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.
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.
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
Orem began her theory development in the 1960’s, and her first publication was in 1971. During that time the mass media played a small role in portraying nursing as a respected profession but unfortunately played a much larger role in the destruction of that image.
In the early 1960’s Nurses were depicted as subordinate to Physicians in films and on television. For example, in TV shows such as Dr. Kildare and Ben Casey, nurses were shown delivering messages to the doctors, carrying trays and doing minimal skill level tasks. Throughout the show, the doctors were condescending towards the nurses, and constantly portrayed as superior.
In 1962 a revolutionary TV show came about, and for the first time nurses were depicted in a positive realistic light.
This ushered in an era of sexually suggestive material which included nurses as promiscuous women, having sex with patients, physicians and other male characters without any attachment, such as in “Carry on Nurse”.
Soon the context had completely left the screen and all that was left was outright pornography. Including such titles as “Night Call Nurses”, “I, A Woman” and “Deep Throat”.
Fortunately, although this portrayal hindered the progress nurses were making, this was not the image the majority of society assumed when thinking about what nurses do.
Every mature person has the ability to meet self care needs, but when a person experiences the inability to do so due to limitations, thus exists a self care deficit.
A person benefits from nursing intervention when a health situation inhibits their ability to perform self care or creates a situation where their abilities are not sufficient to maintain own health and wellness.
Nursing action focuses on identification of limitation/deficit and implementing appropriate interventions to meet the needs of person.
The nurse’s role in helping the client to achieve or maintain a level of optimal health and wellness is to act as an advocate, redirector, support person and teacher, and to provide an environment conducive to therapeutic development.
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.
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.
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.
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.
The supportive-educative role indicates that the client is participating in most of their self-care, and the nurse’s role is simply to monitor and regulate the client’s self-care.
Newly diagnosed diabetic patient received diabetic care teaching while in hospital. Now, patient visits module and reports highly variable BS/chemstrip readings. Nurse suspects patient may be performing procedure incorrectly. Nurse assesses that patient has been cutting some of his chemstrips in half to save money. Nurse instructs patient that cutting strips exposes chemicals and inaccurate readings may result. Additionally, nurse assesses that patient's wife (who does family cooking) did not receive any nutritional education while patient was hospitalized. Nurse begins nutritional counseling and provides wife with referral to nutritional services department.
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.
Nursing is being able to intervene when the person is unable to care for themselves and teach them methods to help them move beyond their inability. This can include offering information, teaching and tools necessary for their well being.
It is believed that Orem’s theory portrays the idea that nursing is the ability to care for another, especially when they are unable to care for themselves. This corresponds to our philosophy of caring for person with the goal of achieving optimal level of health and wellness.
Orem, D.E. (1991). Nursing: Concepts of practice (4 th ed.). St. Louis, MO: Mosby-Year Book Inc.
Taylor, S.G. (2006). Dorthea E. Orem: Self-care deficit theory of nursing. In A.M.
Tomey, A. & Alligood, M. (2002). Significance of theory for nursing as a discipline and profession. Nursing Theorists and their work. Mosby, St. Louis, Missouri, United States of America.
Whelan, E. G. (1984). Analysis and application of dorothea orem’s self-care practuce model. Retrieved October 31, 2006 from http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=Pubmed&list_uids=6094754&dopt=Abstract