THEORETICAL FOUNDATION IN NURSING

Dorothea Orem (1970, 1985)

History And Background

 Born in Baltimore, Maryland in 1914. Eight Fields of knowledge

 BSN education in 1939 and MSN in
1945. 1. SOCIOLOGY
 Worked as a staff nurse, private duty
2. PROFESSION/OCCUPATION
nurse, nurse educator and
administrator, and nurse consultant. 3. JURISPRUDENCE
 Received honorary Doctor of Science
degree in 1976. 4. HISTORY
 Published first normal articulation at 5. ETHICS
her ideas in “Nursing: Concepts of
Practice” in 1971, second in 1980 and 6. ECONOMICS
finally in 1995.
7. ADMINISTRATION
 Developed the SCDNT
 Orem died in June 22, 2007 at age 8. NURSING SCIENCE
92.
Orem’s General Theory of Nursing is
Overview of Orem’s “Self-care Deficit Expressed in Three Related Parts:
Nursing Theory” (SCDNT)
A. Theory of Self-Care
 Nursing practice oriented by the
B. Theory of Self-Care Deficit
SCDNT represents a caring approach
that uses experiential specialized C. Theory of Nursing System
knowledge (Science) to design and
produce nursing care (Art).
 The body of knowledge that guides A. Theory of Self-Care
the art and science incorporates
empirical and antecedent knowledge The Theory includes:
(Orem, 1995).
1. Self-Care
 EMPIRICAL KNOWLEDGE
2. Self-Care Agency
 Rooted in experience and
3. Therapeutic Self-Care
addresses specific events and
related conditions that have Demand
relevance for health and 4. Self- Care Requisites
well-being.
The Three Categories of Self-Care
 ANTECEDENT KNOWLEDGE
Requisites:
 Includes previously
 (1) universal self-care requisites
mastered knowledge
and identified fields of  (2) Developmental
knowledge, conditions,
 (3) Health deviation.
and situations.
THEORETICAL FOUNDATION IN NURSING
Dorothea Orem (1970, 1985)
B. Theory of Self-Care Deficit
5 Methods of Helping:
1. Acting for and doing for others
2. Guiding others
3. Supporting another
4. Providing an environment to
promote patient’s ability.
5. Teaching another
C. Theory of Nursing Systems
 Describes how the patient’s self-
care needs will be met by the
nurse, the patient or both.
Classifications of Nursing Systems to
Meet the Self-Care Requisites:
1. Wholly compensatory system
2. Partially compensatory system
3. Supportive-educative system
Concepts
Persons
 A total being with universal
developmental needs and
capable of continuous self-care.
Nursing client
 Human being who has health
related/health derived limitation.
Environment
 Components
 Environmental factors
 Environmental elements
 Conditions
 Developmental
environments
Health
 Human being is structurally and
functionally whole or sound.
Application of Orem’s Self Care
Deficit Nursing Theory (SCDNT)
Case History of Mrs. Trinidad
Villarama
 Mrs. Trinidad Villarama, a 76-
year-old female came to the
hospital with complaints of pain
over all joints, stiffness which is
more in the morning and reduces
ability on performing activities.
She had these complaints for 6
years ago and has taken
treatment from a private
physician’s clinic and herbolario.
 Sometimes she self-medicates.
The symptoms were not
reducing, and came to Briones
General Hospital for further mgt.
The pt. was able to do the ADL by
herself but the way she
performed and the posture she
used was making her at risk to
develop the complications of the
dose. She was also malnourished
and was not having awareness
about the deficiencies and
effects. Medical diagnosis:
Rheumatoid arthritis.
 Nurse Jane Salazar was assigned
to care for the pt. She decided to
use Orem’s SCDNT for the
patient.
THEORETICAL FOUNDATION IN NURSING
Dorothea Orem (1970, 1985)
Water Drinks 6 to 8 glasses
of fluids per day.
Data Collection for Mrs. Villarama
Edema present over
According to Orem’s Self-Care Deficit ankles.
Nursing Theory Turgor normal for the
1. Basic Conditioning Factors age.
Food Food intakes is not
Age 76 years old
adequate, diet is not
Gender Female
nutritious (mostly
Health State Disability due to
carbohydrates).
joint pains, needs
Hemoglobin – 9.6 gm
nursing
%. BMI = 14%
therapeutics.
Elimination Occasional urinary
Developmen Ego integrity vs.
incontinence, wears
tal State despair.
pull-up diapers when
Sociocultural Elementary
going out home.
Orientation graduate, Ilocano.
Frequent
Healthcare Combination of
constipation. takes
System institutional and
laxatives occasionally
alternative health
Activity/Rest Frequent rest is
care.
required due to pain.
Family Married, husband
Pain not completely
System retired teacher.
relieved.
Patterns of At home with Activity level is low.
Living husband, daughter Deformity of the
and her family. joints (specially the
Environment Urban area, two- fingers) secondary to
story home, sleeps the disease process.
in bedroom Social communicates well
upstairs, bathroom Interaction with husband,
downstairs, items daughter and family,
for ADL not in easy neighbors, friends;
reach, no special calls son in the
precautions to U.S. by phone.
prevent injuries. Need for medical care
Resources Husband’s pension, is communicated to
daughter, and son the husband and
in the U.S. daughter
Prevention of Needs instructions on
2. Universal Self-Care Requisites Hazards care of joints and
Air Breaths without prevention of falls.
difficulty, no pallor. Needs instruction or
THEORETICAL FOUNDATION IN NURSING
Dorothea Orem (1970, 1985)
improvement of effects of
nutritional status. medicines.
Prefers to walk bare Has difficulty in
foot inside the home. performing
Needs shower chair prescribed
and safety bears in exercises.
bathroom. Awareness of Not aware about
Promotion of Has good relationship potential the actual disease
Normalcy with husband, problem process.
daughter and her associated with Not compliant
family. the regimen with the diet,
claims she has no
appetite to eat.
3. Developmental Self-Care Not aware of
Requisites prevention of
Maintenance of Able to feed self. hazards.
developmental Difficulty in Not aware of side
environment dressing, bathing, effects of
toileting, medicines.
ambulating. Modification of Has adapted to
Prevention/ Feels that the self-image to limitations in
Management of problems are due incorporate mobility.
the conditions to her own changes in The adoption of
threatening the behaviors and health status new ways for
normal discusses the activities leads to
development problems with deformities and
husband and progression of the
daughter. disease.
Adjustment of Adjusted with the
lifestyle to deformities.
4. Health Deviation Self-Care accommodate Pain tolerance not
Requisites changes in the achieved, needs
health status frequent
Adherence to Reports the and medical medication to
Medical problem to the regimen. relieve pain.
Regimen physician during
clinic visits and
hospitalization.
Cooperates with
the medication.
Inadequate
knowledge on the
use and side
THEORETICAL FOUNDATION IN NURSING
Dorothea Orem (1970, 1985)
THEORETICAL FOUNDATION IN NURSING
Dorothea Orem (1970, 1985)
THEORETICAL FOUNDATION IN NURSING
Dorothea Orem (1970, 1985)