Orem's theory presentation

1. OREM’S THEORY
&
JOHNSON'S THEORY
PRESENTED BY
RITIKA SHARMA
MSC 1ST YEAR

2. Orem’s General Theory of Nursing
Dorothea Elizabeth Orem
(1914-2007)

3. Introduction of theorist
◦ Theorist: Dorothea Orem
◦ Born 1914 in Baltimore, US
◦ BSN (1939) and MSN(1945) from Catholic university of
America
◦ Orem’s concept of nursing as the provision of self- care was
first published in 1959.
◦ Orem continued to develop her nursing concepts and her
self- care deficit theory of nursing. In 1971 she published
Nursing : concepts of practice.

4. Major Assumptions Of Theory
Nursing is a form of action- interaction between two or more
persons.
People should be self-reliant and responsible for their own
care
A person’s knowledge of potential health problems is
necessary for promoting self-care behaviors

5. METAPARADIGM OF OREMS THEORY
1. Person
2. Health
3. Environment
4. Nursing

6. Orem’s General Theory of Nursing
Its related parts:-
◦Theory of self care
◦Theory of self care deficit
◦Theory of nursing system

7. 1. Theory of self care
Based on the concepts of :
•Self – Care
•Self – Care Agency
•Self- Care Requisites
•Therapeutic Self- Care Demand

8. Self Care

9. Self –Care Agency
◦Definition: the individual’s ability to perform self- care
activities.
Consists of 2 agents:
Self-care Agents- person who provide the self- care
Dependent Care Agents- person other than the individual
who provides the care ( such as a parent)
◦Affected by the basic conditioning factors

10. Self –Care Requisites
Definition : reasons for which self –care is done; these express
the intended or desired results
◦Consists of 3 categories:
-Universal – needs that are common to all individuals
-Developmental- needs resulting from maturation or develop
due to a condition or event
-Health deviation – needs resulting from illness, injury and
disease or its treatment

11. Therapeutic self-care Demand
◦ The totality of care measures necessary at specific times or
over a duration of time for meeting an individual self care
requisites by using appropriate methods and related sets and
actions.
◦ Intentionally performed by someone.

12. 2.Theory of self care deficit
◦ It is the central focus of Orem’s
general theory of nursing.
◦ It describe how people can be
helped though nursing.
◦ It defines WHEN nursing is
needed.
◦ If there is more demand then
agency .. Nursing care is needed

13. ◦According to this theory role of the nurses are:
Acting (or) doing for another
Guiding and directing
Providing physical (or) Psychological support
Providing and maintaining environment that support
personal development
Teaching another

14. 3. Theory of Nursing Systems
It describe how the patient’s self care needs will be met by
the nurse, the patient or both.
Refers to the actions a nurse takes to meet a patients' self
care requisites.

15. Classification of nursing system
Wholly compensatory system
Partly compensatory system
Supportive –educative system

19. APPLICATION OF THEORY
Areas Patient details
Name
Age
Sex
Education
Occupation
Marital status
Religion
Diagnosis
Theory applied
Mrs. Laxmi
56 years
Female
No formal education
House hold
Married
Hindu
Rheumatoid arthritis Orem’s theory of self care
deficit.

20. ◦ CASE HISTORY
She came to the hospital with complaints of pain over all the joints,
stiffness which is more in the morning and reduced by the activities.
She has these complaints since 5 years and has taken treatment from local
hospital.
The symptoms were not reducing and came to --MC, Hospital for further
management.
Patient was able to do the ADL by herself but the way she performed and
the posture she used was making her prone to develop the complications
of the disease.
She also was malnourished and was not having awareness about the
deficiencies and effects.

