You are on page 1of 44

Dorothea Orem

SELF- CARE, SELF-CARE DEFICIT, NURSING SYSTEMS

C. U. J., BSN RN

Dorothea Orem (1914-2007)


Born 1914 in Baltimore, Maryland Father: construction worker

Mother: homemaker

Educational Background
Early 1930s: Diploma from Providence Hospital School of Nursing 1939: B.S.N. from The Catholic University of America 1945: M.S. in nursing education from The Catholic University of America

Educational Background
1976 Doctor of Science from Georgetown University and in 1980 at San Antonio Texas 1988: Doctor of Humane Letters from the Illinois Wesleyan University and Doctor Honoraris Causae from the University of Missouri Columbia

Professional Experiences
y Worked as a staff nurse, private duty nurse, nurse

educator and administrator y Director of Nursing Service and Director of Nursing Education at Providence Hospital Detroit 1940-1949 y Nurse consultant (1949-1957) at the Division of Hospital and Institutional Services of the Indiana State Board of Health  Influenced the development of her theory

Nursing during her time


 a conglomerate of folk healing, housework, and

mothering

Professional Experiences
Influences for Theory Development

Definition of Nursing While working for Indiana State Board of Health (1949-1957) she wanted to upgrade the quality of nursing. It was in this role that she defined nursing practice with clear statements of the distinction between nursing and medicine.
What do nurses do? Why do they do what they do? What are the outcomes of their care?

Professional Experiences
Influences for Theory Development

Nursing Curricula y (1958-1960) Worked for US Dept of Health, Education and Welfare where she published Guidelines for Developing Curricula for the Education of Practical Nurses y Served as acting dean of CUA School of Nursing, and as an assistant professor of nursing education where she introduced self-care concepts.

Hartweg, D. (1991). Dorothea Orem: Self-Care Deficit Nursing Theory. Newbury London, Sage Publications Inc., pg 4.

Professional Experiences
Influences for Theory Development
y 1968-1978 Chairperson of the

Nursing Development Conference Group y 1970 Opened own consulting firm Orem and Shields, Inc. of Chevy Chase, Maryland

Researches and Publications


y 1962

Published The Hope of Nursing in the Journal of Nursing Education y 1971 Nursing: Concepts of Practice was published and subsequently in 1980, 1985, 1991, 1995 and 2001 y 1972 Published Concept Formalization in Nursing: Process and Product

METAPARADIGMS Human- being


INTEGRATED WHOLE-

composed of internal physical, psychological and social nature with varying degrees of self care ability
Self- reliant, responsible

and capable of continuous self- care, not only of himself , but also of his dependents

Able to meet own needs through: y Nutrition y Fitness y Hygiene y Interpersonal Relationships y Meaningful work y Spiritual Practices y Prevention and Health Promotion Practices

Human- being

Patient
y An individual with health

related limitations that make him incapable of continuous self- care or dependent care y Has self care requisites or demands which are beyond his self care abilities

Requires help from others in sustaining life and health, recovering from disease and injury or coping with their effects. ( Requirement for Nursing)

METAPARADIGM Health
y A state of wholeness or

integrity: where one is structurally and functionally whole or sound y One who has the necessary self-care ability to meet his challenging selfcare demands.

METAPARADIGM Environment

yContext

where self-care

occurs. yCan hinder or support self-care activities. y Includes the family, work, community, health care system.

METAPARADIGM Nursing
y Actions

deliberately selected and performed by nurses to help individuals or groups under their care to maintain or change conditions in themselves or their environments

METAPARADIGM Nursing
y An ART, a COMMUNITY

SERVICE and TECHNOLOGY

METAPARADIGM Nursing
ART  design, provision and management of systems COMMUNITY SERVICE  deliberative actions of assisting another in maintaining or reestablishing balance TECHNOLOGY  Formalized methods of Practice and described ways of performing actions a.) interpersonal b.) regulatory

SELF- CARE DEFICIT THEORY OF NURSING Published Orems Nursing: Concept of Practice in 1971,
and subsequently in 1980, 1985, 1991, 1995, and 2001.

People should be self-reliant and responsible for their own care and others in their family needing care People are distinct individuals

SELF- CARE DEFICIT THEORY OF NURSING


Published Orems Nursing: Concept of Practice in 1971, and subsequently in 1980, 1985, 1991, 1995, and 2001.

