related to Nursing

1. DorotheaElizabethOrem’s
Self-CareDeficitTheoryof Nursing

2. Objectives
 Biography ofTheorist
 DevelopmentofTheory
 TheoreticalSources
 MajorAssumptions
 Majorconceptsanddefinitions
 Orem’sgeneraltheoryofnursing
 Meta-paradigm concepts
 Strengths/limitations
 Orem’stheoryappliication

3. DOROTHEAOREM: Whoisshe???
 Shewasborn(July22,1914)in
Baltimore,Maryland, U.S.
 Father :construction,fishing
 Mother: homemaker,reading
 Youngestoftwogirls
 Died:June22,2007

4. Education
Degrees:
 Diploma(1930's),ProvidenceHospitalSchoolofNursing,Washington
DC
 BSNEd.(1939)andMSN Ed.(1945),CatholicUniversityofAmerica,
WashingtonDC.
HonoraryDoctorates:
 DoctorofScience(1976)GeorgetownUniversity,(1980)IncarnateWord
CollegeinSanAntonio,Texas
 DoctorofHumaneLetters(1988)IllinoisWesleyanUniversity,
Bloomington,Illinois(US).
 DoctorofNursingHonorisCausae,(1998)UniversityofMissouri-
Columbia

5. SpecialAwards
 CatholicUniversityofAmerica AlumniAchievementAwardfor
NursingTheory (1980).
 Linda RichardsAward,NationalLeagueforNursing(1991).
 HonoraryFellowoftheAmericanAcademy ofNursing(1992).

6. NursingExperience
 Herclinicalpracticeincluded staffnurseintheoperatingroom,
paediatricsandadultmedical/surgical units.
 Shealso did private-dutynursinginprivatehomesandthehospital
andwasanemergencyroomsupervisor.
 Shetaughtbiologicalsciencesandlaterservedas directorofnursing
service anddirectoroftheschoolofnursingatProvidenceHospital.

7. Development ofTheory
 1949-1957 Orem workedfor theDivisionofHospital andInstitutionalServices
of theIndianaStateBoardofHealth.Hergoalwastoupgrade thequalityof
nursingingeneralhospitals throughout thestate.During thistimeshe
developedherdefinitionof nursingpractice.
 1958-1960 U.SDepartmentof Health,Education andWelfare whereshe help
publish “GuidelinesforDevelopingCurricula fortheEducation ofPractical
Nurses”in1959.

8. Development ofTheory
 1959Orem subsequently(later) servedasactingdeanof theschool of Nursing
andasanassistantprofessor of nursingeducation atCUA. Shecontinuedto
developherconceptof nursingandselfcareduring thistime.
 In1971shefirst published herbooktitled,“Nursing: Conceptsof Practice”.
The2nd,3rd,4th,5th,and6theditionswere published in1980,1985,1991,
1995,and2001respectively.
 Continuestodevelophertheoryafterherretirementin1984

9. HerThoughts
 Whatisnursing?”
 “Whatisthedomainandwhatare theboundariesofnursingasa
field ofpracticeandafield ofknowledge?”
 Orem(citedinFawcett2005)commentedthatthetaskrequired
identificationofthedomainand boundariesofnursingasascience
andanart(1978).

10. TheoreticalSources
Mentorship:
 Eugenia.K.Spaulding asagreatfriendandteacher.
Experience:
 Orem saysherideasareprimarilytheresultofreflecting upon herexperiences
andshewasnotinfluencedbyanyoneperson (Hartweg,1991).
 Workofothers:
 Nightingale,Abdellah,Henderson, King,Levine,Hall,andmanyother
nursingtheorists.
 Manyauthors from otherdisciplines.

11. MajorAssumptions
 Peopleshould beself-reliant andresponsible for theirown care andothers in
their familyneedingcare.
 Peoplearedistinctindividuals.
 Humansareuniqueindividualsthatare separatedfrom eachotherandfrom
their environment.
 Nursing isaform ofaction –interactionbetweentwoormorepersons.
 Nursing isa deliberatehelpingactionsperformed bynurses for thebenefits
of othersoveracertainperiodof time.

