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  1. 1. DEO<br />Born: 1914, Baltimore, Maryland.Education: Diploma (early 1930's), Providence Hospital School of Nursing, Washington, DC; BSN Ed. (1939) and MSN Ed. (1945) from the Catholic University of America, Washington, DC.Honorary Doctorates: Doctor of Science from Georgetown University (1976) and Incarnate Word College in San Antonio, Texas (1980); Doctor of Humane Letters from Illinois Wesleyan University, Bloomington, Illinois (1988); Doctor Honoris Causae, University of Missouri-Columbia (1998).<br />Dr. Orem continues to be active in theory development. She completed the 6th edition of Nursing:Concepts of Practice, published by Mosby in January 2001.<br />FAQ<br />Frequently Asked Questions1. I need information about the theorist Dorothea Elizabeth Orem.Dorothea E. Orem was born 1914 in Baltimore, Maryland. She passed away on June 22, 2007 in her home in Savannah, GA, USA. Dorothea died shortly before her 93rd birthday.       Education: Diploma (early 1930's), Providence Hospital School of Nursing, Washington, DC; BSN Ed. (1939) and MSN Ed. (1945) from the Catholic University of America, Washington, DC.Honorary Doctorates: Doctor of Science from Georgetown University (1976) and Incarnate Word College in San Antonio, Texas (1980); Doctor of Humane Letters from Illinois Wesleyan University, Bloomington, Illinois (1988); Doctor Honoris Causae, University of Missouri-Columbia (1998).Special Awards: Catholic University of America Alumni Achievement Award for Nursing Theory (1980); Linda Richards Award, National League for Nursing (1991); and honorary Fellow of the American Academy of Nursing (1992).2. What were some of the influences that led her to develop the theory?Information on the influences on Orem can be found in the November 1998 IOS newsletter. The development of Self-Care Deficit Nursing Theory: A Historical Analysis by Susan Taylor.3. I need information about the theory.There are many articles about the theory. The best source is Orem's textbook which should be available in your library or through an interlibrary loan.Orem, Dorothea. Nursing: Concepts of Practice. January, 2001. Mosby, ISBN 032300864X. Summaries and analyses of the theory are available. Comprehensive reviews of the theory and supporting literature can be found in:D.E. Orem (1979) Concept Formalization in Nursing: Process and Product. (A reprint was supported by the IOS in 2004. For more information click here.)Young, A., Taylor, S. & Renpenning, K. (2003) Connections: Nursing Research, Theory and Practice. Mosby.For more information click here.Fawcett, J. (2005) Contemporary Nursing Knowledge: Analysis and Evaluation of Nursing Models and Theories.F.A. Davis.There are other reviews in nursing theory anthologies available. The IOS newsletters (full text available) also contains much information. Click here to go to the newsletters webpage.4. Is there a bibliography available online?There is an old bibliography, last updated in 1996, accessible through the Oakland University web site.There is a number of review articles that include extensive bibliographies, such as Orem's self-care deficit nursing theory: its philosophic foundation and the state of the science, by Taylor, S., Geden, E., Isaramalai, S. & Wongvatunyu, S., 2000, Nursing Science Quartely, 13(2):104-110.A CINAHL search will also yield an extensive bibliography. Search keywords Orem; self-care model.5. Do you have an assessment form or a nursing process form?There are none online at this time. There are case studies and other descriptions of clinical use of SCDNT in the IOS newsletters that you can access.Orem includes a nursing history form in her textbook, Appendix B.Allison, S. & Renpenning, K. Nursing Administration in the 21st Century, 2000, Sage Publications, has samples of care plans and other applications.<br />Orem Archive<br />The Dorothea Orem CollectionAt the Alan Mason Chesney Medical Archives, John's Hopkins Medical Institutions.Scope and ContentThe Dorothea Orem Collection documents her activities from the 1950s to the present. The collection contains personal and professional correspondence, notebooks, published and unpublished articles, diplomas, honorary degrees, educative materials, and course materials from The Catholic University of America (1960s).It also includes page proofs, correspondence and other materials related to the publication of Nursing: Concepts of Practice and Concept Formalization in Nursing: Process and Product. Other items include curriculum materials and committee records from CUA, documentation of the Self-Evaluation Project at Incarnate Word College (1970s), documentation from the Georgetown Curriculum Project (1970s), conference papers, notes, correspondence, and other materials relating to conferences throughout the 1970s and 