Dorothea Orem's Self-Care Theory
Dorothea Orem (1914-2007)
INTRODUCTION
One of foremost nursing theorists.
Born 1914 in Baltimore.
Earned her diploma at Providence Hospital – Washington, DC
1939 – BSN Ed., Catholic University of America
1945 – MSN Ed., Catholic University of America
Involved in nursing practice, nursing service, and nursing education
During her professional career, she worked as a staff nurse, private duty nurse, nurse educator and
administrator and nurse consultant
Received honorary Doctor of Science degree in 1976
Published first formal articulation of her ideas in Nursing: Concepts of Practice in 197, second in 1980, and in
1995.
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 CUA. 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.
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 primary
care prevention and ill health
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
PARADIGM OF OREM’S THEORY
"Nursing is a community service, an art, and a technology."
Man
Orem viewed man as an integrated whole composed of an internal physical, psychologic, and social
nature with varying degrees of self-care ability.
He/she has the potential for learning and development as he/she is gifted with rational ability and
capacity to reflect on his/her experience and use symbols (ideas and words).
Under normal conditions, man is self-reliant, responsible and capable continuous self-care, not only of
himself/herself, but also oh his/her dependents.
Orem viewed a patient as an individual with health related limitations that make him/her incapable of
continuous self care or dependent care.
His/ her self-care requisites or demands are beyond his/her self-care abilities which can be attributed to
his/her lack of knowledge, skills, motivation or orientation.
Health
Orem defined health as a state of wholeness or integrity of a human being: a state where one is
structurally and functionally whole or sound. She further added that a healthy being is one who has the
necessary self-care ability to meet his/her changing self-care demands.
She supported the concepts of health promotion and health maintenance and claimed that it is not just
the individual’s responsibility, but also the society as a whole, including its members.
Environment
Orem viewed the environment as not just the elements external to man. She viewed man and
environment as an integrated system.
Client’s environment includes physical, chemical, biological, and socioeconomic-cultural components as
well as their values, goals, and attitudes. All of these factors influence the person, health, self care and
nursing.
Nursing
According to Orem, nursing consists of actions deliberately selected and performed by nurses to help
individuals or groups under their care to maintain or change conditions in themselves or their
environment.
She further viewed nursing as an art, community service and a technology. As an art, it has a theoretical
base which serves as the basis in providing self-care towards improvement of one’s functioning and
development. As a community service, it is geared towards deliberative actions of assisting another in
maintaining or reestablishing balance between self-care abilities and demands also leading to
improvement in one’s functioning and development. As a technology, it has specialized methods or
practice of delivering self-care.
OREM’S GENERAL THEORY OF NURSING
Orem’s general theory of nursing in three related parts:-
Theory of self care
Theory of self care deficit
Theory of nursing system
A. THEORY OF SELF CARE
This theory Includes:
Self care – Practices of activities that individual initiates and perform on their own behalf in maintaining life,
health and well being.
Self-care is referred to as set of activities that people take on themselves to maintain good health. Success
depends upon the level of the person’s maturity, experience, and mental status (Orem, 2001).
Self care agency – is a human ability which is "the ability for engaging in self care" -conditioned by age
developmental state, life experience sociocultural orientation health and available resources
Therapeutic self care demand – "totality of self care actions to be performed for some duration in order to
meet self care requisites by using valid methods and related sets of operations and actions"
Self care requisites-action directed towards provision of self care. 3 categories of self care requisites are-
1. Universal
2. Developmental
3. Health deviation
1. 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
2. Developmental self care requisites
Meeting of the developmental self-care requisites promotes human development and prevents or
overcomes conditions and situations encountered throughout the life cycle that can adversely
affect human development.
Associated with developmental processes/ derived from a condition…. Or associated with an event. Examples
can include such things as toilet training a child or learning healthy eating.
o E.g. adjusting to a new job
o adjusting to body changes
3. Health deviation self care
Health-deviation self-care requisites relate to the health states of individuals.
According to the theory, health deviation self-care requisites exist for persons who are ill or injured,
have specific forms of pathology, have a predisposition to specific diseases, or are under medical
diagnosis and treatment.
Meeting of the health-deviation self-care requisites contributes to the goals of health maintenance,
health restoration, and the prevention of disease.
B. THEORY OF SELF CARE DEFICIT
Specifies when nursing is needed
Nursing is required when an adult (or in the case of a dependent, the parent) is incapable or limited in the
provision of continuous effective self care.
Orem identifies 5 methods of helping:
o Acting for and doing for others
o Guiding others
o Supporting another
o Providing an environment promoting personal development in relation to meet future demands
o Teaching another
C. THEORY OF NURSING SYSTEMS
Describes how the patient’s self care needs will be met by the nurse , the patient, or both
Nurse Agency: The nurse agency is a set of abilities developed by the nurse through education, skill and
experience. Means the nurse’s ability to compensate for or help someone overcome limitations for self-care.
Identifies 3 classifications of nursing system to meet the self care requisites of the patient:-
Wholly compensatory system: Total compensatory support encompasses total nurse care- client unable to
do for themselves
Partly compensatory system: Partial compensatory support involves both the nurse and the client sharing in
the self care requirements
Supportive – educative system: Educative/supportive compensatory support elicits the help of the nurse
solely as a consultant, teacher or resource person. Client is responsible for their own self care.
Design and elements of nursing system define
Scope of nursing responsibility in health care situations
General and specific roles of nurses and patients
Reasons for nurses’ relationship with patients and
The kinds of actions to be performed and the performance patterns and nurses’ and patients’ actions in
regulating patients’ self care agency and in meeting their self care demand
Orem recognized that specialized technologies are usually developed by members of the health profession
A technology is systematized information about a process or a method for affecting some desired result
through deliberate practical endeavor ,with or without use of materials or instruments
NURSING THEORY IN PRACTICE
In order to help explain this concept, Orem also created three areas of how care can be
administrated to a client depending on the physical and mental capabilities of the client.
