OREM'S SELF-CARE
DEFICIT THEORY
   

 
 

Dorothea E Orem
 Introduction
 One of America’s foremost nursing theorists.

      Dorothea Orem earned her Bachelor of science in

nursing education in 1939 and Master of science in nursing
in 1945

      During her professional career ,she worked as a staff

nurse ,private duty nurse ,nurse educator,
administrator and nurse consultant

      Received honorary Doctorate of Science degree in

1976
 cont.
      Dorothea Orem as a member of a curriculum
subcommittee at Catholic University, recognized the
need to continue in developing a conceptualization of
nursing.

      Published first formal articulation of her ideas in

Nursing: Concepts of Practice in 1971 second in 1980,
and again in 1995
 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 US Department of Health,
Education and Welfare where she help
publish "Guidelines for Developing
Curricula for the Education of Practical
Nurses" in 1959.
cont.
  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
 Definitions of domain concepts

Nursing – is art, a helping service, and a

technology
      Actions deliberately selected and
performed by nurses to help individuals
or groups under their care to maintain or
change conditions in themselves or their
environments
 Goal of Nursing
• To render the patient or members of his
family capable of meeting the patient’s self
care needs
• To maintain a state of health
• To regain normal or near normal state of
health in the event of disease or injury
• To stabilize ,control ,or minimize the
effects of chronic poor health or disability
 Health
• Health and healthy are terms used to
describe living things … it is when they are
structurally and functionally whole or
sound … wholeness or integrity. .includes
that which makes a person human,…
operating in conjunction with physiological
and psychophysiological mechanisms and
a material structure and in relation to and
interacting with other human beings
 Cont.
  Environment – environment components are
environmental factors , environmental elements,
conditions ,and developmental environnent
   Human being – has the capacity to reflect
,symbolize and use symbols Conceptualized as
a total being with universal ,developmental
needs and capable of continuous self care
• A unity that can function biologically,
symbolically and socially
Cont..
Nursing client-
a human being who has "health related /health
derived limitations that render him incapable of
continuous self care or dependent care or limitations
that result in ineffective / incomplete care.
A human being is the focus of nursing only when a
self –care requisites exceeds self care capabilities
Nursing problem –
deficits in universal, developmental, and health
deviation or health related conditions
 Cont..

      Nursing process-

a system to determine (1)why a person
is under care (2)a plan for care ,(3)the
implementation of care

      Nursing therapeutics– deliberate

,systematic and purposeful action
Orem’s General Theory of Nursing

      Theory of self care

      Theory of self care deficit

      Theory of nursing systems

 Evolution of theory

• Human require deliberate input to self and

environment to be alive and to function
• The power to act deliberately is exercised in
caring for self and others
• Mature human some time experience limitation
in there ability to care for self and others
• Human discover develop and transmit ways to
care for self and others
• Human structure relationship and tasks to
provide self care
 CONCEPTS

• Core concepts are

• Self-care
• Self-care agency (Related to person)
• Therapeutic self-care demand
• Self-care deficit
• Nursing agency (Related to nurses and
their actions)
• Nursing system
Peripheral concept is basic conditioning
factors
• Age
• Gender
• Developmental state
• Sociocultural orientation
• Health state
• Family system factors
• Patterns of living
• Environmental factors
• Resource availability and adequacy
Dorothea Orem,1971, Developed a definition
of Nursing which emphasizes the client’s self
care needs. She defines self care as a
learned,goal oriented activity directed toward
the self in the interest of maintaining
life,health,development & well being. The goal
of this theory is “To Help The Client To
Perform Self Care.”
The goal of Nursing is To Increase The
Client’s Ability To Independently meet All The
Needs.
 Cont….
Acc. To Orem,”Nursing has special concern
about individual’s need for self care action
provision & management of it on a continues
basis in order to sustain life & health, recover
disease or injury, & cope with their effects.”
Orem develops her general theory of nursing
in 3 related parts:-
a) Self Care
b) Self Care Deficit
c) Nursing Systems
 THEORY OF SELF CARE
It includes self care,self care agency &
therapeutic self care demand as well as
self care requisites.
Self care is practice of activities which
individuals initiate & perform on their own
behalf in order to maintain life, health &
well being.
Self Care Agency is human ability for
engaging in self care.
Therapeutic Self Care Demand is
totality of self care actions to be
performed for some duration to meet self
care requisites.
Contd…

