Dorothea Orem

Self-Care Model
Historical

Background
 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.
 Definitions

• Theory- a set of related statements that

describes or explains phenomena in a
systematic way

• Concept- a mental idea of a

phenomenon
 Definitions
• Proposition- a statement of relationship
between concepts

• Conceptual model- made up of

concepts and propositions
 People involve

• Individual- Maintains self care as long

as possible but may require some
degree of assistance

• The Nurse- may serve as “another self”

-An extension of the
individual
 Self care
• consist of action activities
that individual carries out
on their own behalf
 Actions must be:

• Deliberate

• Having pattern and sequence

• Develop from day to day living

 Self care Agency
• Ability to perform self care

• Normally carried out by adults

 Those who need help with self
care activities:

• Infant
• Children
• The aged
• The ill
• The disabled
 3 categories of self-care
requisites
1. Universal self care requisites
• common to humans
• they are essentials in maintaining life,
health and well being
• Examples are air, water, food,
elimination.rest. solitude, social
interaction,
• prevention of hazard, promotion of
human functions
2. Developmental self care requisites-

• this include maintaining conditions to

support life to human development
• developmental stage
• social adaptation
• education
• Coping up with loss
• performing roles
3. Health Deviation self care requisites- required
in illness, injury or any medical
• treatments and test to correct the condition
• being aware of the current condition
• seeking and securing of medical assistance in
the event of exposure to specific physical or
biological agents
• carrying out medically prescribed diagnostics,
therapeutic and rehabilitative measures directed
to the prevention of specific type of diseases
• correcting of deformities or abnormalities to
compensate the condition
• Self care deficit- when a persons
therapeutic demand exceeds self-care
agency

Self care demand

>
Self care Agency
=
Self care deficit
3 Parts nursing theory
1. Self Care – systematize and deliberate actions
that regulates structural integrity, human
function, human development
2. Self care deficit- the core of Orem’s general
comprehensive theory of nursing
• when demands is greater than the ability to do
self care
3. Nursing System- Explains how a person can
be help through nursing
• The ability of the nurse to aid the person in
meeting current and potential self care
demands.
• Focused on person
Nursing System 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.
 Concepts of the
Model
1. Person
2. Environment
3. Health
4. Nursing
1. Person (man)- Is an embodied person
- considers the person to be self-
reliant and responsible for his self care
and well being
- self care is a requirement for a person
- an organism integrated whole
- can interact with environment and society
- has the capacity to reflect personal
experience and environment and can
Symbolize (has ideas and can put into
words)
 Self-evident characteristics of
human beings
a. requires continuous deliberate inputs to
themselves and their environments for survival
and functions
b. the power to act deliberately and identify needs
input(self-care agency)
c. mature human experience limitations in such
actions
d. human agency is exercised in discovering,
developing and transmitting ways to identify
needs for input and ways of providing them for
self and others
2. Environment- subcomponent of a
person;
integrated system related to self care
- Environmental factors have impact on the
persons health needs and thus Can
possibly be modified by the nurse
- These are the things outside a person from
the physical to psychosocial

Developmental- is the total environment

conditions that motivate the person to
establish appropriate goals
3. Health- state of wholeness or integrity of
the individual human beings, his parts and
his modes of functioning.
-it is the responsibility of the whole society
-the view will depend on each person.
Various definition will rise
-a healthy person is a sound person both
structural and functional
-it is a continuous effort; is there is a break
in maintenance a person will be ill Eventually
• 4. Nursing-Helping Service; a creative
effort of one human being to help
another human being.
-the individual’s need for self-care action
and the provision and management of it
on a continuous basis in order to
sustain life and health, recover from
disease or injury and cope with their
effects
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 helpiang 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.
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.
Thank You for
Listening

Randolf
Garcia