OREM'S SELF-CARE DEFICIT THEORY

 

 

 

 

Dorothea E OremDorothea 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

      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

cont.

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 CAREIt 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 DEFICITIt 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

ss Self Care

Self Care Agency

Therapeutic Self CareDemand

NursingAgency

Orem’s Five Areas Of Activity For Nursing

Practice Are:-Entering into and maintaining nurse patient relationship with indivdualsDetermining how patients can be helped through nursingResponding to patients requests, desires and needs for nurse contacts and assistancePrescribing, providing and regulating direct help to patient and their significant others in form of nursingCoordinating 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     

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

Cont..

Dorothea E Orem (1971)

Nursing: Concepts of Practice.

PURPOSE:

To provide care & to assist the client to attain self care.

PERSON: Biopsychosocial being capable of self care. Includes physical, psychological , interpersonal & social aspects of human functioning.

Env: External & Internal stimuli. 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.

Overview

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

Nursing diagnosis

Plans with scientific rationale

Implementation

Evaluation

Step 1:- Diagnosis & prescription, determine why nursing is needed. Analyze & interpret-make judgements regarding care.

Step 2:- Design of nursing system & plan for delivery of care.

Step 3;- Production & management of nursing systems.

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