This WEEK 8

B.Nursing Conceptual Models

1. Roger’s Science of Unitary Human Beings Nursing Conceptual Model

Introduction

 Theorist - Martha E Rogers

 Born :May 12, 1914, Dallas, Texas, USA
 Diploma : Knoxville General Hospital School of Nursing(1936)
 Graduation in Public Health Nursing : George Peabody College, TN, 1937
 MA :Teachers college, Columbia university, New York, 1945
 MPH :Johns Hopkins University, Baltimore, MD, 1952
 Doctorate in nursing :Johns Hopkins University, Baltimore, 1954
 Fellowship: American academy of nursing
 Position: Professor Emerita, Division of Nursing, New York University,
Consultant, Speaker
 Died : March 13 , 1994

Publications of Martha Rogers

 Theoretical basis of nursing (Rogers 1970)

 Nursing science and art :a prospective (Rogers 1988)
 Nursing :science of unitary, irreducible, human beings update (Rogers 1990)
 Vision of space based nursing (Rogers 1990)

Overview of Rogerian model

 Rogers conceptual system provides a body of knowledge in nursing.

 Rogers model provides the way of viewing the unitary human being.
 Humans are viewed as integral with the universe.
 The unitary human being and the environment are one, not dichotomous
 Nursing focus on people and the manifestations that emerge from the mutual
human /environmental field process
 Change of pattern and organization of the human field and the environmental
field is propagated by waves
 The manifestations of the field patterning that emerge are observable events
 The identification of the pattern provide knowledge and understanding of human
experience
  Basic characteristics which describes the life process of human: energy field,
openness, pattern, and pan dimensionality
 Basic concepts include unitary human being, environment, and homeodynamic
principles

Concepts of Rogers model

Energy field

 energy field "provide a way to perceive people and environment as irreducible

wholes"
 The energy fields continuously varies in intensity, density, and extent.

Openness

 The human field and the environmental field are constantly exchanging their
energy
 There are no boundaries or barrier that inhibit energy flow between fields

Pattern

 Pattern is defined as the distinguishing characteristic of an energy field perceived

as a single waves
 "pattern is an abstraction and it gives identity to the field"

Pan dimensionality

 Pan dimensionality is defined as "non linear domain without spatial or temporal

attributes"
 The parameters that human use in language to describe events are arbitrary.
 The present is relative, there is no temporal ordering of lives.

Homeodynamic principles

 The principles of homeodynamic postulates the way of perceiving unitary human

beings
 The fundamental unit of the living system is an energy field
 Three principle of homeodynamics
o Resonancy
o Helicy
o integrality

Resonance

 Resonance is an ordered arrangement of rhythm characterizing both human field

and environmental field that undergoes continuous dynamic metamorphosis in
the human environmental process

Helicy

 Helicy describes the unpredictable, but continuous, nonlinear evolution of energy

fields as evidenced by non repeating rhythmicties
 The principle of Helicy postulates an ordering of the humans evolutionary
emergence

Integrality

 The mutual, continuous relationship of the human energy field and the
environmental field .
  Changes occur by by the continuous repatterning of the human and
environmental fields by resonance waves
 The fields are one and integrated but unique to each other

Nursing Paradigms

Unitary Human Being (person)

 A unitary human being is an "irreducible, indivisible, pan dimensional (four-

dimensional) energy field identified by pattern and manifesting characteristics
that are specific to the whole and which cannot be predicted from knowledge of
the parts" and "a unified whole having its own distinctive characteristics which
cannot be perceived by looking at, describing, or summarizing the parts"

Environment

 The environment is an "irreducible, pan dimensional energy field identified by

pattern and integral with the human field"
 The field coexist and are integral.
 Manifestation emerge from this field and are perceived.