21. DATA COLLECTION ACCORDING TO OREM’S THEORY OF SELF CARE
DEFICIT
◦ 1.BASIC CONDITIONING FACTORS
• Age
• Gender
• Health state
• Development state
• Sociocultural orientation
• Health care system
• Family system
• Patterns of living
• Environment
• Resources

22. UNIVERSAL SELF-CARE REQUISITES
Air Breaths without difficulty, no pallor cyanosis
Water Fluid intake is sufficient. Edema present over ankles. Turgor
normal for the age
Food intake is not adequate or the diet is not nutritious.
Elimination Voids and eliminates bowel without difficulty.
Activity/ rest Frequent rest is required due to pain.
Pain not completely relieved, Activity level ha s come down.
Deformity of the joint secondary to the disease process and use
of the joints.
Social interaction Communicates well with neighbors and calls the daughter by
phone Need for medical care is communicated to the daughter.
Prevention of hazards Need instruction on care of joints and prevention of falls.
Need instruction on improvement of nutritional status. Prefer
to walk barefoot.
Promotion of normalcy Has good relation with daughter

23. DEVELOPMENTAL SELF-CARE REQUISITES
Maintenance of the
developmental environment
Prevention/ management of the
conditions threatening the
normal development

24. HEALTH DEVIATION SELF-CARE REQUISITES
Adherence to medical regimen Reports the problems to the physician when in the
hospital. Cooperates with the medication, Not much
aware about the use and side effects of medicines
Awareness of potential problem
associated with the regimen
Not aware about the actual disease process.
Not compliant with the diet and prevention of
hazards. Not aware about the side effects of the
medications
Modification of self-image
to incorporate changes in health status
Has adapted to limitations in mobility.
The adoption of new ways for activities leads to
deformities and progression of the disease.
Adjustment of lifestyle to
changes in the health status and
regimen.
Adjusted with the deformities. Pain tolerance not
achieved

25. MEDICAL PROBLEM AND PLAN
◦ Medical Diagnosis: Rheumatoid arthritis
◦ Medical Treatment: Medication and physical therapy.

26. AREAS AND PRIORITY ACCORDING TO OREM’S THEORY OF SELF CARE DEFICIT:
IMPORTANT FOR PRIORITIZING THE NURSING DIAGNOSIS.
•
Air
•
Water
•
Food
•
Elimination
•
Activity/ Rest
•
Solitude/ Interaction
•
Prevention of hazards
•
Promotion of normalcy
•
Maintain a developmental environment.
•
Prevent or manage the developmental threats
•
Maintenance of health status
•
Awareness and management of the disease process.
•
Adherence to the medical regimen
•
Awareness of potential problem.
•
modify self image
•
Adjust life style to accommodate health status changes and MR

27. APPLYING THE OREM’S THEORY OF SELF-CARE DEFICIT
◦ Therapeutic self-care demand: deficient area: pain control
◦ Adequacy of self-care agency: Inadequate
Nursing Diagnosis
◦ • Ineffective pain control related to lack of utilization of pain relief
measures

28. ◦ OUTCOMES AND PLAN
◦ a. Outcome:
• improved pain self control
• achieve and maintain a reduction in the pain.
◦ b. Nursing Goals and objectives
Goal: to achieve a reduction in pain.
Objectives: Mrs. Laxmi will
• describe the total plan of pharmacological and nonpharmacological
pain relief
• demonstrate a reduction in the pain behaviours
• verbalize a reduction in the pain scale score from 7 – 4

29. ◦ Design of the nursing system: Supportive educative
◦ Method of helping:
◦ Guidance
◦ Support
◦ Teaching
◦ Providing the developmental environment

30. EVALUATION
• Patient still has pain over the joints and she agreed that she
will use the measures for pain relief that is told to her.
• The pain scale score was 6 after the measures were provided
to the patient.
• She demonstrated slight reduction in pain behaviours.
• The supportive educative system was useful for Mrs. Laxmi

31. APPLICATION OF OREM’S THEORY IN NURSING
a. In Practice
b. In Education
c. In Research

32. Strengths
Provides a comprehensive base to nursing practice.
It has utility for professional nursing in the areas of nursing
practice, curricula, education, administration and research
Specifies when nursing is needed
Expanded her focus of individual self-care to include
multiperson units
Can be used in multiple nursing specialities.