3 Categories of self care requisites

are:-

 Universal

 Developmental

 Health Deviation
Contd…
UNIVERSAL:- Associated with life processes
& maintenance of integrity of human
structure & functioning. They are common
to all.
DEVELOPMENTAL:- Related to
developmental processes or derived from
some condition or event.
HEALTH DEVIATION:- Required in
conditions of illness, injury or disease which
required to be diagnosed & correction of the
condition.
 THEORY OF SELF CARE
DEFICIT
It is the core of Orem’s theory. It explains nursing is
needed when a adult is incapable or limited in the
provision of continous effective self care.
In this Orem’s identifies 5 methods of helping:-
 Acting for or doing for another.
 Guiding.
 Supporting.
 Providing environment which promotes personal
development to meet future demands for action.
 Teaching.
CONCEPTUAL FRAMEWORK
FOR NURSING
SelfssCare

Therapeutic
Self Care Self Care
Agency Demand

Nursing
Agency
 Orem’s Five Areas Of Activity For
Nursing Practice Are:-
Entering into and maintaining nurse
patient relationship with indivduals
Determining how patients can be
helped through nursing
Responding to patients requests,
desires and needs for nurse
contacts and assistance
Prescribing, providing and
regulating direct help to patient and
their significant others in form of
nursing
Coordinating and integrating
nursing with the patient daily living,
other health care needed or care
being received.
 Theory Of Nursing System
 It is based on self care needs
and the ability of patient to
perform self care activities.
 The three classification of
nursing system to meet self
care requisites are:-
Wholly compensatory system
Partly compensatory system
Supportive educative system
BASIC NURSING SYSTEMS
 WHOLLY COMPENSATORY
SYSTEM
It is represented by situation
in which individual is
unable to engage in those
self care actions which
require self directed &
controlled ambulation &
manipulative movement.
These persons are socially
dependent on others for
their existence like persons
in coma, with mental
retardation etc.
 PARTLY COMPENSATORY
SYSTEM
It is represented by situation
in which both nurse &
patient performs care
measures or other actions
involving manipulative tasks
or ambulation. In this either
nurse or the patient may
have the major role in
performance of care
measures e.g. patient with
recent abdominal surgery.
 SUPPORTIVE EDUCATIVE
SYSTEM
In this the person is able to
perform or can perform &
should learn to perform required
measures of externally or
internally oriented therapeutic
self care but cannot do so
without assistance. Also
patient’s requirements for help
are confined to decision
making, behavior control &
acquiring knowledge &
skills.And nurses role is to
promote patient as self care
agent.
 Design and elements of nursing
system are:-
1. nursing responsibilities in
health care situation
2. General and specific roles of
nurses and patients
3. Reasons for nurses
relationship with patients
4. Kinds of action to be
performed and performance
• Patterns and nurses and
patient action in regulating
pt self care agency and
meeting self care demand
•Orem recognized that specialized technologies
are usually developed by members of the health
profession
•A technology is systematized information about
a process or a method for affecting some desired
result through deliberate practical endeavor ,with
or without use of materials or instruments
 Categories of technologies

      Social or interpersonal

      Communication adjusted to age, health status
      Maintaining interpersonal ,intragroup or
intergroup relations for coordination of efforts
      Maintaining therapeutic relationship in light of
psychosocial modes of functioning in health and
disease
      Giving human assistance adapted to human
needs ,action abilities and limitations     
Cont..
Regulatory technologies

1.Maintaining and promoting life processes

2.Regulating psycho physiological modes of

functioning in health and disease

3.Promoting human growth and development

4.Regulating position and movement in space

 Overview
Dorothea PURPOSE: PERSON: Biopsychosocial
E Orem being capable of self care.
To provide Includes physical,
(1971) care & to psychological , interpersonal &
Nursing: assist the social aspects of human
Concepts client to functioning.
of attain self Env: External & Internal stimuli.
Practice. care. Requisites for self care have
their origins in human beings &
their env.
Health: State of wholeness.
Nursing: Creative effort of one
human being to help another.
Consists of 3 nursing systems:-
Wholly compensatory, partially
compensatory &
supportive/educative.
NURSING ( Acc.To Orem)
“Human service….a mode of
helping men, women &
children & mot a tangible
comodity.” Nursing is
deliberate action,…a function
of practical intelligence of
nurses,…to bring about
humanly desired conditions in
persons & their environments.
The specialised abilities that
enable nurses to provide
nursing care to individuals is
termed as NURSING
AGENCY.
 OREM’S THEORY &
NURSING PROCESS
Orem’s approach to nursing process presents a
method to determine the self care deficits &
then to define the role of a person or nurse to
meet the self care demands.
 COMPARISON OF OREM’S NURSING
PROCESS & NURSING PROCESSS