Health

 "an expression of the life process; they are the "characteristics and behavior
emerging out of the mutual, simultaneous interaction of the human and
environmental fields"
 Health and illness are the part of the sane continuum.
 The multiple events taking place along life's axis denote the extent to which man
is achieving his maximum health potential and very in their expressions from
greatest health to those conditions which are incompatible with the maintaining
life process

Nursing

 Two dimensions Independent science of nursing

1. An organized body of knowledge which is specific to nursing is arrived at
by scientific research and logical analysis
2. Art of nursing practice:

 The creative use of science for the betterment of the human

 The creative use of its knowledge is the art of its practice

 Nursing exists to serve people.

 It is the direct and overriding responsibility to the society
 The safe practice of nursing depends on the nature and amount of scientific
nursing knowledge the individual brings to practice…….the imaginative,
intellectual judgment with which such knowledge is made in service to the man
kind.

Rogerian theories-Grand theories

 The theory of paranormal phenomena

 The theory of rhythmicities
 The theory of accelerating evolution

Theory of paranormal phenomena

 This theory explains precognition, déjàvu, clairvoyance, telepathy, and

therapeutic touch
  Clairvoyance is rational in a four dimensional human field in continuous mutual,
simultaneous interaction with a four dimensional world; there is no linear time nor
any separation of human and the environmental fields

The theory of accelerating evolution

 Theory postulates that evolutionary change is speeding up and that the range of
diversity of life process is widening.
 Higher wave frequencies are associated with accelerating human development

Theory of Rhythmicity

 Focus on the human field rhythms (these rhythms are different from the
biological, psychological rhythm)
 Theory deals with the manifestations of the whole unitary man as changes in
human sleep wake patterns, indices of human field motion, perception of time
passing, and other rhythmic development

Theories derived from the science of unitary human beings

 The perspective rhythm model (Patrick 1983)

 Theory of health as expanding consciousness (Neuman, 1986)
 Theory of creativity, actualization and empathy (Alligood 1991)
 Theory of self transcendence (Reed1997)
 Power as knowing participation in change (Barrett 1998)

References

1. George B. Julia , Nursing Theories- The base for professional Nursing Practice ,
3rd ed. Norwalk, Appleton & Lange.
2. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing
Philadelphia. Lippincott Williams& wilkins.
3. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd
ed. Philadelphia,  Lippincott.
4. Taylor Carol,Lillis Carol (2001)The Art & Science  Of Nursing Care 4th ed.
Philadelphia,  Lippincott.
5. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts
Process & Practice 3rd ed. London Mosby Year Book.

Reference: http://currentnursing.com/nursing_theory/unitary_human_beings.html
 2. Orem’s Self- Care Deficit Model

Dorothea Orem is a nurse theorist who pioneered the Self-Care

Deficit Nursing Theory. Get to know the biography and works of Orem,
including a discussion about the major concepts, subconcepts, nursing
metaparadigm, and application of Self- Care Deficit Theory.

Biography of Dorothea E. Orem

Dorothea Elizabeth Orem (July 15, 1914 – June 22, 2007) was one of America’s
foremost nursing theorists who developed the Self-Care Deficit Nursing Theory, also
known as the Orem Model of Nursing.

Her theory defined Nursing as “The act of assisting others in the provision and
management of self-care to maintain or improve human functioning at home level of
effectiveness.” It focuses on each individual’s ability to perform self-care, defined as “the
practice of activities that individuals initiate and perform on their own behalf in
maintaining life, health, and well-being.”

Self-Care Theory

Dorothea Orem’s Self-Care Deficit Theory focuses on each “individual’s ability to

perform self-care, defined as ‘the practice of activities that individuals initiate and
perform on their own behalf in maintaining life, health, and well-being.'” The Self-Care
or Self-Care Deficit Theory of Nursing is composed of three interrelated theories: (1)  the
theory of self-care, (2) the self-care deficit theory, and (3) the theory of nursing
systems, which is further classified into wholly compensatory, partial compensatory and
supportive-educative. It is discussed further below.

