JOFRED M. MARTINEZ, RNGraduate SchoolUniversity of San AgustinGeneral Luna Street, Iloilo City
BACKGROUND OF THE THEORIST Born in Baltimore, Maryland. Orem began her career at ProvidenceHospital School of Nursing in WashingtonDC, Orem received a B.S.N.E. from the CatholicUniversity of America (CUA) in 1939 and, in1946; she received an M.S.N.E. from thesame university.
Providence Hospital School ofNursing Washington DC
Orem held the directorship of both thenursing school and department of nursing atProvidence Hospital in Detroit from 1940 to1949. Orem worked in Indiana working in theDivision of Hospital and Institutional Servicesof Indiana State Board of Health (1949 to1957) . In 1957, Orem moved to Washington, DC;the office of education, U.S. Department ofhealth, Education and Welfare (DHEW)employed her as a curriculum consultantfrom 1958 to 1960.
Orem held the directorship of both thenursing school and department of nursingat Providence Hospital in Detroit from 1940to 1949. Orem worked in Indiana working in theDivision of Hospital and Institutional Servicesof Indiana State Board of Health (1949 to1957) . In 1957, Orem moved to Washington, DC;the office of education, U.S. Department ofhealth, Education and Welfare (DHEW)employed her as a curriculum consultantfrom 1958 to 1960.
Honorary Doctor of Science, IncarnateWord College, 1980; Doctor of HumaneLetters, Illinois Wesleyan University (IWU),1988; Linda Richards Award, NationalLeague for Nursing, 1991; and HonoraryFellow of the American academy ofNursing, 1992. Doctor of Nursing Honoris Causae from theUniversity of Missouri in 1998. Orem retired in 1984 and resides atSavannah, Georgia.
The practice of activities that maturingand mature persons initiate and performwithin time frames, on their own behalf, andin the interest of maintaining life andhealthful functioning and continuingpersonal development and well-being.
A formulated and expressed insightabout actions to be performed that areknown or hypothesized to be necessary inthe regulation of an aspect(s) of humanfunctioning and development, eithercontinuously or under specified conditionsand circumstances.
A formulated self-care requisite names:1. the factor to be controlled or managed tokeep an aspect(s) of human functioningand development within the normscompatible with life and health andpersonal well being and2. the nature of the required action.Formulated and expressed self-carerequisite constitutes the formalizedpurposes of self-care.
Universally required goals to be metthrough self-care or dependent care havetheir origins in what is known and what isvalidated or what is in the process of beingvalidated about human structural andfunctional integrity at various stages of thelife cycle.
Six self-care requisites are suggested:a. The maintenance of a sufficient intake ofair, water, and food.b. The provision of care associated withelimination processes and excrements.c. The maintenance of balance the balanceactivity and rest.d. The maintenance of balance betweensolitude and interaction.
e. The prevention of hazards to human life,human functioning, and human well-being.f. The promotion of human functioning anddevelopment within social groups inaccordance with human potential, knownhuman limitations, and the human desire tobe normal.
They promote processes of life andmaturation and prevent conditionsdeleterious to maturation or those thatmitigate those effects.
The following are actions to beundertaken that will provide developmentalgrowth:1. Provision of conditions that promotedevelopment.2. Engagement in self-development3. Prevention of the effects of humanconditions that threatens life.
These self-care requisites exists forpersons who are ill or injured, who havespecific forms of pathological conditions ordisorders, including defects or disabilities,and who are undergoing medical diagnosisand treatment.
The summation of care measuresnecessary at specific times of over aduration of time for meeting all of anindividual’s known self-care requisitesparticularized for existent conditions and forcircumstances using methods appropriatefor:
1. controlling or managing factors identifiedin the requisites, the values of which areregulatory of human functioning(sufficiency of air, water, and food)2. fulfilling the activity element of the requisite(maintenance, promotion, prevention, andprovision)
Therapeutic self-care demand at any time:1. describes factors in the patient or theenvironment that must be held steady withinthe range of values or brought within andheld within such a range for the sake of thepatient’s life, health or well-being2. has a known degree of instrumentaleffectiveness derived from choice oftechnologies and specific techniques forusing changing, or in some way controlling,patient or environmental factors.
The complex acquired ability of matureand maturing persons to know and meettheir continuous requirements for deliberate,purposive action to regulate their ownhuman functioning and development.
The person who engages in the course ofaction or has the power to engage in acourse of action.
Maturing adolescents or adults whoaccept and fulfill the responsibility to knowand meet the therapeutic self-caredemand of relevant others who are sociallydependent on them or to regulate thedevelopment or exercise of these persons’self-care agency.
