PREPARED BY: MS SHALINI ABRAHAM, ASSOCIATE PROFESSOR, D Y PATIL SCHOOL OF NURSING, NERUL, NAVI MUMBAI. About Theorist : Dorothea Orem (1914-2007) Born 1914 in Baltimore, US Earned her diploma at Providence Hospital –Washington 1939 – BSN Ed., Catholic University of America 1945 – MSN Ed., Catholic University of America She worked as a staff nurse, private duty nurse, nurse educator and administrator and nurse consultant. Received honorary Doctor of Science degree in 1976. She Is focusing on: 1. Theory if self care 2. Theory of self care deficit 3. Theory of Nursing System

1. DOROTHEA OREM’S
SELF CARE THEORY
Ms. Shalini Abraham , Associate Professor DYPUSON

2. ABOUT OREM……
 Theorist : Dorothea Orem (1914-2007)
 Born 1914 in Baltimore, US
 Earned her diploma at Providence Hospital –Washington
 1939 – BSN Ed., Catholic University of America
 1945 – MSN Ed., Catholic University of America
 She worked as a staff nurse, private duty nurse, nurse
educator and administrator and nurse consultant.
 Received honorary Doctor of Science degree in 1976.

3. People are distinct individuals
Self care and dependent care are behaviors learned within a socio-
cultural context
Person’s knowledge of potential health problems is necessary for
promoting self-care behaviors
Self-care requisites is an important component of primary care
prevention and ill health
People should be self-reliant and responsible for their own care
ASSUMPTIONS

4. OREM’S
GENERAL
THEORY
OF
NURSING
Theory of self
care
Theory of self
care deficit
Theory of nursing
system

6. Theory
of self
care
SELF
CARE
SELF
CARE
AGENCY
SELF
CARE
DEMAND
SELF CARE
REQUISITIES

7. practice of activities that
individual initiates and
perform on their own
behalf in maintaining
life ,health and well
being

8. 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
resources

9. "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"

10. Action directed towards
provision of self care.
3 categories of self care
requisites are-
 Universal self care requisites
 Developmental self care
requisites
 Health deviation self care
requisites

12.  Specifies when nursing is needed
 Nursing 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 others
 Guiding others
 Supporting another
 Providing an personal development in
relation to meet future demands
 Teaching another

14. WHOLLY COMPENSATORY SYSTEM
PARTLY COMPENSATORY SYSTEM
SUPPORTIVE-EDUCATIVE SYSTEM

16. OREM’S THEORY
AND
NURSING PROCESS

17. 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.

18. Nursing Process Orem’s Nursing Process
Assessment 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

19. Nursing Process Orem’s Nursing Process
Nursing diagnosis
Plans with scientific rationale
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

20. Nursing Process Orem’s Nursing Process
Implementation
evaluation
 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

21. Application of
Orem’s theory to
nursing process

22. NURSE
ACTION
Accomplish the patient’s
Therapeutic care
Compensates for patient ability
in self care
Supports and protect the patient
WHOLLY COMPENSATORY SYSTEM
PATIENT ACTION
LIMITED

23. NURSE
ACTION/
PATIENT
ACTION
Performs Care
Compensates and regulate the
ability in self care
Assists and accepts the care
PARTLY COMPENSATORY SYSTEM

24. ACCOMPLISH SELF CARE
REGULATES THE EXERCISES
AND GET GUIDANCE
NURSE
ACTION
PATIENT
ACTION

25. EXAMPLE WITH SCENARIO
&APPLICATION OF THEORY
1. MEDICAL PROBLEM AND PLAN
Physician’s perspective of the condition: Diagnosed with
pancreatitis and is on the following treatment:
 IV fluid NS 8 hourly
 NPM
 Continuous gastric drainage
 Inj. Paracetamol 1gm IV TDS
 Inj. Voveran 75 mg IM SOS
 Inj. Pan 40 mg IV OD
 Inj. Pipzo 4.5 gm IV BD
 Inj. Metronidazole 500mg IV TDS
 Inj. Fortwin 1amp IM HS
 Inj. Calmpose 1amp Im HS
Medical Diagnosis: peptic perforation with peritonitis
Medical Treatment: Medication and restriction in oral intake
Surgical treatment: Repair of perforation is done under general
anesthesia

26. Therapeutic self care demand: deficient area:
pain control
Adequacy of self care agency: inadequate
Nursing diagnosis
Ineffective pain control related to presence of
surgical wound in abdomen
Outcome:
Improved pain control
Achieve and maintain a reduction in the pain
Goal: To reduce pain
Design of the nursing system: Acting or doing
, supportive and educative

27. Method of helping:
Guidance:
Ask the client to report the intensity, location,
severity, associated and aggravating factors.
Support:
Administer analgesics
Provide diversion and psychological support to
the patient
Teaching:
Teach the non – pharmacological method to the
patient once the pain is a little reduced.

28. Implementation
 Assessed the pain along with its location,
characteristics, duration, frequency, quality,
intensity.
 Patient is kept NPM to control pain.
 Continuous nasogastric drainage is provided for
gastric decompression.
 Non-pharmacological techniques(guided
imagery) are taught to the client to perform to
reduce pain.
 Inj. Voveran 75mg is administered IM
 Inj. Paracetamol 1 gm is administered IV
 support provided.
Evaluation
Patient explained slight reduction in pain and
demonstrated to perform pain relieving non-
pharmacological measures.

29. STRENGTHS OF
THEORY
Provides a comprehensive base to nursing practice
It has utility for professional nursing in the areas of
nursing practice nursing curricula ,nursing education
administration ,and nursing research
Specifies when nursing is needed
Her self-care approach is contemporary with the
concepts of health promotion and health
maintenance

30. LIMITATIONS OF
THEORY
In general system theory a system is
viewed as a single whole thing while
Orem defines a system as a single whole,
thing.
Health is often viewed as dynamic and
ever changing.
The theory is illness oriented.