12. MajorAssumptions
 Successfully meetinguniversalanddevelopmentself-care requisites(necessity)
isanimportantcomponentofprimary carepreventionandillhealth.
 Aperson’sknowledgeof potentialhealthproblemsisnecessaryfor promoting
self-care behaviors.
 Selfcare anddependentcare arebehaviorslearnedwithinasocio-cultural
context (through human communication andinteractionwitheachother.)

13. MAJORCONCEPTSANDDEFINITIONS
OREM’SGENERALTHEORYOFNURSING

14. Orem’sGeneral TheoryofNursing
 ThreeMajorTheoriesbyOrem:
1. Theoryofselfcare Theory
 “WhatismeantbySC?”
2. Theoryofselfcare deficit Theory
 “Whennursingisneeded?”
3. NursingsystemTheory
 “Howtheself-careneedsaremet?”

15. Theory #1:Self-CareTheory
 Basedontheconceptsof:
 SELF-CARE
 SELF-CAREAGENCY
 SELF-CAREREQUISITES
 THERAPEUTICSELF-CAREDEMAND

17. Theory#1:Self-CareTheory
ThistheoryIncludes:
 Self–care:- istheperformanceorpracticeofactivitiesthatindividuals
initiateandperformontheirownbehalftomaintainlife,healthandwell-
being.
 Whenself-careiseffectivelyperformed,ithelpstomaintainstructural
integrityandhumanfunctioningandcontributestohuman
development.

18. Theory #1:Self-CareTheory
 Selfcareagency:- Selfcare agencyisthehuman’sabilityorpower toregulate
their ownhuman functioning anddevelopment.
 Consists oftwo agnets:
 Self-care agents:personwho providestheself-care
 Dependantcareagents:personotherthantheindividualwho provides the
care(such asaparent)
 Selfcare abilitiesare influencedbyage,lifeexperience&socio cultural
background andavailableresources..

19. Theory#1:Self-CareTheory
 Therapeutic selfcare demand:-
 "totalityofselfcareactionstobeperformedforsomedurationin
ordertomeetselfcarerequisitesbyusingvalid methodsandrelated
setsofoperationsandactions“

20. Theory #1:Self-CareTheory
 Selfcarerequisites:- actiondirectedtowardsprovisionofselfcare.
 Three categoriesofselfcarerequisitesare:
Universalselfcarerequisites
Developmentalselfcarerequisites
Healthdeviationselfcarerequisites

21. 01.Universalselfcarerequisites
 Thisincludesactivitieswhichareessentialtohealthandvitality.
 Commontoall;activitiesofdailyliving
 Identifiestheserequisitesas:
 Maintenanceofsufficientintakeofair,water,food.
 Provisionofcareassocwitheliminationprocess.
 Balancebetweenactivityandrest,betweensolitudeandsocialinteraction.
 Preventionofhazardstohumanlifewellbeingand
 Promotionofhumanfunctioninganddevelopment.

22. 02.Developmental selfcare requisites
 Morespecific totheprocesses ofgrowth anddevelopmentandare influencedby
whatishappeningduring thelifecyclestages;suchinfluencemaybepositiveor
negative.
 Examples:
 Selfdevelopment:Adjusting tonewjoboradjusting tobodychanges.
 Preventionoflife situationsthatcanadverselyaffect human development.(Loss
of spouse,change inImage, pregnancy)

23. 03.Health deviation selfcare requisites
 Required in conditions of:
 illness, injury, ordisease.
 Changes in humanstructure andfunction, outof normalrange,
 The health deviation self-care requisites areasfollows:
1. Seeking andsecuring appropriatemedicalassistance
2. Being awareofandattendingtothe effects andresults ofpathologic conditions
3. Effectively carrying outmedically prescribed measures

24. 03.Health deviation selfcare requisites
 Modifyingselfconceptsinacceptingoneselfasbeingina particular
stateofhealthandinspecificformsofhealthcare
 Learningtolive witheffectsofpathologicconditions.

