You are on page 1of 40

Dorothea Orem’s

Theory of Self
Care
Dorothea Orem
Born in Baltimore, Maryland.
One of America’s foremost nursing
theorists.
Father was a construction worker
Mother was a homemaker.
Youngest of two daughters.
Education
Studied at Providence Hospital school of
Nursing in Washington D.C. in 1930’s
Got her B.S.N.E. in 1939 and her M.S.N.E in
1946 both from the Catholic University of
America Got her M.S.N.E. at Catholic University
of America in 1946
1958-1960 upgraded practical nursing training
at Department of Health, Education and
Welfare
Was editor to several texts including Concepts
Formalization in Nursing: Process and
Production, revised in 1980, 1985, 1991, 1995,
2001
Nursing Experience
Early nursing experience included operating
room nursing, private duty nursing (in home
and hospital), pediatric and adult medical
and surgical units, evening supervisor in the
emergency room, and biological science
technician.
1940-1949 Orem held directorship of both
nursing school and the department of
nursing at Providence Hospital in Detroit.
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 U.S Department of Health, Education and
Welfare where she help publish “Guidelines for
Developing Curricula for the Education of Practical
Nurses” in 1959.
Development of Theory
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.
Continues to develop her theory after her retirement in
1984
Achievement
1976 and 1980 Honorary degree of Doctor of
Science.
1980 CUA Alumni Association Award for
Nursing Theory.
1988 Doctor of Humane Letters from Illinois
Wesleyan University
1988 Linda Richards Award
1991 National League for Nursing
1992 Honorary Fellow of the American
Academy of Nursing.
1998 Doctor of Nursing Honoris Causae from
the University of Missouri.
Image of Nursing
Orem began her theory development in
the 1960’s, and her first publication was in
1971. During that time the mass media
played a small role in portraying nursing
as a respected profession but
unfortunately played a much larger role in
the destruction of that image.
Image of Nursing
In the early 1960’s Nurses were depicted as
subordinate to Physicians in films and on
television. For example, in TV shows such
as Dr. Kildare and Ben Casey, nurses were
shown delivering messages to the doctors,
carrying trays and doing minimal skill level
tasks. Throughout the show, the doctors
were condescending towards the nurses,
and constantly portrayed as superior.
In 1962 a revolutionary TV show came
about, and for the first time nurses were
depicted in a positive realistic light.
“The Nurses”1962-1964
This TV show was the first of medical
drama’s to focus on the nurse instead of the
physician, and showed the nurses in their
true profession. They were depicted as:
-objective
-articulate
-disciplined
-concerned with professional development
of herself and colleagues
-demonstrated the existence of nursing
standards and organization
“The Nurses”1962-1964
For the first time in TV history, when
problems arose, instead of waiting for the
physician to arrive and give orders, the
nurses identified the problem themselves
and found solutions.
In the short time that it was on the air it
did a great deal for the propagation of a
positive nursing image.
Image of Nursing
In the mid 1960’s the positive image of
nursing took a plunge.
In the media, the obsession with nurse’s
sex lives dominated over all other thematic
elements.
Films, books and television shows depicted
the nurse as a tall, thin, well endowed
blonde whom every man craved. Nurses
would often fall in love with their patients,
and the physicians would woe them.
Image of Nursing
This ushered in an era of sexually suggestive
material which included nurses as promiscuous
women, having sex with patients, physicians and
other male characters without any attachment,
such as in “Carry on Nurse”.
Soon the context had completely left the screen
and all that was left was outright pornography.
Including such titles as “Night Call Nurses”, “I, A
Woman” and “Deep Throat”.
Fortunately, although this portrayal hindered the
progress nurses were making, this was not the
image the majority of society assumed when
thinking about what nurses do.
Images of Nursing
Media Portrayal
Image of Nursing
Realistic Portrayal
Metaparadigm Concept
Person: An individual with physical and
Person: An individual with physical and
emotional requirements for development of self
and maintenance of their well-being.
Environment: Client’s surroundings which may
affect their ability to perform their self-care
activities.
Health: “Structural and functional soundness and
wholeness of the individual” (Orem 1991).
Nursing: The acts of a specially trained and able
individual to help a person or multiple people
deal with their actual or potential self-care
deficits.
Orem’s Theory of Self
Care
Each person has a need for self care in
order to maintain optimal health and
wellness.
Each person possesses the ability and
responsibility to care for themselves and
dependants.
Theory is seperated into three conceptual
theories which include: self care, self care
deficit and nursing system.
Theory of Self Care
Self care is the ability to perform activities
and meet personal needs with the goal of
maintaining health and wellness of mind,
body and spirit.
Self care is a learned behaviour influenced
by the metaparadigm of person,
environment, health and nursing.
Three components: universal self care
needs, developmental self care needs, and
health deviation.
Universal Self Care
This includes activities which are essential
to health and vitality.
Eight elements identified these include:
air, water, food, elimination, activity and
rest, solitude and social interactions,
prevention of harm, and promotion of
normality.
Developmental Self Care
Need
These include the interventions and
teachings designed to return a person to
or sustain a level of optimal health and
well being.
Examples can include such things as toilet
training a child or learning healthy eating.
Health Deviation Self
Care
This encompasses the variations in self
care which may occur as a result of
disability, illness, or injury.
In other words the person with a variation
is meeting self care and maintaining
health and wellness in a more individualize
meaning.
Theory of Self Care
Deficit
Every mature person has the ability to meet self
care needs, but when a person experiences the
inability to do so due to limitations, thus exists a
self care deficit.
A person benefits from nursing intervention when
a health situation inhibits their ability to perform
self care or creates a situation where their
abilities are not sufficient to maintain own health
and wellness.
Nursing action focuses on identification of
limitation/deficit and implementing appropriate
interventions to meet the needs of person.
Theory of Nursing
Systems
The ability of the nurse to aid the person in
meeting current and potential self care
demands.
Focused on person
Three support modalities identified in
theory including: total compensatory,
partial compensatory, and
educative/supportive compensatory.
The client’s ability for self care involvement
will determine under which support
modality they would be considered.
Support Modalities
Total compensatory support encompasses total
nurse care- client unable to do for themselves.
Partial compensatory support involves both the
nurse and the client sharing in the self care
requirements.
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.
A person can fluctuate between support
modalities at any given time throughout life.
Nurse’s Role
The nurse’s role in helping the client to
achieve or maintain a level of optimal
health and wellness is to act as an
advocate, redirector, support person and
teacher, and to provide an environment
conducive to therapeutic development.
Application of Theory To
Nursing Process
Orem’s theory of self-care is applied to
many undergraduate nursing curricula.
The nursing care plan is one example of
how her theory of self-care can be applied
to nursing process
Nursing Care Plan
The nursing care plan includes;
assessment data pertaining to Gordon’s
Functional Assessment, a NANDA nursing
diagnosis, the identification of client
expected outcomes, the nursing
interventions and evaluation.
Nursing Theory in
Practice
The self-care aspect of Orem’s theory
applies to the assessment and evaluation
of the nursing process. Orem emphasizes
the importance of how one’s own self-care
is important for maintaining life, health
development and wellbeing.
The only restriction to this method is that
the nurse can only make assessments
where there is direct contact between the
nurse and the client and or the family.
Nursing Theory in
Practice
The area of self-care deficit applies to the
diagnosis area of the nursing care process.
Although self-care deficit is an abstract
concept, it does provide a guideline for the
selection of methods for helping and
understanding the patient roles in self-
care.
Nursing Theory In
Practice
The third area of her theory, nursing systems,
applies to the interventions of the nursing care.