Dorothea Orem’s Self-Care Deficit Theory

There are instances wherein patients are encouraged to bring out the best in them
despite being ill for a period of time. This is very particular in rehabilitation settings, in
which patients are entitled to be more independent after being cared for
by physicians and nurses. Through these, the Self-Care Nursing Theory or the Orem
Model of Nursing was developed by Dorothea Orem between 1959 and 2001. It is
considered a grand nursing theory, which means the theory covers a broad scope with
general concepts that can be applied to all instances of nursing.

Description

Dorothea Orem’s Self-Care Deficit Theory defined Nursing as “The act of assisting
others in the provision and management of self-care to maintain or improve human
functioning at home level of effectiveness.” It focuses on each individual’s ability to
perform self-care, defined as “the practice of activities that individuals initiate and
perform on their own behalf in maintaining life, health, and well-being.”

“The condition that validates the existence of a requirement for nursing in an adult is the
absence of the ability to maintain continuously that amount and quality of self-care
which 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) to maintain continuously for the child the amount and quality of care that is
therapeutic.” (Orem, 1991)

Major Concepts of the Self-Care Deficit Theory

In this section are the definitions of the major concepts of Dorothea Orem’s Self-Care
Deficit Theory:

Nursing

Nursing is an art through which the practitioner of nursing gives specialized assistance
to persons with disabilities which makes more than ordinary assistance necessary to
meet needs for self-care. The nurse also intelligently participates in the medical care the
individual receives from the physician.

Humans

Humans are defined as “men, women, and children cared for either singly or as social
units,” and are the “material object” of nurses and others who provide direct care.

Environment

The environment has physical, chemical and biological features. It includes the family,
culture, and community.

Health

Health is “being structurally and functionally whole or sound.” Also, health is a state that
encompasses both the health of individuals and of groups, and human health is the
ability to reflect on one’s self, to symbolize experience, and to communicate with others.

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

Self-care agency is the human’s ability or power to engage in self-care and is affected
by basic conditioning factors.

Basic Conditioning Factors

Basic conditioning factors are age, gender, developmental state, health state, socio-
cultural orientation, health care system factors, family system factors, patterns of living,
environmental factors, and resource adequacy and availability.

Therapeutic Self-Care Demand

Therapeutic Self-care Demand is the totality of “self-care actions to be performed for

some duration in order to meet known self-care requisites by using valid methods and
related sets of actions and operations.”

Self-Care Deficit

Self-care Deficit delineates when nursing is needed. Nursing is required when an adult
(or in the case of a dependent, the parent or guardian) is incapable of or limited in the
provision of continuous effective self-care.

Nursing Agency

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 System

Nursing System is the product of a series of relations between the persons: legitimate
nurse and legitimate client. This system is activated when the client’s therapeutic self-
care demand exceeds available self-care agency, leading to the need for nursing.
Theories

The Self-Care or Self-Care Deficit Theory of Nursing is composed of three interrelated

theories: (1) the theory of self-care, (2) the self-care deficit theory, and (3) the
theory of nursing systems, which is further classified into wholly
compensatory, partial compensatory and supportive-educative.

Theory of Self-Care

This theory focuses on the performance or practice of activities that individuals initiate
and perform on their own behalf to maintain life, health and well-being.

Self-Care Requisites
Self-care Requisites or requirements can be defined as actions directed toward the
provision of self-care. It is presented in three categories:

Universal Self-Care Requisites

Universal self-care requisites are associated with life processes and the maintenance of
the integrity of human structure and functioning.

 The maintenance of a sufficient intake of air

 The maintenance of a sufficient intake of water
 The maintenance of a sufficient intake of food
 The provision of care associated with elimination process and excrements
 The maintenance of a balance between activity and rest
 The maintenance of a balance between solitude and social interaction
 The prevention of hazards to human life, human functioning, and human well-
being
 The promotion of human functioning and development within social groups in
accord with human potential, known human limitations, and the human desire
to be normal
Normalcy is used in the sense of that which is essentially human and that which is in
accord with the genetic and constitutional characteristics and the talents of individuals.