Nursing is a form of action interaction between two or more persons Successfully meeting universal and development self-care requisites is an important component of primary care prevention and ill health

SELF- CARE DEFICIT THEORY OF NURSING


Published Orems Nursing: Concept of Practice in 1971, and subsequently in 1980, 1985, 1991, 1995, and 2001.

A persons knowledge of potential health problems is necessary for promoting self-care behaviors Self care and dependent care are behaviors learned within a socio-cultural context

SELF- CARE DEFICIT THEORY OF NURSING


Published Orems Nursing: Concept of Practice in 1971, and subsequently in 1980, 1985, 1991, 1995, and 2001.

Goal of nursing is to render the patient or members of his family capable of meeting the patients self care needs.

SELF- CARE DEFICIT THEORY OF NURSING Published Orems Nursing: Concept of Practice in 1971,
and subsequently in 1980, 1985, 1991, 1995, and 2001.

Published Orems Nursing: Concept of Practice in 1971, and subsequently in 1980, 1985, 1991, 1995, and 2001.

SELF- CARE DEFICIT THEORY OF NURSING

a. Orems general theory of nursing: Nursing

encompasses not only the what and the why, but also the who and how ( Orem, 2006) b. An action theory with clear specifications for nurse and patient roles c. Comprises 3 minor interrelated theories: selfcare self-care deficit and nursing systems d. Consists of 6 major concepts and 1 peripheral concept

Six Basic Concepts


1. Self- care/ dependent

care 2. Self- care agency/ dependent care agency 3. Therapeutic self- care demand 4. Self- care deficit or dependent care deficit 5. Nursing Agency 6. Nursing System

Patient related

Nursing related

Peripheral Concept: Basic Conditioning Factors


y Related to both the self- care agent (person receiving

care) and dependent care agent ( family member/ friend providing care) and also to the nurse ( nurse agent) y Self- Care Agent- the person who engages in a course of action or has the power to do so ( Orem 2001)

Peripheral Concept: Basic Conditioning Factors


y Age

Health Care y Gender System factors y Developmental State Family System y Health State Factors y Sociocultural Patterns of living Orientation Environmental Factors Resource (Orem 2001) Availability

Theory of
Self- Care
Based on the presumption that individuals learn self-care practices through experience, education, culture, scientific knowledge, growth, and development.  The practice of activities that Individuals perform on their behalf in maintaining life, health and well-

Self Care
Dependent Care
 performed by MATURE, RESPONSIBLE PERSONS on behalf of socially dependent individuals or self- care agents Purpose: to meet socially dependent persons health related demands ( dependent care demand) or needs and/ or develop their self- care capabilities ( selfcare agency) (Taylor et. al, 2001)

Self- Care Agency


Orem (2001) definition:  complex acquired capability to meet ones continuing requirements for care of self that regulates life processes, maintains or promotes integrity of human structure and functioning (health) and human development and well- being

Therapeutic Self- Care Demand


 a complex theoretical concept that summarizes all

actions that should be performed over time for life, health and well- being ( Orem, 2001)  a.k.a. action demand or self- care demand

Self- Care Requisites


(3) Categories : 1.)Universal Self Care - common to all people and include physiological and social interaction needs
(food, air, water, activity & rest, solitude & social interactions etc.)

2.)Developmental Self Care needs that occur as the individual grows and develops
(toilet training, adjustment to new job, new baby, etc.)

3.) Health Deviation Self Care needs produced by disability, illness, or injury

y Whenever there is an INADEQUACY in any of

these care requisites, the person will be in need of self-care or will have a deficit in self care

the DEFICIT is identified by the nurse through the assessment of the patient

Theory the value of relationship a.) Expresses of Self Care Deficit between two components: self- care agency and therapeutic self- care demand (Orem,2001) When the persons self- care agency is not adequate to meet all self- care requisites ( TSCD), a self-care deficit exists b.) Also described as complete or partial COMPLETE DEFICIT= no capability to engage in self-care or dependent care PARTIAL DEFICIT= able to provide some self- care

Implications
y Understanding self- care deficit is a requirement in

order for the nurse to design and implement nursing system y The nurse must reflect with the patient: Is self- care agency adequate to meet the TSCD comprising of all 3 requisite types? - If adequate, then nursing is not needed; if inadequate then nursing is needed

Theory of Nursing System 3 Support Modalities


Addresses the ability of the nurse to aid the person in meeting current and potential self care demands. Focus is on the person, within or across particular support modalities (e.g., nursing systems) Nursing systems are determined by whether the clients self care needs are met by the nurse, the client, or both.
Wholly compensatory nurse provides complete health care for the individual (ex. newborn, or comatose patient) Partially compensatory nurse and patient contribute to meeting patients needs (ex. CVA patient with some physical limitations) Supportive-Developmental nurses primary supportive role is patient education, enabling the patient to independently address their own self care needs (ex. teaching a patient glucose monitoring)

