Dorothea Orem's Self-Care Theory

This page was last updated on February 4, 2012

INTRODUCTION

Theorist : Dorothea Orem (1914-2007) Born 1914 in Baltimore, US Earned her diploma at Providence Hospital Washington, DC 1939 BSN Ed., Catholic University of America 1945 MSN Ed., Catholic University of America She worked as a staff nurse, private duty nurse, nurse educator and administrator and nurse consultant. Received honorary Doctor of Science degree in 1976. Theory was first published in Nursing: Concepts of Practice in 1971, second in 1980, in 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 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

DEFINITIONS OF DOMAIN CONCEPTS Nursing is art, a helping service, and a technology

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

Encompasses the patients perspective of health condition ,the physicians perspective , and the nursing perspective Goal of nursing to render the patient or members of his family capable of meeting the patients self care needs To maintain a state of health 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

Environment

environment components are enthronement factors, enthronement elements, conditions, and developed environment

Human being has the capacity to reflect, symbolize and use symbols

Conceptualized as a total being with universal, developmental needs and capable of continuous self care A unity that can function biologically, symbolically and socially

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

deficits in universal, developmental, and health derived or health related conditions

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

deliberate, systematic and purposeful action,

OREMS GENERAL THEORY OF NURSING Orems 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 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-

o o o

Universal self care requisites Developmental self care requisites Health deviation self care requisites

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:

o o o o o

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

Associated with developmental processes/ derived from a condition. Or associated with an event

o o

E.g. adjusting to a new job adjusting to body changes

3. 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

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 o o o o

Acting for and doing for others Guiding others Supporting another Providing an environment promoting personal development in relation to meet future demands Teaching another

C. Theory of Nursing Systems

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:Wholly compensatory system Partly compensatory system Supportive educative system 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 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.

Categories of technologies 1. Social or interpersonal

Communication adjusted to age, health status Maintaining interpersonal, intra group or inter group relations for coordination of efforts Maintaining therapeutic relationship in light of psychosocial modes of functioning in health and disease Giving human assistance adapted to human needs ,action abilities and limitations

2. Regulatory technologies

Maintaining and promoting life processes Regulating psycho physiological modes of functioning in health and disease Promoting human growth and development Regulating position and movement in space

OREMS THEORY AND NURSING PROCESS

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. Orem emphasizes that the technological component "must be coordinated with interpersonal and social processes within nursing situations.

Nursing Process

Orems Nursing Process

Assessment

Diagnosis and prescription; determine why nursing is needed. analyze and interpret make judgment regarding care Design of a nursing system and plan for delivery of care Production and management of nursing systems

Step 1-collect data in six areas:-

The persons health status


Nursing diagnosis Step 2 Plans with scientific rationale

The physicians perspective of the persons health status The persons perspective of his or her health The health goals within the context of life history ,life style, and health status The persons requirements for self care The persons capacity to perform self care

Nurse designs a system that is wholly or partly compensatory or supportiveeducative. The 2 actions are:Bringing out a good organization of the components of patients therapeutic self care demands Selection of combination of ways of helping that will be effective and efficient in compensating for/ overcoming patients self care deficits

Implementation evaluation

Step 3

Nurse assists the patient or family in self care matters to achieve identified and described health and health related results. collecting evidence in evaluating results achieved against results specified in the nursing system design Actions are directed by etiology component of nursing diagnosis evaluation

Application of Orems theory to nursing process Therapeutic self care demand Air Maintain effective respiration Water No problem Food maintain sufficient intake Adequacy of self care agency Inadequate Nursing Methods of helping diagnosis Potential for Guiding & directing impaired respiratory status P F fluid imbalance Actual nutritional Teaching deficit r/t nausea Providing physical support Personal development P/F injury Guiding & directing Guiding & directing Inadequate A/d in environment Shared housing

Adequate Inadequate

Hazards Prevent spouse abuse Promotion of normalcy

Inadequate

Maintain Inadequate developmental environment Support ed normalcy in Inadequate environment Prevent /manage dev threat Maintenance of Inadequate health status Management of Inadequate disease process Adherence to med Inadequate regimen Awareness of Inadequate potential problems Adjust to loss of Inadequate reproductive ability & dev healthy view of illness Adjust life style to Inadequate cope with change

Actual delay in Guiding & directing normal dev. R/T Providing psy support early parenthood Level of education Providing physical, psy support Dev deficit r/t loss of reproductive organs P/F contd. Guiding & directing, alterations in health teaching status Guiding & directing, P/F UTI teaching P/F adherence in teaching self catheterization & OPD RT Actual deficit in teaching awareness of advisability of HRT & RT effects Actual threat to self Providing psy support image Guiding & directing Actual self deficit in planning for future needs

OREMS WORK AND THE CHARACTERISTICS OF A THEORY

Orem's theory

o o o o o

interrelate concepts in such a way as to create a different way of looking at a particular phenomenon is logical in nature. is relatively simple yet generalizable is basis for hypothesis that can be tested contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them

o o

can be used by the practitioners to guide and improve their practice must be consistent with other validated theories ,laws and principles

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

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. The theory is illness oriented.

RESEARCH ON OREM'S THEORY 1. 2. Self-care requirements for activity and rest: an Orem nursing focus Nursing diagnoses in patients after heart catheterization--contribution of Orem 3. 4. 5. Self-care--the contribution of nursing sciences to health care Self-care: a foundational science Orem's self-care deficit nursing theory: its philosophic foundation and the state of the science 6. 7. 8. 9. Dorothea E. Orem: thoughts on her theory Orem's theory in practice. Hospice nursing care Solving the Orem mystery: an educational strategy Orem's family evaluation

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.

Whelan, E. G. (1984). Analysis and application of Dorothea Orems Selfcare Practuce Model. Retrieved October 31, 2006. 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.