Developmental self-care requisites

Developmental self-care requisites are “either specialized expressions of universal self-
care requisites that have been particularized for developmental processes or they are
new requisites derived from a condition or associated with an event.”

Health deviation self-care requisites

Health deviation self-care requisites are required in conditions of illness, injury, or

disease or may result from medical measures required to diagnose and correct the
condition.

 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
 Being aware of and attending to or regulating the discomforting or deleterious
effects of prescribed medical measures
 Modifying the self-concept (and self-image) in accepting oneself as being in a
particular state of health and in need of specific forms of health care
 Learning to live with the effects of pathologic conditions and states and the
effects of medical diagnostic and treatment measures in a lifestyle that
promotes continued personal development

Theory of Self-Care Deficit

This theory delineates when nursing is needed. Nursing is required when an adult (or in
the case of a dependent, the parent or guardian) is incapable of or limited in the
provision of continuous effective self-care. Orem identified 5 methods of helping:

 Acting for and doing for others

 Guiding others
 Supporting another
 Providing an environment promoting personal development in relation to meet
future demands
 Teaching another

Theory of Nursing System

This theory is the product of a series of relations between the persons: legitimate nurse
and legitimate client. This system is activated when the client’s therapeutic self-care
demand exceeds available self-care agency, leading to the need for nursing.

Wholly Compensatory Nursing System

This is represented by a situation in which the individual is unable “to engage in those
self-care actions requiring self-directed and controlled ambulation and manipulative
movement or the medical prescription to refrain from such activity… Persons with these
limitations are socially dependent on others for their continued existence and well-
being.”

Example: care of a newborn, care of client recovering from surgery in a post-

anesthesia care unit
Partial Compensatory Nursing System
This is represented by a situation in which “both nurse and perform care measures or
other actions involving manipulative tasks or ambulation… [Either] the patient or the
nurse may have a major role in the performance of care measures.”

Example: Nurse can assist postoperative client to ambulate, Nurse can bring a meal
tray for client who can feed himself

Supportive-Educative System
This is also known as supportive-developmental system, the person “is able to perform
or can and should learn to perform required measures of externally or internally oriented
therapeutic self-care but cannot do so without assistance.”

Example: Nurse guides a mother how to breastfeed her baby, Counseling a psychiatric
client on more adaptive coping strategies.

Dorothea Orem’s Theory and The Nursing Process

The Nursing Process presents a method in determining self-care deficits and to define
the roles of persons or nurse to meet the self-care demands.

Assessment

 Diagnosis and prescription; determine why nursing is needed. Analyze and

interpret by making a 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

1. The person’s health status

2. The physician’s perspective of the person’s health status
3. The person’s perspective of his or health health
4. The health goals within the context of life history, lifestyle, and health status.
5. The person’s requirements for self-care
6. The person’s capacity to perform self-care

Nursing Diagnosis & Care Plans

Step 2

 The nurse designs a system that is wholly or partly compensatory or

supportive-educative.
 The two actions are: (1) Bringing out a good organization of the components
of patients’ therapeutic self-care demands. (2) Selection of combination of
ways of helping that will be effective and efficient in compensating
for/overcoming patient’s 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.

Analysis of the Self-Care Deficit Theory

There is a superb focus of Orem’s work which is self-care. Even though there is a wide
range of scope seen in the encompassing theory of nursing systems, Orem’s goal of
letting the readers view nursing care as a way to provide assistance to people was
apparent in every concept presented.

ADVERTISEMENTS
From the definition of health which is sought to be rigid, it can now be refined by making
it suitable to the general view of health as a dynamic and ever-changing state.

The role of the environment to the nurse-patient relationship, although defined by Orem

was not discussed.

The role of nurses in maintaining health for the patient was set by Orem with great
coherence in accordance with the life-sustaining needs of every individual.

Although Orem viewed the importance of the parents or guardian in providing for their
dependents, the definition of self-care cannot be directly applied to those who need
complete care or assistance with self-care activities such as the infants and the aged.