A relationship between the humanproperties of therapeutic self-care demandand self-care agency in which constituentdeveloped self-care capabilities within self-care agency are not operable or notadequate for knowing and meeting some orall components of the existent or projectedtherapeutic self-care demand.
The developed capabilities of personseducated as nurses that empower them torepresent themselves as nurses and withinthe frame of a legitimate interpersonalrelationship to act, know, and help personsin such relationships to meet theirtherapeutic self-care demands and toregulate the development or exercise oftheir self-care agency.
A professional function performed bothbefore and after nursing diagnosis andprescription to which nurses, on the basis ofreflective practical judgments aboutexistent conditions, synthesize concretesituational elements into orderly relations tostructure operational units.
A helping method from a nursingperspective is a sequential series of actions,which, if performed, will overcome orcompensate for the health associatedlimitations of persons to engage in actions toregulate their own functioning anddevelopment or that of their dependents.
Health-associated action limitations:a. Acting for or doing for anotherb. Guiding and directingc. Providing physical or psychological supportd. Providing and maintaining an environmentthat supports personal developmente. Teaching
Series and sequences of deliberatepractical action of nurses performed attimes in coordination with actions of theirparents to know and meet components oftheir patients’ therapeutic self-caredemands and to protect and regulate theexercise or development of patients’ self-care agency.
BASIC NURSING SYSTEMSNurseActionWHOLLY COMPENSATORY SYSTEMAccomplishes patientstherapeutic self-careCompensates for patients inabilityto engage in self-careSupports and protect the patient
NurseActionPARTIALLY COMPENSATORY SYSTEMPatientActionPerforms some self-care measuresfor patientCompensates for self-carelimitations of patientsAssists patients as requiredPerforms some self-care measuresRegulates self-care agencyAccepts care and assistance fromnurse
NurseActionSUPPORTIVE-EDUCATIVE SYSTEMPatientActionAccomplishes self-careRegulates the exercise anddevelopment of self-care agency
DEFINITION OF MAN, HEALTHENVIRONMENT AND NURSING• Human beings are very much different fromother living organisms in terms of theircapacity.• Human functioning is an integrated systemcomprised of physical, psychological,interpersonal, and other aspects• Individuals have the potential to bedeveloped and learned.
• Orem support’s the World HealthOrganization’s definition of health.• Orem presents health based on preventivehealthcare. This model of health careincludes the promotion and maintenance ofhealth, the treatment of disease or injury,and the prevention of complications.
• Orem’s shows her view of the surroundingenvironment as an external source ofinfluence in the internal interaction of aperson’s different aspects.
• According to Orem, nursing is helping toestablish or identify ways to perform self-care activities.• Further, Orem defines nursing as a humanservice.• She added that nursing is based on values.
IMPLICATIONS OF THE THEORY TO THENURSING COMMUNITY• The first documented use of Orem’s theoryas the basis for structuring practice is foundin descriptions of nurse-managed clinics atJohn Hopkins Hospital in 1973.
• Research articles on the use of SCNDT orcomponents in clinical practice includeteaching self-care to individuals withdiabetes mellitus, cardiac research, end-stage renal failure, hemodialysis andperitoneal dialysis, renal transplant, painassessment, and cancer management.• Occupational health nursing and elderlycare also base their practice in SCDNT
• In addition to the use of the theory for thesesclinical populations, it has been used in avariety of healthcare settings.• SCDNT helps assist graduate nurses incombining their school teachings with theirnursing work that occurs after graduation.• Orem’s theory has been also used todescribe and define various roles for nurseswithin multiple settings.
• There are a number of reports in theliterature describing the use of SCDNT as thebasis for the curriculum.• At least 45 schools of nursing use SCDNT asthe basis for their curriculums.
• The Sinclair School of Nursing, University ofMissouri at Columbia that used SCDNT as theframework for curriculum and teachingsince 1978.• Oakland University, College of St. Benedictand Anderson College are three schoolsdesigned with curricula designed withinSCDNT.
• The first instrument to measure the exerciseof self-care agency (ESCA) was published in1979.• The SCDNT was the conceptual frameworkfor Kearney and Fleisher’s ESCA in 1979,DSCAI in 1980, and Hanson and Bickel’sPerception of Self-Care agency in 1981.
• The SCDNT was a pivotal construct in thedesign of the Self-As-Career Inventory (SCI).• The Appraisal of Self-Care Agency (AAA)scale was developed to measure the coreconcept of Orem’s SCDNT. The researchinstruments used most frequently include theDSCAI, DSCPI, ASA, and SCI. Other includeMaieutic Dimensions of Self-Care AgencyScale (MDSCAS) and Moore and Gaffney’sDCA questionnaire.