1980s, current conference papers and work in progress.The Nursing Development Conference Group and the International Orem Society are both represented. The NDCG is particularly well represented by correspondence and other materials relating to the publication of Concept Formalization in Nursing: Process and Product.Additional CollectionsIn addition to these materials, the collection also contains two small but significant sub-collections dedicated to Joan Backscheider and Monica Orem, Dorothea Orem’s sister.The Joan Backscheider Collection contains personal and professional correspondence, students’ work including dissertations and field work diaries, and committee notes and minutes from The Catholic University of America (1960s).The Monica Orem Collection contains personal photos and correspondence and a full run of the Patna Mission Newsletter from 1950-1959.<br /> Biography<br />1930 exams at the nursing for the sick school in Washington DC<br />occupation-accompanying study of the<br />1945 conclusion of the master OF Science OF Education to the Catholic UniversityOF America, Washington (D.C.)<br />1970 establishment of their consulting firm to care and training<br />1971 publication of their theory of the self care<br />Self care concept after Orem<br />In the year 1958 Dorothea Orem began with the development as well as the testing of itstheory of the self care, which her to 1971 in the book " “only-sing concepts OF practice" ” published. It receives to today acknowledgment in the professional world, whereby the largest point of criticism of its theory consists of the fact that it proceeds from " “disturbed functions" ” of humans and thus develops a rather negative aspect. Their definitions have a high value in the care science.<br />Works<br />Only-sing - concepts OF practice. 1971; 41991 (Dt.: Structure concepts of care practice. Berlin; Wiesbaden: Ullstein Mosby 1997 ISBN 3-86126-548-6)<br />Literature<br />Connie M. Dennis: Dorothea Orem: Self care and self care deficit theory. Berne and others: Huber 2001 ISBN 3-456-83300-8<br />DOROTHEA OREM’S THEORYThis page was last updated on 17-01-2010----------------------------------------------------------------IntroductionOne 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 1945During her professional career ,she worked as a staff nurse ,private duty nurse ,nurse educator and administrator and nurse consultantReceived honorary Doctor of Science degree in 1976Dorothea 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 finally in 1995Development of Theory1949-1957 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 1959.1959 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 1984DEFINITIONS OF DOMAIN CONCEPTSNursing – is art, a helping service, and a technologyActions deliberately selected and performed by nurses to help individuals or groups under their care to maintain or change conditions in themselves or their environmentsEncompasses the patient’s perspective of health condition ,the physician’s perspective , and the nursing perspectiveGoal of nursing – to render the patient or members of his family capable of meeting the patient’s self care needsTo maintain a state of healthTo regain normal or near normal state of health in the event of disease or injuryTo stabilize ,control ,or minimize the effects of chronic poor health or disabilityHealth – 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 beingsEnvironnentenvironnent components are environnemental factors, environnemental éléments, conditions, and développemental environnentHuman being – has the capacity to reflect, symbolize and use symbolsConceptualized as a total being with universal, developmental needs and capable of continuous self careA unity that can function biologically, symbolically and sociallyNursing clientA 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 capabilitiesNursing problemdeficits in universal, developmental, and health derived or health related conditionsNursing processa system to determine (1)why a person is under care (2)a plan for care ,(3)the implementation of careNursing therapeuticsdeliberate,  systematic and purposeful actionOREM’S GENERAL THEORY OF NURSINGOrem’s general theory of nursing in three related parts:-Theory of self careTheory of self care deficitTheory of nursing systeA. Theory of Self CareThis theory Includes :--Self care – practice of activities that individual initiates and perform on their own behalf in maintaining life ,health and well beingSelf care agency – is a human ability which is " the ability for engaging in self care" -conditioned by age developmental state, life experience sociocultural orientation health and available resourcesTherapeutic self care demand – " totality of self care actions to be performed for some duration in order to meet self care requisites by using valid methods and related sets of operations and actions" Self care requisites-action directed towards provision of self care. 3 categories of self care requisites are:--1.  