Strengths

 A major strength of Dorothea Orem’s theory is that it is applicable for nursing

by the beginning practitioner as well as the advanced clinicians.
 Orem’s theory provides a comprehensive basis for nursing practice. It has
utility for professional nursing in the areas of nursing practice, nursing
education and administration.
 The terms self-care, nursing systems, and self-care deficit are easily
understood by the beginning student nurse and can be explored in greater
depth as the nurse gains more knowledge and experience.
 She specifically defines when nursing is needed: Nursing is needed when the
individual cannot maintain continuously that amount and quality of self-care
necessary to sustain life and health, recover from disease or injury, or cope
with their effects.
 Her self-care approach is contemporary with the concepts of health
promotion and health maintenance.
 Three identifiable nursing systems were clearly delineated and are easily
understood.

Limitations

 Orem’s theory, in general, is viewed as a single whole thing while Orem

defines a system as a single whole thing.
  Orem’s theory is simple yet complex. The use of self-care in multitudes of
terms, such as self-care agency, self-care demand, self-care deficit, self-care
requisites, and universal self-care, can be very confusing to the reader.
 Orem’s definition of health was confined in three static conditions which she
refers to a “concrete nursing system,” which connotes rigidity.
 Throughout her work, there is limited acknowledgement of the individual’s
emotional needs.
 Health is often viewed as dynamic and ever-changing.

Conclusion

Orem’s theory is relatively simple, but generalizable to apply to a wide variety of

patients. It explains the terms self-care, nursing systems, and self-care deficit which are
very essential to students who plan to start their career in nursing.

Moreover, this theory signifies that all patients want to care for themselves, and they are
able to recover more quickly and holistically by performing their own self-care as much
as they’re able. This theory is particularly used in rehabilitation and primary care or
other settings in which patients are encouraged to be independent.

Though this theory greatly influences every patient’s independence, the definition of
self-care cannot be directly applied to those who need complete care or assistance with
self-care activities such as the infants and the aged.

See Also

You may also like the following nursing theories study guides: 

 Nursing Theories and Theorists – The Ultimate Nursing Theories and

Theorists Guide for Nurses.

References

References and sources for this study guide about Dorothea Orem:

1. “Obituary: Dorothea Elizabeth Orem” , Savannah Morning News, June 24,

2007, retrieved June 17, 2014
2.  Taylor, Carol R.; Lillis, Carol; LeMone, Priscilla; Lynn, Pamela (2011).
Fundamentals of Nursing. Philadelphia: Wolters Kluwer Health. p. 74. ISBN
978-0-7817-9383-4.
3. Orem, D. (1991). Nursing: Concepts of practice. (4th ed.). In George, J. (Ed.).
Nursing theories: the base for professional nursing practice. Norwalk,
Connecticut: Appleton & Lange.
4. Orem, D. (1995). Nursing: Concepts of practice. (5th ed.). In McEwen, M. and
Wills, E. (Ed.). Theoretical basis for nursing. USA: Lippincott Williams &
Wilkins.
5. Orem, D. (2001). Nursing: Concepts of practice. (6th ed.). In McEwen, M. and
Wills, E. (Ed.). Theoretical basis for nursing. USA: Lippincott Williams &
Wilkins.
6. Taylor, S.G. (2006). Dorothea E. Orem: Self-care deficit theory of nursing. 
 7. Meleis Ibrahim Afaf (1997), Theoretical Nursing: Development & Progress 3rd
ed. Philadelphia, Lippincott.

External Links

 International Orem Society for Nursing Science and Scholarship

 Self-care requirements for activity and rest: an Orem nursing focus.
 Self-care: a foundational science.
 Self-care–the contribution of nursing sciences to health care  (in German).

Further Reading

 Nursing Concepts of Practice

With contributions by Wayne, G., Ramirez, Q.

Reference: https://nurseslabs.com/dorothea-orems-self-care-theory/