26. B.Theoryofselfcaredeficit
 Itisthe centralfocus ofOrem’s generaltheory ofnursing.
 Itdescribesandexplainshow peoplecanbehelpedthrough nursing.
 Nursing isrequired whenadults(or inthecaseofa
 dependent,theparentorguardians) areincapable oforlimited intheir ability
toprovidecontinuouseffective self-care.
 If therearemoredemands(TherapeuticSelf-Care Demands)than
abilities(Self-Care Agency),nursingisneeded.

28. FiveMethodsofNursingHelp
 Oremidentifies5 methodsofhelping:-
1. Actinganddoingforothers
2. Guidinganddirecting
3. Providingphysical orpsychologicalsupport
4. Providinganenvironmentpromotingpersonaldevelopment
5. Teaching

29. Theory#3:TheoryofNursingSystems
 Thisdescribes:
 Howthepatient’sselfcareneedswillbemetbythenurse,thepatient,or
both.
 Nursing responsibilities.
 Rolesofthenurseandpatient
 Rationalesforthenurse-patientrelationship
 Typesofactionsneededtomeetthepatient’sdemands
 Designedbythenurse
 Basedontheassessmentof patient’sabilitytoperform self-care activities.

30. TheNursingAgency Concept
 Acomplex property ofpeople educatedandtrainedasnursesthatenablesthem
toact,toknow,andtohelpothers meettheirtherapeuticself-care demandsby
exercisingordevelopingtheirownself-care agency.

31. Theory#3:TheoryofNursingSystems
 Identifies3classificationsofnursingsystemtomeettheselfcare
requisitesofthepatient:-
Whollycompensatorysystem
Partlycompensatorysystem
Supportive–Educativesystem

32. Whollycompensatory system
 Apatient’sself-careagencyissolimitedthats/hedependsonothersforwell-being.
 Unabletoengageinanyformofaction(e.g.coma).
 Awareandwhomaybeabletomakeobservationsorjudgments,anddecisions
aboutself-carebutcannot/shouldnotperformactionsrequiringambulationand
manipulativemovements(e.g.patientswithC3-C4vertebralfractures).
 Unabletoattendtothemselvesandmakereasonablejudgmentsaboutself-care
butwhocanbeambulatoryandabletoperformsomeself-carewithguidance(e.g.
severelymentallyretarded).

34. PartlyCompensatory
 Apatientcanmeetsomeself-carerequisitesbutneedsanurseto
help meetothers;eitherthenurseorthepatienthave themajorrole
intheperformanceofself-care.
 E.g.a patientwithrecentabdominalsurgery
 Nursecanassistpostoperativeclientto ambulate,Nursecanbringa
meal trayforclientwho canfeedhimself

36. Supportive-educative:
 Apatientcanmeetself-carerequisitesbutneedshelpindecision-
making,behaviorcontrol,orknowledgeacquisition;thenurse’s
roleistopromotethepatientasaself-careagent (
teacher/consultant)
 E.g.a16-year-oldwhoisrequestingbirthcontrolinformation
 Nurseguidesamotherhowtobreastfeedher baby,Counselinga
psychiatricclientonmoreadaptive copingstrategies.

38. Meta-paradigmconcepts
FourMajorConceptsofOrem’sTheory
 Health
 Environment
 Nursing
 Humanbeing/ Person

39. Health
 Healthandhealthyaretermsusedtodescribelivingthings…
 Astatecharacterized bysoundness orwholenessofbodilystructure and
function;illnessisitsopposite.
 Itconsistsof physical, psychological, interpersonalandsocial aspects;these
aspects areinseparable.
 Healthincludespromotion andmaintenanceof health,treatmentofdisease,
andpreventionofcomplications.

40. Environment
 ..Prevailinginternalandexternalconditionsinsometimeandplaceframeof
reference.”
 Encompassedbytwodimensions
 Environmental:physical,chemicalandbiologicfeatures.
 atmosphere,pollutants,weatherconditions,pets,infectiousorganisms,etc.
 Developmental:socioeconomicfeatures
 family&community
 genderandageroles,culturalroles.
 Environmentcanpositivelyornegativelyaffectstheperson’sabilitytoprovideself
care.

