Dorothea Orem self care deficit theory

A grand nursing theory.

Orem’s Self care theory is based on the philosophy that “all patients wish to care for themselves.” If
they are allowed to perform their own self-care requisites to the best of their ability, they will recover
more quickly and holistically.

Dorothea Orem (1914-2007)

Dorothea Orem
Born in 1914
1939 – BSN completed from Catholic University of America.

1945 - MS in nursing education from Catholic University of America.

Held many nursing roles during her career – educator, administrator, staff, director, consultant
Worked on many different nursing units – medical-surgical, emergency room, operating room
Received many honorary awards

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

Orem’s book of “ guidelines for developing curricula for the education of practical nursing” was the seed
for her work

DEVELOPMENT OF THEORY 1949-1957

Orem worked for the Division of Hospital and Institutional Services of the Indiana State Board of Health.

Her goal was to upgrade the quality of nursing in general hospitals throughout the state.

During this time she developed her definition of nursing practice.

1959 Orem subsequently served as acting dean of the school of Nursing and as an assistant professor of
nursing education at catholic university of America.

She continued to develop her concept of nursing and self care during this time.

Orem’s Nursing: Concept of Practice was first published in 1971 and subsequently in 1980, 1985, 1991,
1995, and 2001.

Publications
1959: Guidelines For Developing Curricula For The Education Of Practical Nurse

1962: The Hope Of Nursing

1971: Nursing: Concept And Practices 6 th edition in (1999).

1972: Concept Formalization In Nursing: Process And Product.

1979: Levels of nursing education and practice

MAJOR ASSUMPTIONS

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

People are distinct individuals 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

A person’s 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

Orem’s General Theory of Nursing

Concepts within the three “sub-theories”

(1) Theory of Self Care

(a) Self care

(b) Self care agency

(c) Therapeutic self care demand

(d) Self care requisites

(i) Universal

(ii) Developmental

(iii) Health deviation

(2) Theory of Self Care Deficit

(a) Self care deficit

(3) Theory of Nursing Systems

(a) Wholly Compensatory

(c) Supportive-educative

Self-care Theory:

3 types of self-care requisites (needs) or categories

SELF-CARE AGENCY

SELF-CARE REQUISITES

THERAPEUTIC SELF-CARE DEMAND

Self-care Definition

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

Orem’s Self-care Agency

Definition: the individual’s ability to perform self-care activities

Refers to ability of individuals to: determine requirements for regulating functioning, judge/ decide what
to do and how to perform care measures to meet self-care requisites

Consists of TWO agents:

Self-care Agent - person who provides the self-care

Dependent Care Agent - person other than the individual who provides the care (such as a parent)

Therapeutic self-care demand

Refers to demands on individuals to meet:

Universal self-care requisites associated with life processes and maintenance of the integrity of human
structure and function.

Self-care requisites associated with human developmental processes and conditions and events that
occur during various stages during the life cycle as well as events that may adversely affect development.

Health deviation self-care requisites associated with genetic and constitutional defects and human
structural and functional deviations and their effects, as well as with medical and diagnostic and
treatment measures prescribed or performed by physicians.

Orem’s Self-care Requisites (also called Self-care Needs)

Definition: the actions or measures used to provide self-care

Universal - requisites/needs that are common to all individuals

Developmental - needs resulting from maturation or develop due to a condition or event

Health Deviation - needs resulting from illness, injury & disease or its treatment

Universal self care requisites

Associated with life processes and the maintenance of the integrity of human structure and functioning

Common to all , ADL

Identifies these requisites as:

Maintenance of sufficient intake of air ,water, food

Provision of care assoc with elimination process

Balance between activity and rest, between solitude and social interaction

Prevention of hazards to human life well being and

Promotion of human functioning

Health deviation self care

Required in conditions of illness, injury, or disease .these include:--

Seeking and securing appropriate medical assistance

Being aware of and attending to the effects and results of pathologic conditions

Effectively carrying out medically prescribed measures

Modifying self concepts in accepting oneself as being in a particular state of health and in specific forms
of health care

Learning to live with effects of pathologic conditions

Orem’s Self-care Deficit Theory

Explains when nursing is needed

Describes and explains how people can be helped through nursing

Results when the Self-care Agency (patient) can’t meet her/his self-care needs or administer self-care

Nursing meets these self-care needs through five methods of help

The expression of a relationship of inadequacy between self-care agency and therapeutic self-care
demand.

Five Methods of Nursing Help

Acting or doing for

Guiding

Teaching

Supporting

Providing an environment to promote the patient’s ability to meet current or future demands

Orem’s 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 patient’s demands

Orem’s Nursing Systems Theory

Refers to a series of actions a nurse takes to meet a patient’s self-care needs

Is determined by the patient’s self-care needs

Is composed of THREE systems:

Wholly Compensatory: a patient’s self-care agency is so limited that s/he depends on others for well-
being .This system is selected when an individual cannot or should not perform any self-care actions.

Partly Compensatory: a pt can meet some self-care requisites but needs a nurse to help meet others.
This system is selected when an individual can perform some, but not all, self-care actions

Supportive-educative: a pt can meet self-care requisites but needs help in decision-making, behavior
control, or knowledge acquisition. This system is selected when an individual can and should perform all
self-care actions

Orem’s Theory & Nursing’s Metaparadigm - 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)

- 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. Environmental Conditions - external physical & psychosocial
surroundings

Developmental Environment - promotion of personal development through motivation to establish

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. Is required when self-care demands exceed a patient’s
self-care ability (agency) Promotes the patient as a self-care agent Has several components

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. Supports health
promotion and health maintenance

Strengths

Provides a comprehensive base to nursing practice. It has utility for professional nursing in the areas of
nursing practice nursing curricula ,nursing education administration ,and nursing research

Specifies when nursing is needed. Her self-care approach is contemporary with the concepts of health
promotion and health maintenance

Limitations : Health is often viewed as dynamic and always changing. However, Orem presents nursing
systems as fixed and constant, implying that there are three static conditions of health. · Orem’s
presentation of the theory makes it appear illness-oriented rather than wellness-oriented

Clarity

concepts are clear and well defined. concepts are consistently used throughout the theory

Simplicity
There are many theories and concepts within the overall theory; more complex than simple when
taken as a whole

Generality

Theory is broad and can be applied to many different settings, individuals, or communities

Accessibility

Empiric indicators can be identified. Concepts can be defined in research studies due to clarity
of concepts defined