibilities
• Roles of the nurse and patient
• Rationales for the nurse-patient relationship
• Types of actions needed to meet the patients
  demands

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Orems Nursing Systems Theory

• Refers to a series of actions a nurse takes to
  meet a patients self-care needs
• Is determined by the patients self-care needs
• Is composed of THREE systems
• Wholly compensatory
• Partly compensatory
• Supportive-educative

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Three Nursing Systems

• Wholly Compensatory a patients self-care agency
  is so limited that s/he depends on others for
  well-being
• Partly Compensatory a pt can meet some self-care
  requisites but needs a nurse to help for others.
• Supportive-educative a pt can meet self-care
  requisites but needs help in decision-making,
  behavior control, or knowledge acquisition

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Orem's theory, Nursing process Critical thinking
operations
Intellectual Phase Step I the initial and
determination of needs Step II the designing
of system (Planning). Practical phase Step
III Initiation, conduction controlling of
assisting actions.
Critical Thinking Operations It includes four
cognitive operations Diagnostic
Operation Identify self-care practice, its
limitation Perspective Operations Select the
appropriate therapeutic method and explaining it
to client Regulatory operations Design plan and
implement it. Control operations Evaluation of
the effectiveness of regulatory operations
Nursing process Assessment Diagnosis Planning
Implementation Evaluation
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Thank You