“Individuals, families, groups and communities need to be taught self care.

”
•is one of America’s foremost nursing theorists.

Born: 1914, Baltimore, Maryland.

Father : construction worker
Mother: homemaker.
•She was the younger of two daughters.
Died: June 22, 2007
Diploma of Nursing
Providence School of Nursing in Washington D.C.
early 1930s
B.S.N.
Catholic University of America
1939
M.S. in Nursing Education
Catholic University of America
1946.
üPrivate duty nurse
üStaff nurse of the following area: OR, Pedia ward and Surgical ward
üEvening Supervisor in the ER
üBiological Science Teacher
ü(1940 – 1949) Director of both Nursing School and Nursing
Department of the Providence Hospital, Detroit
ü(1949 - 1957) work in the Division of Hospital and Institutional
Services of the Indiana State Board of Health
ü(1958 - 1960) Curriculum Consultant – Dept. of Health Education
and Welfare in US Dept of Health, Washington DC
ü(1959) Assistant Prof. of Nursing Education at CUA
ü(1970) left CUA and began her own consulting firm
ü(1971) Orem’s First Published Book – Nursing: Concepts of Practice
ü(1984) Orem retired and resides in Savannah Georgia.
§Began between 1949 and 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 US Department of Health, Education and Welfare
where she help publish "Guidelines for Developing Curricula for
the Education of Practical Nurses" in 1959.
· 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
1976 – Honorary Degree of Doctor of Science
Georgetown University
1980 – Award for Nursing Theory
CUA Alumni Association
1980 – Honorary Doctor of Science
Incarnate Word College
1988 – Doctor of Humane Letters
Illinois Western University
1991 – Linda Richards Award
National League for Nursing
1992 – Honorary Fellow of American Academy of Nursing
1998 – Doctor of Nursing Honoris Causae
University of Missouri
 PERSON
Who can be viewed
as functioning
biologically, symbolically
and socially and who
initiates and performs
self care activities on
own behalf in
maintaining life.
 •Helping or assisting client to identify ways to
perform self care activities.
•Nursing is HUMAN SERVICE

NURSING

PERSON
 NURSING

PERSON HEALTH
•Is a state that is
characterized by soundness
or wholeness of developed
human structures and of
bodily and mental
functioning.
•It includes physical,
physiologic, interpersonal
and social aspects.
 NURSING

PERSON HEALTH

ENVIRONMENT

•External source of influence in the internal

interaction of a person’s different aspects.
§ goal
oriented activities that are set towards
generating interest in the part of the client to
maintain life and health development.

§Is the synthesis of knowledge about the

theoretical entities self care, self care agency,
therapeutic self care demand and nursing agency.

§ AIM: making the client’s perform self care activities

in order to live independently
–Postulates that self-care and self care dependents are learned
behaviors that individuals initiate and perform on their own
behalf to maintain life, health and well being.

–Describes WHY and HOW people care for themselves.

Self care
– practice of activities that individual initiates and performs
on their own behalf in maintaining life, health and well
being
Self care requisites
Ø action directed towards provision of self care
ØInsights of action or requirements that a person must
be able to meet and perform in order to achieve well
being.
ØThey are the reasons for self care is undertaken; they
express the intended or desired result.
3 categories of self care requisites are:
üUniversal Self care requisites
üDevelopmental Self care requisites
üHealth deviation Self care requisites
Universal self care requisites
ØAssociated with life processes and the maintenance of
the integrity of human structure and functioning

Øidentifies these requisites as:

qMaintenance of sufficient intake of air ,water, food
qProvision of care assoc with elimination process and
excrement
qBalance between activity and rest,
qBalance between solitude and social interaction
qPrevention of hazards to human life well being and
qPromotion of human functioning
Developmental self care requisites

ØAssociated with developmental processes/ derived from a

condition…. Or associated with an event

ØThey promote processes for life and maturation and prevent

conditions deleterious to maturation or those that mitigate those
effects.

ØE.g. adjusting to a new job and adjusting to body changes

Health deviation self care requisites

ØThese requisites exist for persons who are ill or injured,

including those with defects and disabilities. These include:-
v 1. Seeking and securing appropriate medical assistance
v 2. Being aware of and attending to the effects and results of pathologic
conditions and states.
v 3. Effectively carrying out medically prescribed measures
v 4. Being aware of and attending to or regulating the discomforting or
deleterious effects of prescribed medical measures.
v 5. Modifying self concepts (self - image) in accepting oneself as being in a
particular state of health and in specific forms of health care
v 5. Learning to live with effects of pathologic conditions
ØDescribes and explains WHY people can be helped
through nursing.

