Dorothea Elizabeth Orem

"In the inability of the client to do the universal, developmental or health deviation self-care requisites, the nurse provides wholly or partially compensatory or supportiveeducative assistance."
Dorothea Elizabeth Orem

Who is she?
She was born in Baltimore, Maryland on 1914. Her father was a construction worker and her mother is a home maker. She studied Diploma in Nursing in early 1930s at the Providence Hospital School of Nursing In Washington D.C., In 1939 and 1945 she finished B.S. Nursing Education ( BSN Ed.) and MSN Ed successively in Catholic University of America, Washington D.C. In 1976 She become Honorary Doctorates: Doctors of Science from Georgetown University and Incarnate word college in San Antonio in Texas in 1980. In 1988 she finished Doctor of Humane Letters from Illinois Wesleyan University in Bloomington, Illinois. 1988 She graduated from University of Missouri in Columbia, Doctor Honoris Causae.

NURSING CAREER
Occupied important nursing positions, like the directorship of both the nursing school and the department of nursing at Providence Hospital, Detroit (1940 to 1949). Spent seven years at the Division of Hospital and Institutional Services of the Indiana State Board of Health (1949-1957), developed her definition of nursing practice Joined the Catholic University of America first as Assistant Professor, then later became Assistant Dean and Associate Professor of the School of Nursing. Her theory was first published in Nursing: Concepts of Practice in 1971, second in 1980, in 1995, and 2001 She received the Catholic University of America Alumni Association Award for Nursing Theory in 1980. The second edition of Nursing: Concept of Practice was published (1980)

Self-Care Deficit Theory

Self-Care Deficit Theory

The theory of Orem is considered client centered, because it mainly evolves in the patient as the main focus of care, this is due to the patients inability and incapacity to perform self care which is brought about by health related problems. Orem views nursing as a complex form of deliberate interpersonal action that ultimately provides a helping human health service. She chose the name deficit as it describes and explain a relationship between abilities of individual, their children or adults for whom they care. The notion deficit does not refer to a specific type of limitation, but to the relationship between the capabilities of the individual and the need for action.

Metaparadigm of the theory

Person
Client is an integrated whole; a unity functioning biologically, symbolically and socially. Client is self-reliant and responsible for self-care and well-being of his or her dependents and selfcare is a requisite for all. Client has capacity to reflect on their own experience and the environment and they use of symbols, ideas and words that distinguished them from other species A client is a holistic individual who is in need of assistance in meeting specific health-care demands because of lack of knowledge, skills, motivation, or orientation

Metaparadigm of the theory

Health
A healthy person is likely to have sufficient self-care abilities to meet their universal self-care needs. The client is in a state of wholeness or integrity of the individual human beings, his parts, and his modes of functioning. Balance
Self care abilities
Universal Self Care needs

Metaparadigm of the theory

Environment
Encompasses the elements external to man but she considered man and environment as an integrated system related to selfcare. Environmental conditions conducive to development include opportunities to be helped: being with other persons or groups where care is offered; opportunities for solitude and companionship; provision of help for personal and group concerns without limiting individual decisions and personal pursuits: shared respect , belief, and trust; recognition and fostering of developmental potential.

Metaparadigm of the theory

Nursing
Orem believed that nursing is a community service, an art, and a technology

As a service
Nursing is a service of deliberately selected and performed actions to assist individuals or groups to maintain self-care, including structural integrity, functioning, and development. Requirements for nursing are modified and eventually eliminated when there is progressive favorable change in the state of health of the individual, or when he learns to be self-directing daily self-care.

Metaparadigm of the theory

As an art
Orem says that nursing is also an art because of the ability to assist others in the design, provision, and management of systems of self-care to improve or maintain human functioning at some level of effectiveness Also nursing has an intellectual aspect the discernment of obstacles to care and planning how these obstacles can be overcome.

Metaparadigm of the theory

As a technology
Nursing has formalized methods or techniques of practice, clearly described ways of performing specific actions so that some particular result will be achieved. Techniques of nursing must be learned and skill and expertness in their use must be developed by persons who pursue nursing as career.