Theory Limitations Orientation & Context


y Appears illness oriented y Leans more to providing care to adults y May not be as beneficial for prevention and health

promotion y Has Western focus, failing to address cultural groups valuing interdependence & harmony y Biomedical orientation of theory fails incongruent with folk health practices

Meleis, A. (2007). Theoretical nursing Development and progress. Philadelphia: Lippincott Williams & Wilkins. Robertson, M. and Kelly, J. (1996). Using Orems theory in trans-cultural settings: a critque. Nurse Forum. 31:22-28.

Contribution to Nursing
Though Orems theory contains elements of systems theory, an interaction model, and a developmental theory, Meleis classifies the self care deficit theory as therapeutic. Why? Because the theory focuses on action, with both nurse and patients engaging in deliberate actions, and these actions form the basis on the practical science of nursing. Provides framework for nursing care.  Though developed around the ill person, it is used for all ages and in all settings (ex. diabetes management, chronically ill, critical care, hospice care, oncology, etc.).  Operationalized and used in research, practice, nursing administration, and nursing curriculum.


y Alligood & Tomey (2006), stated that" Highly regarded for

its usefulness in all aspects of nursing, Orem's Self Care Model continues to be the organizing frame work of many nurse researchers, educators, administrators and providers of client care". Its popularity and practicability can be seen by the different nursing bodies' interest in Orem's model and even the nurses interested in it, have formed an International Orem's Society for nursing science and scholarship (Alligood &Tomey,2006). This organization has worked a lot on Orem's work and utilizing Orem's theory in clinical practice, in nursing research and education.
y

References Books
Abdul, H., 2002, The Academic Implications of the Grand Nursing Theories, International Journal of Nursing, Vol 12 no. 10 Alshamsi, M,1995, The complexity of the modern nursing theories, International Journal of Nursing, Vol 8 no. 4 Balabagno, et al., Pathophysiology, UP Open University; 2006 Dela Cruz, M, et al, 1991, Grand Nursing theories applied in a health care setting, MAN Thesis, Philippine Womens University Fitzpatrick JJ, Whall AL. Conceptual models of nursing, analysis and application. 4th ed. Upper Saddle River, New Jersey: Pearson Prentice-Hall; 2005. George, J. B. (1985). Nursing theories: The base for professional nursing practice (2nd ed.). Alexandria, VA: Prentice Hall; 1990

References Books
George JB. Nursing theories, the basis for professional nursing practice. 4th ed. Norwalk: Appleton & Lange; 1995. George, Julia B. (1995). Nursing theories: The base for professional practice (4th Ed.) Prentice-Hall International McEwen, M., & Wills, E., 2nd ed. (2002). Dorothea E. Orem: The Self-Care Deficit Nursing Theory. Theoretical Basis for Nursing (pp. 144-145) New York: Book Tommey, A. M., Alligood, M.R, 6th ed.(2006). Dorothea E. Orem. Nursing Theorists and Their Work. (pp. 272-273).St. Louis Missouri: Book Meleis, A., 2nd ed. ( 1991). Dorothea E. Orem Theoretical Nursing: Development and Progress. Second Ed.,( 443). Philadelphia: Book

References Books
Mendoza, A., et al, 1998, The Students perspective on the foreign and local nursing theories, An Assessment., MAN thesis, Philippine College of Health Science Moustafa, E, 1999, The Modern Nursing Theories and their deficiencies, The Scientific Society of Arab Nursing Faculties, Vol 1 no. 12 Orem, Dorothea E. (1991). Nursing: Concepts of practice (4th Ed.) St. Loius: Mosby Tomey, A. M., & Alligood, M.R. (1998). Nursing theorists and their work. St. Louis, Missouri: Mosby-Year Book.

References Internet Application of Orems Self-Care Deficit Theory In Nursing Practice( 2010). Retrieved from http://currentnursing.com/nursing_theory/application_se lf_care_deficit_theory.html Dorothea orems Theory (2010). Retrieved from http://currentnursing.com/nursing_theory/self_care_defi cit_theory.html Dorothea Orem's Self Care Deficit Theory by Jean Bridge et.al, Troy University http://prism.troy.edu/~scabell/Orem.pdf (Taylor et al, 1998, p. 179)., p46

You might also like