33. Limitations
◦ time consuming for nurses
◦ Direct contact is necessary through the nursing process.
◦ It Appears that the theory is illness oriented rather with no
indication of its use in wellness settings.

34. JOHNSON’S BEHAVIORAL SYSTEM MODEL
Dorothy E. Johnson
(Aug 21, 1919- Feb1999)

35. Background of theorist
•Theorist- Dorothy E Johnson
•Born on August 21, 1919, in Savannah, Georgia
•BSN from Vanderbilt University Tennessee in 1942
•MPH from Harvard University Boston in 1948
•Staff nurse at the Chatham-Savannah Health Council from
1943 to 1944.
•Assistant professor in pediatric nursing at Vanderbilt University
School of Nursing.
•“Behavioral System Model of Nursing,” which was first proposed
in 1968.
•Dorothy Johnson died in February 1999 at the age of 80.

36. BEHAVIORAL SYSTEM MODEL
JBSM is a model of nursing care that advocates the fostering
of efficient and effective behavioral functioning in the patient
to prevent illness and stress.
Johnson (1980) conceptualized a nursing client as a behavioral
system.
◦The client is seen as a collection of behavioral subsystems
that interrelate to form the behavioral system.

37. METAPARADIGM OF THEORY
◦Person
◦Health
◦Environment
◦Nursing

38. ◦ The system may be defined as those complex, overt actions or
responses to a variety of stimuli present in the surrounding
environment that are purposeful and functional.
◦ Nursing: an external regulatory force which can act to preserve the
organization and integration of the patient's behaviors at optimum
level.
◦ Client: bio psychosocial being with an instability in one of the
subsystem due to stress.
◦ Subsystem: part of behaviour system that carry out specialized task
and functions to maintain integrity of the whole behavior system.

39. Subsystems
Subsystems are
1. Affiliative or Attachment
2. Dependency
3. Ingestion
4. Elimination
5. Sexual
6. Achievement
7. Aggressive

41. APPLICATION OF THEORY
◦The process of the BSM of nursing begins with –
 Assessment
 Diagnosis
 Interventions
 Evaluations

42. EXAMPLE OF APPLICATION OF THEORY IN PRACTICE
Areas Patient details
Name
Age
Sex
Education
Occupation
Marital status
Religion
Diagnosis
Theory applied
Mrs. Laxmi
56 years
Female
No formal education
Secretarial graduate
Married
Hindu
Acute Ischemic Attack
Johnson’s bevaioral system model

43. ◦Case study
Mrs. Laxmi, a 56-year-old woman was admitted to ER having
chief complain of Decrease Level of Consciousness, Nausea
and Vomiting According to her daughter, Mrs. Laxmi and her
Husband having an argument and suddenly Mrs. Laxmi fell
down on the ground so she was rushed to the nearby hospital
within 15 minutes. She was immediately sent for CT scan and
diagnosed with Acute Ischemic Attack.

44. o AFFILIATION
ASSESSMENT
• Subjective- “I don’t want to see my husband yet”
• Objective- Changing topic when husband was mentioned
DIAGNOSIS
Impaired social interaction related to previous argument with husband as verbalized by
patient “I don’t want to see my husband yet”
PLANNING
Gradually introduce husband and the importance of their relationship. Talk to her husband
and include him during nursing care gradually.
IMPLEMENTATION
• Talked to her husband and ask few questions about how they met and become husband and
wife.
• Taught her husband how to her check blood sugar
EVALUATION
She tell story about her husband

45. o ELIMINATION
ASSESSMENT
• Subjective- I have difficulty defecating,
• Objective- Straining during defecation
DIAGNOSIS
Impaired Bowel Elimination related to decrease bowel movement as manifested by
straining during defecation
PLANNING
Educate the client on the importance of drinking water
IMPLIMENTATION
Give patient small frequent drinking water.
EVALUATION
Bowel become loose
All subsystem must be assessed like the above

46. LMITATIONS
• Johnson does not clearly interrelate her concepts of subsystems
comprising the behavioral system model.
• The definition of concept is so abstract that they are difficult to use.
• It is difficult to test Johnson's model by development of hypothesis.
• The focus on the behavioral system makes it difficult for nurses to
work with physically impaired individual to use this theory.
• The model is very individual oriented :
- so the nurses working with the group have difficulty in its
implementation.
- so the family of the client is only considered as an environment.
• Behavioral system model is not flexible.

