Dorothea Orem
Dorothea Orem
Dorothea Orem
Dorothea Orem earned her Bachelor of science in nursing education in 1939 and Master
of science in nursing in 1945
During her professional career ,she worked as a staff nurse ,private duty nurse ,nurse
educator and administrator and nurse consultant
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.
1958-1960 US Department of Health, Education and Welfare where she help publish
"Guidelines for Developing Curricula for the Education of Practical Nurses" in 1959.
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.
Orems Nursing: Concept of Practice was first published in 1971 and subsequently in
1980, 1985, 1991, 1995, and 2001.
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
Goal of nursing to render the patient or members of his family capable of meeting the
patients self care needs
To regain normal or near normal state of health in the event of disease or injury
To stabilize ,control ,or minimize the effects of chronic poor health or disability
Health health and healthy are terms used to describe living things
It is when they are structurally and functionally whole or sound wholeness or integrity.
.includes that which makes a person human,operating in conjunction with
physiological and psychophysiological mechanisms and a material structure and in
relation to and interacting with other human beings
Environnent
Human being has the capacity to reflect, symbolize and use symbols
Nursing client
A human being who has "health related /health derived limitations that render him
incapable of continuous self care or dependent care or limitations that result in ineffective
/ incomplete care.
A human being is the focus of nursing only when a self care requisites exceeds self care
capabilities
Nursing problem
Nursing process
a system to determine (1)why a person is under care (2)a plan for care ,(3)the
implementation of care
Nursing therapeutics
Self care practice of activities that individual initiates and perform on their own behalf
in maintaining life ,health and well being
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
Developmental
Health deviation
Associated with life processes and the maintenance of the integrity of human structure
and functioning
Balance between activity and rest, between solitude and social interaction
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
Describes how the patients self care needs will be met by the nurse , the patient, or both
Identifies 3 classifications of nursing system to meet the self care requisites of the
patient:-
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
Categories of technologies
1. Social or interpersonal
Giving human assistance adapted to human needs ,action abilities and limitations
2. Regulatory technologies
Orems approach to the nursing process presents a method to determine the self care
deficits and then to define the roles of person or nurse to meet the self care demands.
The steps within the approach are considered to be the technical component of the
nursing process.
Nursing Process
Assessment
Nursing
diagnosis
Plans with
scientific
rationale
Step 2
demands
Implementation Step 3
evaluation
Selection of combination of
ways of helping that will be
effective and efficient in
compensating for/ overcoming
patients self care deficits
evaluation
29 yr.
32pack /yr
Female Water-no
Early
restrictions
adulthood Food nil
transition Wt89lb
Wt loss19%
nauseated
Teenage
Seeks
pregnancy-2 medica
OC-10 yrs l
Husband
attentio
emotionally n for
away
overt
s/s
Aware
of
Self
care
deficits
disease
No
eviden
ce
8th grade
Teenage
pregnanc
y
No work
Married
Child-2
Urinary
No BSE
ability Surgery on Differen
retention Infrequent to
reproductiv ce
Intermitten physical
manag e organs between
t self
examination e
knowled
catheterizat No HRT
effects
ge base
ion
Poor health
&
Pain
lifestyle
Lives at Tearful
mothers Husband
home.
abusive
Environm Dissatisfie
ent
d with
unclean home
Limited RT
resources
EDU
deprivation
Oppressive
living
conditions
Will
receive
RT
,perform
intermitten
t
catheterizat
ion
Therapeutic Adequacy of
self care
self care
demand
agency
Nursing
diagnosis
Methods of
helping
Air
Inadequate
Maintain
effective
respiration
Water
Adequate
No problem
Food maintain Inadequate
sufficient
intake
Potential for
impaired
respiratory
status
P F fluid
imbalance
Actual
nutritional
deficit r/t
ausea
Guiding &
directing
Teaching
Providing
physical support
Personal
development
Hazards
Inadequate
Prevent
spouse abuse
Promotion of
normalcy
Inadequate
P/F injury
A/d in
environment
Shared
housing
Guiding &
directing
Maintain
Inadequate
developmental
environment
Support ed
normalcy in
Inadequate
environment
Prevent
/manage dev
threat
Actual delay
in normaldev.
R/T early
parenthood
Level of
education
Guiding &
directing
Providing psy
support
Maintenance Inadequate
of health
status
Inadequate
Management
of disease
process
P/F contd.
alterations in
health status
P/F UTI
Guiding &
directing,
teaching
Guiding &
directing,
teaching
Adherence to Inadequate
med regimen
P/F
teaching
adherence in
self
catheterization teaching
& OPD RT
Actual deficit
in awareness
of advisability
of HRT & RT
effects
Awareness of Inadequate
potential
problems
Guiding &
directing
Providing
physical, psy
Dev deficit r/t support
loss of
reproductive
organs
Actual threat
to self image
Providing psy
support
Actual self
deficit in
planning for
future needs
Guiding &
directing
Theories can interrelate concepts in such a way as to create a different way of looking at a
particular phenomenon
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
Theory Testing
Orems theory has been used as the basis for the development of 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 (Fenner
1979) also in many nursing schools
Strengths
It has utility for professional nursing in the areas of nursing practice nursing curricula
,nursing education administration ,and nursing research
Her self care approach is contemporary with the concepts of health promotion and health
maintenance
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 .Orems 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
References
Orem, D.E. (1991). Nursing: Concepts of practice (4th ed.). St. Louis, MO: Mosby-Year
Book Inc.
Taylor, S.G. (2006). Dorthea E. Orem: Self-care deficit theory of nursing. In A.M.
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.
George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed.
Norwalk, Appleton & Lange.
Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia.
Lippincott Williams& wilkins.
Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed.
Philadelphia, Lippincott.
Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed.
Philadelphia, Lippincott.
Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing Concepts Process &
Practice 3rd ed. London Mosby Year Book.