UniversalDevelopmentalHealth deviation2. Universal self care requisitesAssociated with life processes and the maintenance of the integrity of human structure and functioningCommon to all , ADLIdentifies these requisites as:Maintenance of sufficient intake of air ,water, foodProvision of care assoc with elimination processBalance between activity and rest, between solitude and social interactionPrevention of hazards to human life well being andPromotion of human functioning3. Developmental self care requisitesAssociated with developmental processes/ derived from a condition…. Or associated with an eventE.g. adjusting to a new jobadjusting to body changesHealth deviation self careRequired in conditions of illness, injury, or disease .these include:--Seeking and securing appropriate medical assistanceBeing aware of and attending to the effects and results of pathologic conditionsEffectively carrying out medically prescribed measuresModifying self concepts in accepting oneself as being in a particular state of health and in specific forms of health careLearning to live with effects of pathologic conditionsB. Theory of self care deficitSpecifies when nursing is neededNursing is required when an adult (or in the case of a dependent, the parent) is incapable or limited in the provision of continuous effective self care. Orem identifies 5 methods of helping:--Acting for and doing for othersGuiding othersSupporting anotherProviding an environment promoting personal development in relation to meet future demandsTeaching anotherC. Theory of Nursing SystemsDescribes how the patient’s self care needs will be met by the nurse , the patient, or bothIdentifies 3 classifications of nursing system to meet the self care requisites of the patient:-Wholly compensatory systemPartly compensatory systemSupportive – educative systemDesign and elements of nursing system defineScope of nursing responsibility in health care situationsGeneral and specific roles of nurses and patientsReasons for nurses’ relationship with patients andThe kinds of actions to be performed and the performance patterns and nurses’ and patients’ actions in regulating patients’ self care agency and in meeting their self care demandOrem recognized that specialized technologies are usually developed by members of the health professionA technology is systematized information about a process or a method for affecting some desired result through deliberate practical endeavour ,with or without use of materials or instrumentsCategories of technologies1. Social or interpersonalCommunication adjusted to age, health statusMaintaining interpersonal, intragroup or intergroup relations for coordination of effortsMaintaining therapeutic relationship in light of psychosocial modes of functioning in health and diseaseGiving human assistance adapted to human needs ,action abilities and limitations2. Regulatory technologiesMaintaining and promoting life processesRegulating psycho physiological modes of functioning in health and diseasePromoting human growth and developmentRegulating position and movement in spaceOREM’S THEORY AND NURSING PROCESSOrem’s approach to the nursing process presents a method to determine the self care deficits and then to define the roles of person or nurse to meet the self care demands.The steps within the approach are considered to be the technical component of the nursing process.Orem emphasizes that the technological component " must be coordinated with interpersonal and social processes within nursing situations.Comparison of Orem’s Nursing Process and the Nursing ProcessNursing ProcessOrem’s Nursing. ProcessAssessment Diagnosis and prescription; determine why nursing is needed. analyze and interpret –make judgment regarding careDesign of a nursing system and plan for delivery of careProduction and management of nursing systemsStep 1-collect data in six areas:-The person’s health statusThe physician’s perspective of the person’s health statusThe person’s perspective of his or her healthThe health goals within the context of life history ,life style, and health statusThe person’s requirements for self careThe person’s capacity to perform self careNursing diagnosisPlans with scientific rationale Step 2Nurse 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 demandsSelection of combination of ways of helping that will be effective and efficient in compensating for/ overcoming patient’s self care deficitsImplementationevaluation Step 3Nurse 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 designActions are directed by etiology component of nursing diagnosisevaluationApplication of Orem’s theory to nursing processPersonal factorsUniversal self