PRESENTED BY MELISSA KUREK, NICHOLAS KUREK, KIMBERLY MARINO AND HEATHER NOWAK

DOROTHEA OREM’S THEORY OF SELF CARE DEFICIT

Born in Baltimore, Maryland in 1914

Orem’s parents

Mother was a homemaker

Father was a construction worker

1930- graduated from Providence Hospital School of Nursing, Washington, DC

1935- BSN from Catholic University of America

1945-MSN from Catholic University of America

Orem’s World of Academia

1959- Dean of the School of Nursing at Catholic University of America

1976- Doctorate of Science from Georgetown University 1988- Doctor of Humane Letters from Illinois Wesleyan

University 1998- Doctor of Nursing Honoris Causae from University of

Missouri Retired in 1984

Orem’s nursing experience

Operating room nurse

Staff nurse Private duty nurse Nurse educator Nurse

administrator Nurse consultant

Died June 22, 2007

The Historical Evolution of Orem’s Model

Orem worked on developing

nursing curriculum and nursing

practice

1949-1957

Worked for the Office of

Education, in the U.S. Dept. of

Health, Education and Welfare as a

curriculum consultant

1958-1960

Guidelines for Developing

Curricula for the Education of

Practical Nurses was developed

( Tomey and Alligood, 2006).

1958-1960 cont’d

Evolution continued

Eventually served as the acting dean of

the School of Nursing at the

Catholic University of America

1960-

1970

Published Nursing: Concepts of

Practice

1971

Metaparadigms of Orem’s Model

Person Environment Health Nursing

Metaparadigm: Person

An individual or group of individuals who have the ability to acquire the knowledge necessary to perform tasks of self care.

Ability to integrate self-care tasks and family, community and individual needs.

Motivation to accomplish self care tasks.

Intellectual ability to cognitively perform, delegate and evaluate tasks performed.

Metaparadigm: Health

“Promotes function and development within social groups in accordance with human potential, known human limitation, and the human desire to return to normal” (Tomey & Alligood, 2006 p. 279).

Metaparadigm: Environment4 realms of state are encompassed in Environment:

Physical Chemical Biological Socioeconomical

Environment continued

Environment – Physical Shelter Security- internal

and external Climate Amenities eg. Heat,

electricity, indoor plumbing, sanitation…

Environment-Chemical

Chemical Pollutants:

Air Water

Physical Lead paints Mercury Asbestos

Environment-Biological

Biological Molds Pollens Allergens Mites Animal waste and

its by-products

Environment-Socioeconomic

Socioeconomic Family income Education level Occupation Social status Resources

Metaparadigm: NursingThe skilled professional who evaluates and acknowledges a patient’s health deficit.

Nursing plans and implements care based on the actual and potential self-care deficits.

Task Performanc

e

Self-Care Promotion

DemographicsSupportive

Coordinated

Concepts Unique to Orem’s Model

Three Nursing Theories1. The Theory of

Self Care2. The Theory of

Self-Care Deficit3. The Theory of

Nursing Systems

Theory of Self-Care

“Self –care comprises the practice of activities that maturing and mature persons initiate and perform, within time frames, on their own behalf in the interest of maintaining life, healthful functioning, continuing personal development and well-being through meeting known requisites for functional and developmental regulations”(Tomey & Alligood, 2006 p.269).

Theory of Self-Care continued The Theory of Self-

Care has three components: universal self-care needs, developmental self-care needs and health deviation.

Theory of Self-Care Deficit

A self-care deficit occurs when an individual cannot carry out self-care requisites.

Examples of self-care requisites are: Wound care Activities of Daily Living Bowel program Glucose monitoring

Universal Self-Care Requisites

The 8 elements : Air Food Water Elimination/

Excretion Activity & Rest Solitude/Social

interaction Functioning/Well-

being Normalcy

Developmental Self-Care Requisites

Composed of 3 needs Promote

development Engage in self-

development Preventing or

overcoming adverse human conditions and life situations

Health Deviation Self-Care Requisites

When a condition permanently or temporarily alters structural, physiological or psychological function. Comatose states Autism Mental Retardation

Theory of Nursing Systems

Total compensatory support- patient is unable to complete any self-care independently; nursing compensates for patient’s inability to perform self-care.

Partial compensatory support- patient is able to perform self-care tasks with partial or no assistance from nursing.

Educative/supportive compensatory– patient able to perform tasks independently. Nursing provides ongoing education and support.

Clinical Practice Models for Patient AssessmentTheory applies to multiple clinical settings.

Theory applied in order to:

Home By the patient alone or

with assistance provided

Doctor’s office Education provided and

care supervised by a nurse

Hospital Needs identified,

assessed and plan of care implemented

Extended care facility

Help identify the patient’s ability for self-care deficits that need to be addressed to promote health.

Help identify support available to patient such as family and environment.

Encourage patient to develop self-care abilities

Orem’s Theory Applied to Nursing Education

Teaches the student to encourage compensatory care in the patient population.

Conceptualize patients’ current and potential self-care deficits.

Supports the nursing process in all 3 nursing theories.

Research Status of Orem’s Model

Model used by multiple nursing specialties due to encompassing nature of Orem’s theory.

Current research using Orem’s theory would include: Chinese Medicine Battered woman

counseling

Orem’s Strengths

The Self Care Deficit Theory is specific to nursing.

The Theory can be used in multiple nursing specialties.

The concept of self-care and health maintenance are congruent with contemporary literature in healthcare.

The theory creates a coordinated nursing care plan that adjusts to the patient’s needs throughout recovery.

Orem’s Limitations

Time consuming for nurses

Direct contact is necessary throughout the nursing process.

Multiple levels of the theory to consider Self care, self care deficit and self care deficit potential.

Does not address cultural needs

Analysis and Insights

Three theories combined into one.

Cumbersome Completely

dependent on nursing to assess the patient and family’s ability to complete self-care requisites and deficits

Culturally diverse

References

Marrier Tomey, A. & Alligood, M. (2006). Nursing theorists and their work. (6th ed.) St. Louis, MO : Mosby Elsevier.

Bruce, E., Gagnon, C., Gendron, Puteris, L., & Tamblyn, A.(2009, November 7). Dorothea Orem’s Theory of Self Care. Retrieved from http://www.nipissingu.ca/faculty/arohap/aphome/NURS3006/Resources/DorotheaOremTheory.ppt

Dorothea Orem, Nursing Theory ( 2009, November 7). Retrieved from http://faculty.ucc.edu/nursing-gervase/Orem%5B1%5D.pps

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