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
The wholly compensatory system accomplishes
the client’s therapeutic self-care, compensates
for the client’s inability to participate in their self-
care, provides support and protects the client.
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, 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.
Case Study
The partly compensatory system has a give
and take system in between the nurse and the
client. The nurse performs, compensates for
limitations, regulates and assists the client as
needed. The client participates in some self-
care procedures, regulates and accepts care
and assistance from the nurse.
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.
Case Study
The supportive-educative role indicates that the client
is participating in most of their self-care, and the
nurse’s role is simply to monitor and regulate the
client’s self-care.
Newly diagnosed diabetic patient received diabetic
care teaching while in hospital. Now, patient visits
module and reports highly variable BS/chemstrip
readings. Nurse suspects 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.
Personal Philosophy of
Nursing
Nursing is the art of caring, nurturing and
healing. Nursing goes beyond simply
caring for illness, disease or ailment it is
caring for the person. Part of the person is
caring enough to aid them return to a
state of optimal health and wellness in
mind, body and spirit. These are believe to
be the basic aspects essential to a
fundament nursing philosophy.
Personal Nursing
Philosophy
Nursing is being able to intervene when
the person is unable to care for
themselves and teach them methods to
help them move beyond their inability.
This can include offering information,
teaching and tools necessary for their well
being.
Orem’s Philosophy
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.
Game
While watching the video clip, think of a self-care
nursing diagnosis related to this situation.
Come up with self-care deficit as a class
Divide the class into two groups
Each group is asked to come up with as many
nursing interventions as they can related to this
person and the self-care deficit.
Game
 Flip a coin to find out which team gets
to answer first. Then it will go back and
forth.
 For every intervention that is
appropriate, the team will receive a
game piece.
 The object of the game is to connect
four.
 Prizes at the end!! Good luck
References
Hartweg, D.L. (1995). Dorthea Orem: Self-care
deficit theory. In C.M.
Kalisch, P. A. & Kalisch, B.J. (1987). The Changing
Image of the Nurse. Menlo Park, CA: Addison-
Wesley Publishing Company.
Mayo, A. (1997). Professional nursing web site.
Retrieved October 31, 2006 from
http://members.aol.com/annmrn/nursing_portfolio_I_ind
McQuiston & A.A. Webb (Eds.), Foundations of
nursing theory: Contributions of 12 key theorists
(pp. 139-202). USA: Sage Publications Inc.
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 orem’s self-care practuce model.
Retrieved October 31, 2006 from
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?
cmd=Retrieve&db=Pubmed&list_uids=6094754&
dopt=Abstract