careDevelopmental self careHealth deviationMedical problem & planSelf care deficits29 yr.FemaleEarly adulthood transition32pack /yrWater-no restrictionsFood –nilWt89lbWt loss-19%nauseatedTeenage pregnancy-2OC-10 yrsHusband emotionally awaySeeks medical attention for overt s/sAware of diseaseNo evidence  8th gradeTeenage pregnancyNo workMarriedChild-2Urinary retentionIntermittent self catheterizationPainNo BSEInfrequent physical examinationNo HRTPoor healthability to manage effectsSurgery on reproductive organsDifference between knowledge base & lifestyleLives at mother’s home. Environment uncleanLimited resourcesTearfulHusband abusiveDissatisfied with homeRTEDU deprivationOppressive living conditions Will receive RT ,perform intermittent catheterization  Therapeutic self care demandAdequacy of self care agencyNursing diagnosisMethods of helpingAir Maintain effective respirationWater No problemFood maintain sufficient intakeInadequate AdequateInadequatePotential for impaired respiratory statusP F fluid imbalanceActual nutritional deficit r/t auseaGuiding & directing TeachingProviding physical support HazardsPrevent spouse abusePromotion of normalcy Inadequate Inadequate P/F injury A/d in environmentShared housingPersonal developmentGuiding & directingGuiding & directingMaintain developmental environmentSupport ed normalcy in environmentPrevent /manage dev threatInadequate  InadequateActual delay in normaldev. R/T early parenthoodLevel of educationDev deficit r/t loss of reproductive organsGuiding & directing Providing psy supportProviding physical, psy supportMaintenance of health statusManagement of disease processInadequate  InadequateP/F contd. alterations in health status  P/F UTI Guiding & directing, teaching Guiding & directing, teaching Adherence to med regimenAwareness of potential problemsInadequate  InadequateP/F ¯ adherence in self catheterization & OPD RT Actual deficit in awareness of advisability of HRT & RT effects teaching     teaching Adjust to loss of reproductive ability & dev healthy view of illnessAdjust life style to cope with changeInadequate  InadequateActual threat to self imageActual self deficit in planning for future needsProviding  psy support Guiding & directingOREM’S WORK AND THE CHARACTERISTICS OF A THEORYTheories can interrelate concepts in such a way as to create a different way of looking at a particular phenomenonTheories must be logical in natureTheories must be relatively simple yet generalizableTheories are the basis for hypothesis that can be testedTheories contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate themTheories can be used by the practitioners to guide and improve their practiceTheories must be consistent with other validated theories ,laws and principlesTheory TestingOrem’s theory has been used as the basis for the development of research instruments to assist researchers in using the theoryA self care questionnaire was developed and tested by Moore(1995) for the special purpose of measuring the self care practice of children and adolescentsThe theory has been used as a conceptual framework in assoc. degree programs (Fenner 1979) also in many nursing schoolsStrengthsProvides a comprehensive base to nursing practiceIt has utility for professional nursing in the areas of nursing practice nursing curricula ,nursing education administration ,and nursing researchSpecifies when nursing is neededAlso includes continuing education as part of the professional component of nursing educationHer self care approach is contemporary with the concepts of health promotion and health maintenanceExpanded her focus of individual self care to include multiperson unitsLimitationsIn general system theory a system is viewed as a single whole thing while Orem defines a system as a single whole ,thingHealth is often viewed as dynamic and ever changing .Orem’s visual presentation of the boxed nursing systems implies three static conditions of healthAppears that the theory is illness oriented rather with no indication of its use in wellness settingsSummaryOrem’s general theory of nursing is composed of three constructs .Throughout her work ,she interprets the concepts of human beings, health, nursing and society .and has defined 3 steps of nursing process. It has a broad scope in clinical practice and to lesser extent in research ,education and administrationReferencesOrem, D.E. (1991). Nursing: Concepts of practice (4th 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.George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton & Lange.Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins.Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia,  Lippincott.Taylor Carol,Lillis Carol (2001)The Art & Science  Of Nursing Care 4th ed. Philadelphia,  Lippincott.Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. London Mosby Year Book.<br />