DOROTHEA OREM’S SELF-CARE

DEFICIT NURSING THEORY

 What is Dorothea Orem’s major assumption
about nursing care?
 Orem’s concept of nursing and self care was
published in 1971 and had six editions.
OREM’S GENERAL THEORY OF
NURSING
 Orem (2001) states her general theory as follows:
 The condition that validates the existence of a
requirement of nursing in an adult is the health-
associated absence of the ability to maintain
continuously that amount and quality of self-care that is
therapeutic in sustaining life and health, in recovering
from disease or injury, or in coping with their effects.
With children, the condition is the inability of the parent
or (guardian) associated with the child’s health state to
maintain continuously for the child the amount and
quality of life that is therapeutic.
The Relationship of Orem’s Concepts to the Three Theories
THEORY OF SELF CARE
Self-care
Self-care agency
Self-care requisites
• Universal
• Developmental
• Health deviation
HTEORY OF SELF-CARE THEORY OF NURSING
DEFICIT SYSTEMS
When therapeutic self- Nursing agency
care demand exceeds
self-care agency, a self-
deficit exists and nursing
is needed
Nursing systems
• Wholly compensatory
• Partly compensatory
• Supportive-educative

Therapeutic self-care
demand

------------------------------Basic Conditioning Factors------------------------------

THE THEORY OF SELF-CARE

 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.
 Self-care agency
 The human’s required ability or power to engage
in self-care
THE THEORY OF SELF-CARE

 Basic conditioning factors:

 Age, gender, developmental state, health state,
sociocultural factors, health care system factors,
family system factors, environmental factors, patterns
of living, and resource adequacy and availability.
 Therapeutic self-care demand
 Is the totality of “care measures necessary at specific
times or over a duration of time for meeting an
individuals self-care requisites by using appropriate
methods and related sets of operations and actions.”
THE THEORY OF SELF-CARE

 Self-care requisites
 “The reason for which self-care is undertaken;
they express the intended or desired results.”
 Has 3 categories:
 Universal self-care requisites
 Developmental self-care requisites
 Health deviation requisites
THE THEORY OF SELF-CARE

 Self-care requisites:
 UNIVERSAL REQUISITES:
 Air
 Water
 Food
 Elimination
 Activity and Rest
 Solitude and Social Interaction
 Hazard Prevention
 Promotion of Normality
THE THEORY OF SELF-CARE

 Self-care requisites:
 Developmental self care requisites:
 Associated with human growth and developmental
processes and with conditions and events occurring
during various stages of the life-cycle and events
that can adversely affect development.
 Health deviation self-care requisites:
 Are related to “genetic and constitutional defects
and human and structural and functional
deviations.”
THE THEORY OF SELF-CARE

 Self-care requisites:
 Health deviation self-care requisites:
 Ex:
 Seeking and securing appropriate medical assistance
 Being aware of and attending to the effects and results
of pathologic conditions and states
 Effectively carrying out medically prescribed
diagnostic, therapeutic, and rehabilitative measures
THE THEORY OF SELF-CARE DEFICIT
THE THEORY OF SELF-CARE
DEFICIT
 Delineates when nursing care is needed
 States that nursing care may be provided if “the
care activities are less than those required for
meeting a known-self-care demand”
 Nursing may be needed when individuals need
“to incorporate newly prescribed, complex self-
care measures into their self-care systems or;
 When the individual needs help in recovery from
disease or injury, or in coping with their effects
THE THEORY OF SELF-CARE
DEFICIT
 FIVE METHODS FOR OR DOING FOR
ANOTHER:
 Acting for or doing for another
 Guiding and directing
 Providing physical or psychological support
 Providing and maintaining an environment that
supports personal development
 Teaching
THE THEORY OF NURSING SYSTEMS
THE THEORY OF NURSING
SYSTEMS
 Based on the assessment of an individual’s
self-care needs and on the assessment of the
abilities of the patient to perform self-care
activities.
THE THEORY OF NURSING
SYSTEMS
 Nursing agency is a complex property or
attribute of people educated and trained as
nurses that enables them to act, to know, and
to help others meet their therapeutic self-
care demands by exercising or developing
their own self-care agency.
 NURSING AGENCY VS. SELF-CARE
AGENCY?
THE THEORY OF NURSING
SYSTEMS
 THREE CLASSIFICATIONS OF NURSING
SYSTEMS:
 1. Wholly-compensatory
 2. Partly-compensatory
 3. Supportive-educative system
THE THEORY OF NURSING
SYSTEMS
 1. Wholly-compensatory nursing system:
 Represented by a situation in which the individual
is unable to engage in self-care
 Client is socially dependent
THE THEORY OF NURSING
SYSTEMS
 2. Partly compensatory Nursing System
 Is represented by a situation in which “both the
nurse and the patient perform care measures or
other actions involving manipulative tasks or
ambulation.”
 Either the patient or the nurse may have the major
role
THE THEORY OF NURSING
SYSTEMS
 3. Supportive-educative nursing system:
 The person “is able to perform or can and should
learn to perform required measures of externally a
or internally oriented therapeutic self-care but
cannot do so without assistance.”
 The patient is doing all of the self-care
 The nurse’s role is to promote the patient as a self-
care agent.
OREM’S THEORY AND NURSING’S
METAPARADIGM
OREM’S THEORY AND NURSING’S
METAPARADIGM
 Orem has four major concepts in her work:
 Human beings
 Health
 Society
 Nursing
OREM’S THEORY AND NURSING’S
METAPARADIGM
 1. Human beings:
 Are distinguished from other living things by their
capacity:
 To reflect
 To symbolize what they experience
 To use symbolic creations
 Have the potential for learning and developing
OREM’S THEORY AND NURSING’S
METAPARADIGM
 2. Health:
 Orem supports the WHO’s definition of health
 Orem also presents health based on the concept
of preventive health care
OREM’S THEORY AND NURSING’S
METAPARADIGM
 3. Nursing:
 Orem speaks to several factors related to the
concept of nursing:
 Nursing as service
 Role theory related to nursing
 Technologies in nursing
 Human service
OREM’S THEORY AND THE NURSING
PROCESS
OREM’S THEORY AND THE
NURSING PROCESS
 According to Orem, “Nursing process is a term
used to refer to nurses’ performance of the
professional-technologic operations of nursing
practice.”
 Orem discusses a three-step nursing process:
 Nursing diagnosis and prescription
 Designing the nursing system and planning for the
delivery of care
 The production and management of nursing
systems