Wholly compensatory, partly compensatory and supportive-educative role
Case Study
Bedridden oncology patient arrives via ambulance for chemotherapy. Family insists upon
keeping patient at home; however, leaves patient alone with nurse in chemo clinic for treatment.
Patient requires O2 at 2L/min, continuous tube feeding at 90cc hour, foley catheter, and bedpan.
Nurse in clinic administers chemo premeds and chemo; changes dressing around g-tube due to
leaking; administers O2 at 2L; empties Foley at end of treatment; places patient on bed pan one
time.
Preterm labour patient regularly visits clinic for BP monitoring, etc. Patient on bed rest
(at home), except for weekly visit to module. Nurse assists patient out of wheel chair into
bathroom, assists with urine sample collection, and onto exam table. Nurse administers injection
of terbutaline and educates patient regarding oral terbutaline.
Newly diagnosed diabetic patient received diabetic care teaching while in hospital. Now,
patient visits module and reports highly variable BS/chemstrip readings. Nurse suspect’s patient
may be performing procedure incorrectly. Nurse assesses that patient has been cutting some of
his chemstrips in half to save money. Nurse instructs patient that cutting strips exposes chemicals
and inaccurate readings may result. Additionally, nurse assesses that patient's wife (who does
family cooking) did not receive any nutritional education while patient was hospitalized. Nurse
begins nutritional counseling and provides wife with referral to nutritional services department.
OREM’S WORK AND THE CHARACTERISTICS OF A THEORY
Theories can interrelate concepts in such a way as to create a different way of looking at a particular
phenomenon
Theories must be logical in nature
Theories must be relatively simple yet generalizable
Theories are the basis for hypothesis that can be tested
Theories contribute to and assist in increasing the general body of knowledge within the discipline through the
research implemented to validate them
Theories can be used by the practitioners to guide and improve their practice
Theories must be consistent with other validated theories ,laws and principles
APPLICATION OF THEORY
Orem’s theory has been used as the basis for the development of clinical research instruments to assist
researchers in using the theory
A self care questionnaire was developed and tested by Moore(1995) for the special purpose of measuring the
self care practice of children and adolescents.
The theory has been used as a conceptual framework in assoc. degree programs also in many nursing schools
The theory has been used to guide practice across a wide range of nursing situations in all types of care
settings, ranging from neonatal intensive care units to nursing home facilities.
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
Also includes continuing education as part of the professional component of nursing education
Herself care approach is contemporary with the concepts of health promotion and health maintenance
Expanded her focus of individual self care to include multi person units
LIMITATIONS
In general system theory a system is viewed as a single whole thing while Orem defines a system as a single
whole thing
Health is often viewed as dynamic and ever changing .Orem’s visual presentation of the boxed nursing
systems implies three static conditions of health
Appears that the theory is illness oriented rather with no indication of its use in wellness settings
SUMMARY
Orem’s general theory of nursing is composed of three constructs .Throughout her work, she interprets the
concepts of human beings, health, nursing and society . It has a broad scope in clinical practice and to lesser
extent in research ,education and administration
It is believed that Orem’s theory portrays the idea that nursing is the ability to care for another, especially
when they are unable to care for themselves. This corresponds to our philosophy of caring for person with the
goal of achieving optimal level of health and wellness
REFERENCES
Orem, D.E. (1991), Nursing: Concepts of practice, 4th ed; St. Louis, MO: Mosby-Year Book Inc. p.p-
110-125
Tomey, A. & Alligood, M. (2002), Significance of theory for nursing as a discipline and profession.
Nursing Theorists and their work., Mosby, St. Louis, Missouri, United States of America. P.p.-25,45,68,220
George B. Julia, Nursing Theories- The base for professional Nursing Practice, 3rd ed; Norwalk, Appleton
& Lange.p.p-126-130
Wills M.Evelyn, McEwen Melanie (2002), Theoretical Basis for Nursing Philadelphia. Lippincott
Williams& Wilkins. P.p-231-241
Meleis Ibrahim Afaf (1997), Theoretical Nursing: Development & Progress, 3rd ed;Philadelphia,
Lippincott. P.p-330-335
Taylor Carol,Lillis Carol (2001),The Art & Science Of Nursing Care ,4th ed; Philadelphia, Lippincott.
P.p-11,22,40,51,63
Potter A Patricia, Perry G Anne (1992), Fundamentals Of Nursing –Concepts Process & Practice, 3rd ed;
London Mosby Year Book. P.p-16,19,21,31
WEBSITES
http://www.nursingtheory.net/models_selfcareframework.html
http://upoun207tfn.blogspot.com/2010/07/application-of-orems-self-care-deficit.html
http://currentnursing.com/nursing_theory/self_care_deficit_theory.html
http://www.ncbi.nlm.nih.gov/pubmed/2980633
GUJARAT INSTITUTE OF NURSING
EDUCATION AND RESEARCH
AHMEDABAD
F.Y. M.Sc. Nursing (Batch 2012-2014)
SUBJECT: Advanced Nursing Practice
TOPIC: Orem’s theory
DATE:
SUBMITTED TO:
Mrs. Minaxi D. Patel
Lecturer sr. scale cl-1
H.O.D. of F.Y. M.Sc.Nursing.
GINERA
SUBMITTED BY:
Patel Khyati D.
F.Y. M.Sc. Nursing
GINERA