Interrelated theories of Orem

Theory of Self-Care Theory of Self-Care Deficit Theory of Nursing System

Theory of Self-Care
Self-Care
According to Orem self-care is the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health and well-being. When self-care is effectively performed, it helps to maintain structural integrity and human functioning, and it contributes to human development (Orem, 1991)

Self-Care Agency
This is the humans ability or power to engage in self-care. The individuals ability to engage in self-care is affected by basic conditioning factors. Basic conditioning factors are age, gender, developmental state, health state, sociocultural orientation, health care system factors, family system factors, patterns of living, environmental factors, and resource adequacy and availability. (Nursing theories, Julia George)

Theory of Self-Care
Self-Care Agency
Agents
1. Self-care agent: person who provides the self-care 2. Dependent Care Agent - person other than the individual who provides the care

Self-Care requisites
These are the actions or measures used to provide selfcare. 1. Universal requisites or needs that are common to all individuals 2. Developmental - needs resulting from maturation or develop due to a condition or event

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

Theory of Self-Care Deficit

The core of Orem's grand theory is the Self-Care Deficit Theory because it delineates when nursing is needed. Nursing is required when a client is incapable of or limited in the provision of continuous effective self-care (George 1995). The term "deficit" refers to a particular relationship between self-care agency and self-care demand that is said to exist when capabilities for engaging in self-care are less than the demand for selfcare (Parker, 2005, p. 149).

Self-Care
D: Demand for self care A: Ability to meet demand for self care

Self-Care Deficit

Theory of Self-Care Deficit

2 Classifications of Self-Care Deficit
1. Actual 2. Potential

Orem identifies 6 methods of helping: 1. Doing for or acting for another 2. Guiding or directing another 3. Providing physical support 4. Providing psychological support 5. Providing an environment supportive of development 6. Teaching another

Theory of Nursing Systems

Describes nursing responsibilities, roles of the nurse and patient, rationales for the nurse-patient relationship, and types of actions needed to meet the patients demands. A series of actions a nurse takes to meet a patients self-care needs, is determined by the patients self-care needs, is composed of three systems.

1. Wholly Compensatory 2. Partly Compensatory 3. Supportive-Educative Compensatory

Assumptions
Human beings require continuous deliberate inputs to themselves and their environments to remain alive and functions in accord with natural human endowments. Human agency, the power to act deliberately, is exercised in the form of care of self and others in identifying needs for and in making needed inputs.

Human agency is exercised in discovering, developing, and transmitting to others ways and means to identify needs for and make inputs to self and others.
Groups of human beings with structures relationships cluster tasks and allocate responsibilities for providing care to group members who experience privation for making required deliberate input to self and others

Strengths
The Orem theory is as applicable for nursing by the beginning practitioner as much as the advanced clinician(George JB., 1995) The major strength of Orems theory is its advocacy for the use of the Nursing Process (Balabagno, et.al, 2006). Orem specifically identified the steps of this process. She also mentioned that the nursing process involves intellectual and practical phases

Limitations
Orems theory dont have an unclear definition of family, the nurse-society relationship and public education areas. These issues are essential in the management and treatment plan in caring for patients. Although the family, community and environment are considered in self care action, the focus is primarily on the individual (Balabagno, et.al, 2006)

One of the most obvious limitations of Orems theory is that throughout her work, it can be said that a limited recognition of an individuals emotional needs is present within the theory (George JB., 1995). It focuses more on physical care and gives lesser emphasis to psychological care.

THANK YOU

References
1. Henderson v: The Nature of Nursing: A Definition and Its Implications, Practice, Research, and Education. Macmillan Company, New York, 1966. (Pages 16-17) 2. http://currentnursing.com/nursing_theory/Henderson.html 3. http://en.wikipedia.org/wiki/Virginia_Henderson

4. http://www.angelfire.com/ut/virginiahenderson/concepts.html
5. http://www.nytimes.com/1996/03/22/arts/virginia-henderson-98teacher-of-nurses-dies.html

6. www.youtube.com/watch?v=AbuNz7RLHS8
7. www.youtube.com/watch?v=t89beHi7Xxw

8. Henderson v: The Nature of Nursing: A Definition and Its Implications, Practice, Research, and Education. Macmillan Company, New York, 1966. (Pages 16-17) 9. Nursing theorists and their work By Ann Marriner-Tomey, Martha Raile Alligood pp. 54-57 10. Henderson v: The Nature of Nursing: A Definition and Its Implications, Practice, Research, and Education. Macmillan Company, New York, 1966. (Pages 16-17)

11. http://nursing-theory.org/nursing-theorists/Virginia-Henderson.php