ØNursing is required when an adult (or in the case of a

dependent ,the parent) is incapable or limited in the
provision of continuous effective self care

ØAsserts that people benefit from nursing because they

have health-related limitations in providing self care.
Therapeutic self care demand
– "totality of self care actions to be performed for some duration in
order to meet self care requisites by using valid methods appropriate
for:
ü controlling or managing factors identified in the requisites, the values of
which are regulatory of human functioning (sufficiency of air, water and
food)
ü fulfilling the activity element of the requisite (maintenance, promotion,
prevention and provision)

Self care agency

– is a human ability which is "the ability for engaging in self care“
−Set of activities required to purposively regulate the actions needed
for planning a care plan for a client.

−is the acquired ability to perform the self care and this will be affected
by the basic conditioning factors such as age, gender, health care
system, family system, life experience, socio cultural orientation and
available resources.
 Basic conditioning factors:

Age
Resource
Adequacy Gender
and Ability

Environ- Develop-
mental mental
Factors State
Self-
Care
Agency
Patterns Health
of living State

Family Socio-
system cultural
Health-
factors Factors
care
system
factors
AGENT
– person who engages in meeting the needs of a person. They are like
bridges that facilitate what has been done and what needs to be done.
−Two types:
üSELF CARE AGENT
Who perform self care independently

üDEPENDENT CARE AGENT

Person who takes full responsibility of taking care of a person
who are incapable of providing care for themselves

NURSING AGENCY
– set of established capabilities of a nurse who can legitimately perform
activities of care for a client.
Includes concepts of deliberate action, including operations of diagnosis,
prescription, and regulation.
Orem explains not only when nursing is needed but also
how people can be assisted through the
5 methods of helping:--

vActing for and doing for others

vGuiding others
vSupporting another
vProviding an environment promoting personal development
in relation to meet future demands
vTeaching another
ØDescribes how the patient’s self care needs will be met by the
nurse, the patient, or both.
ØAre action system formed (designed and produced) by nurses
through the exercise of their nursing agency for persons with
health derived or health associated limitations in self care or
dependent care.
ØDescribes and explains relationships that must be brought
about and maintained for nursing to be produced.
Ø3 classifications of nursing system to meet the self
care requisites of the patient:-
v Wholly compensatory system
v Partly compensatory system
v Supportive – educative system
Wholly compensatory system
Required for individuals who are unable to control and
monitor their environment and process information.
“Doing for the patient..”
a. Unable to engage in any form of action (e.g. coma)
b. Aware and who may be able to make observations or
judgments, and decisions about self-care but
cannot/should not perform actions requiring
ambulation and manipulative movements (e.g.
patients with C3-C4 vertebral fractures)
c. Unable to attend to themselves and make reasonable
judgments about self-care but who can be ambulatory
and able to perform some self-care with guidance (e.g.
severely mentally retarded)
 Accomplishes
Patient action
patient’s therapeutic
limited
self-care

Compensates for
Nurse Action patient’s inability to
engage in self-care

Supports and
protects patient

Wholly compensatory system

Partly compensatory system
Designed for individuals who are unable to perform
SOME, but not all self care activity.
“Helping the patient do for himself/herself.”

a patient can meet some self-care requisites but needs

a nurse to help meet others; either the nurse or the
patient have the major role in the performance of self-
care
 E.g. a patient with recent abdominal surgery
 Performs some self-care
measures for patient
Compensates for self-care
limitations of patient
Nurse action
Assists patient as required

Regulates self-care agency

Performs some self-care

Patient Action agency
Accepts care and
assistance from nurse
Partly compensatory system
Supportive – educative system
Designed for persons who need to learn to perform
self care measures and need assistance to do so.

Helping patient to learn self care and emphasizing on

the importance of nurse’s role

a patient can meet self-care requisites but needs help in

decision-making, behavior control, or knowledge
acquisition; the nurse’s role is to promote the patient as a
self-care agent (teacher/consultant)
 E.g. a 16-year-old who is requesting birth control information
 Accomplishes self-
care

Patient action
Regulates the exercise
and development of
self-care agency
Nurse action

Supportive – educative system

 Orem’s General Theory of Nursing

Self
Conditioning factors

care
R R

Conditioning factors
Self
Care / R Therapeutic
Dep. Self care
demands
Care
Agency
Deficit

R R
Conditioning factors

Nursing
Agency
Strengths
üProvides a comprehensive base to nursing practice
üIt has utility for professional nursing in the areas of nursing practice
nursing curricula ,nursing education administration ,and nursing
research
üSpecifies when nursing is needed
üAlso includes continuing education as part of the professional
component of nursing education
üHer self care approach is contemporary with the concepts of health
promotion and health maintenance
üExpanded her focus of individual self care to include multiperson units

Limitations
üIn general system theory a system is viewed as a single whole thing while
Orem defines a system as a single whole thing
üHealth is often viewed as dynamic and ever changing .Orem’s visual
presentation of the boxed nursing systems implies three static
conditions of health
üAppears that the theory is illness oriented rather with no indication of
its use in wellness settings
Consists of 3 steps:

Step 1: determine why a patient needs care

Step 2: design a nursing system & plan the delivery of care

Step 3: management of nursing systems - planning, initiating, &

controlling nursing actions