 Assessment Step 1:- Diagnosis &

prescription, determine why
nursing is needed. Analyze
 Nursing diagnosis & interpret-make
judgements regarding care.
 Plans with scientific Step 2:- Design of nursing
rationale system & plan for delivery
of care.
 Implementation Step 3;- Production &
management of nursing
systems.
 Evaluation
Step 1- :- Diagnosis & prescription, determine why nursing is
needed.
collect data in six areas:
 The person’s health status
 The physician’s perspective of the person’s health status
 The person’s perspective of his or her health
 The health goals within the context of life history ,life style,
and health status
 The person’s requirements for self care
 The person’s capacity to perform self care
Step 2 Design of nursing system & plan for delivery of
care.
 Nurse designs a system that is wholly or partly
compensatory or supportive- educative.
The 2 actions are:-
 Bringing out a good organization of the
components of patients’ therapeutic self care
demands
 Selection of combination of ways of helping
that will be effective and efficient in
compensating for/ overcoming patient’s self care
deficits
Step 3 Production & management of nursing
systems.
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
evaluation
 UTILITY OF OREM’S
THEORY
It has utility for
professional nursing
in areas of nursing
education, clinical
nursing practice,
nursing
administration &
nursing research.
 APPLICATION OF THEORY TO PRACTICE

 Used as a philosophical guide to nursing practice

 Provide examples of nursing process using a case
study to develop a plan of care for an individual client
in many in patient and out patient settings.
 It can be even extended to the use of family settings
and describe how parents can give care for children
with various self-care demands
 It can be used in community, when the community is
viewed as an aggregate of individuals with various self-
care demands
 APPLICATION IN NURSING EDUCATION

 Self-care framework has guided in the formation of

curriculum for nursing programs
 It facilitate the student in the development of
nursing care plans
 It can be used as a clinical assessment tool
 It helps the students to develop a contract of care
with the patient
 Application in Nursing Research

 Numerous master's theses and doctoral

dissertations have used the self-care framework as a
guide
 Self-care framework has guided a wide range of
research designs from psychometric studies to
experimental studies
 Most of the psychometric research has focused on
development of instruments to measure self- care
agency
 CONT…..
 Orem’s theory has been used as the basis for
the development of research instruments to assist
researchers in using the theory
 A self care questionnaire was developed and
tested by Moore(1995) for the special purpose of
measuring the self care practice of children and
adolescents
 The theory has been used as a conceptual
framework in degree programs (Fenner 1979) in
many nursing schools
 Application in Nursing Administration
 Self-care framework has been used as a basis
for patient classification system
 The model emphasizes changes in nursing
strategies as the patients health status changes
 It is used to guide development of measures of
the quality of nursing care
 The most innovative use in nursing
administration is the development of a computer
software package, professional care system for
nursing documentation
 STRENGTHS
 She specified when nursing is needed.
 Included continuing education as part of
professional component of nursing education.
 Promoted concept of professional nursing, defined
roles of vocational, technical & professional nurses.
 Self care is comparable to holistic health,
promoting individual’s responsibility for health care.
 Expanded her focus of individual health care to
multiperson units.
 Emphasized the selection of one or more type of
nursing system for achieving the desired regulation
of patient’s self care agency & meeting their self
care requisites.
Contd…

 Recognized term client as regular

seeker of services & preferred the term
patient for one who is under care of
nurses, physicians or health care
providers.

 Defined system as a “ Single, Whole

Thing”
 LIMITATIONS
Some terms
need more
clarification i.e.
diagnosis,
prescription,
technologies,
therapeutic self
care demands.
 LIMITATIONS CONT……..

 Health is often viewed as dynamic and

ever changing .Orem’s visual presentation of
the boxed nursing systems implies three
static conditions of health
 Appears that the theory is illness oriented
rather with no indication of its use in wellness
settings