47. SUMMARY

48. CONCLUSION
◦ The theory of self-care describes what a person requires and what
actions need to be taken to meet those requirements. It also provides
the structure for examining the actions and antecedent knowledge
required to assist the person. As a general theory, it serves nurses
engaged in nursing practice, in development and validation of nursing
knowledge and in teaching and learning nursing.
◦ The knowledge of Behavioral System Theory allows the nurse to be
aware of providing a constant supply of protection, nurturing and
stimulation. This theory also leads the researcher. The researcher might
investigate the functioning of the system and subsystem by focusing
on the basic science.

49. RESEARCH ARTICLE
◦ Theory-Based Advanced Nursing Practice: A Practice Update on the Application of Orem's Self-
Care Deficit Nursing Theory
◦ 2021 Apr 20: Jeffrey Yuk Chiu Yip
◦ Abstract
◦ Introduction: Many researchers have commended the self-care deficit nursing theory
(SCDNT) developed by Orem as a means of improving patients' health outcomes
through nurses' contributions. However, experimental research has investigated specific
aspects of SCDNT, such as self-care agency and self-care requisites, rather than how the
construct is practiced and understood as a whole. The current research presents a case
study in which an advanced practice nurse (APN) used SCDNT-led practice within a
primary healthcare setting that illustrates how the theory is applied to case
management.
◦ Methods: A case study was conducted by observing an APN during her work in the
asthma clinic of a public hospital in Hong Kong. A comparison was made between the
case management of the APN under observation with the nursing processes stipulated
by the SCDNT across four key operations: diagnostic, prescriptive, treatment or
regulatory, and case management.

50. ◦ Conclusion: During the observed consultation, the APN applied the four key
operations. In SCDNT, the role of the APN is to apply practical nursing knowledge
by determining how a patient can best undertake self-care within the
circumstances of their living arrangements and support facilities. The case study
also demonstrated that SCDNT-based nursing practice has strengths and
limitations in a primary healthcare setting. The study concluded that Orem's
SCDNT serves as an appropriate theoretical framework for nursing practice within
primary healthcare settings. One practical consequence of using SCDNT is that it
enables APNs to use nurse-sensitive indicators when evaluating their clinical
practice. This study offers a practice update to increase the accountability of
nursing practice for nurse-led healthcare services.
◦ Keywords: Orem self-care model; nursing theory; nursing theory-guided
practice; primary care nursing.

51. References
Brar N.K., Rawat HC, Textbook of Advance Nursing Practice ,Jaypee brothers publication; page
no.- 597-605 & 624-634.
George B J, Nursing theories- the base for professional nursing practice, 4 th edition, Norwalk,
Appleton & Lange, 1995
Lewis L, Heitkemper M, Dirksen S R, O ’ Brien P G, Bucher Linda, Medical Surgical Nursing
Assessment and management of clinical problems, 7 th edition, United States, Mosby Elsevier, 2009
Abyu, Gebre. (2020). Orem's self care deficit theory of nursing.Available on
https://www.researchgate.net/publication/339432461_Orem's_self_care_deficit_theory_of_nursing
Yip JYC. Theory-Based Advanced Nursing Practice: A Practice Update on the Application of
Orem's Self-Care Deficit Nursing Theory. SAGE Open Nurs. 2021 Apr 20;7:23779608211011993. doi:
10.1177/23779608211011993. PMID: 33959682; PMCID: PMC8060740. Available on
https://pubmed.ncbi.nlm.nih.gov/33959682/
Abyu, Gebre & University, Bahirdar. (2020). “Behavioral System Model of Nursing,.Available on
https://www.researchgate.net/publication/339432791_Behavioral_System_Model_of_Nursing