41. Nursing
 Nursing–isart,ahelpingservice,andatechnology
 Oremdefinestheartofnursingasanintellectualqualityoftheindividualnurse;this
qualityisrelatedtocreativityaswellasanalysisandsynthesisofinformation,allof
whichcontributetodevelopmentofnursingsystemstoassistindividualsor
multipersonunits.
 Oremfurtherdefinesnursingasahumanservice.
 Nursingisdistinguishedfromotherhumanservicesbyitsfocusonpersonswith
inabilitiestomaintainthecontinuousprovisionofhealthcare.

42. Nursingcont…
 Goal ofnursingis:
torenderthepatientormembersofhisfamilycapable ofmeeting
thepatient’sselfcare needs
tomaintainastateofhealth
toregainnormalornear normalstateofhealthintheeventof
diseaseorinjury
tostabilize,control,orminimize theeffectsofchronicpoorhealth
ordisability

43. Humanbeing/Person
 PersonisdefinedbyOremasthepatient(arecipientofnursing
care)-
 Abeingwhofunctionsbiologically,symbolically,andsociallyand
whohasthepotentialforlearninganddevelopment.
 Personisanindividual, whoiswiththecapacityforselfknowledge,
whocanengageindeliberateaction,interpretexperiences,and
performbeneficialactions

44. Cont,,
 Nursingclient:
 Ahumanbeingwhohas“healthrelated/healthderivedlimitationsthatrenderhim
incapableofcontinuousselfcareordependentcareorlimitationsthatresultin
ineffective/incompletecare.
 Ahumanbeingisthefocusofnursingonlywhenaself–carerequisitesexceedsself
carecapabilities.
 Nursingproblem:-deficitsinuniversal,developmental,andhealthderivedor
healthrelatedconditions

45. Orem’sNursingProcess
 Nursingprocess -Asystemtodetermine:
1.why apersonisundercare
2.aplanforcare
3.theimplementationofcare
 Nursingtherapeutics -deliberate,systematicandpurposeful
action.

46. Strengths
 Providesacomprehensivebasetonursingpractice
 Ithasutilityforprofessionalnursingintheareasofnursingpractice,curricula,
education,administration,andresearch
 Specifieswhennursingisneeded
 Herself-careapproachiscontemporarywiththeconceptsofhealthpromotionand
healthmaintenance
 Expandedherfocusofindividualself-caretoincludemultipersonunits

47. Limitations
 Orem’sdiscussiononhealthis verylimited
 Discussesverylittleaboutthepatientsemotionalneeds(George,
1995,p.120-121)
 Appearsthatthetheoryisillnessorientedratherwithnoindication
ofitsuseinwellnesssettings.

49. OREM’STHEORYAPPLIED

50. TheoryApplication
 Orem’stheorycanbeappliedinClinicalpracticewhile takingcare of
patientwith,
OrganTx
CVA
ICUPatients– Criticallyill,unconscious,FracturePatient,Post
OperativePatient,
 Diabetic,HT,MIPostOperative
Caesarianpop

51. N/CareofpatientwithColostomy
UniversalSelfcarerequisites
 MaintenanceofSufficientair  Ineffective airwayclearance
relatedtoinability toclear
tenacioussecretionsas
manifestedbyabnormalbreath
sounds,low O2saturation

52. Maintenance ofsufficient intake offood
 ImbalancedNutrition:
 Maintenanceof sufficient intake
of water
 Elimination
 Lessthanbodyrequirementrelatedto↓ed
appetiteasmanifestedbywt.loss.
 Deficientfluidvolumerelatedtoexcessfluid
loss,lessintakeoffluidsasmanifestedby
↓edurineoutput.
 Bowelincontinencerelatedtopresenceof
colostomyasmanifestedbyfrequentchange
ofcolostomybag.

53.  Activityand rest
 Preventionofhazards
 ActivityintolerancerelatedtoPostOP
painasmanifestedbyinabilityto
performselfcare Activities.
 Riskforinfectionrelatedto↑ed
susceptibilitytoenvironmental
pathogens.

54.  Maintenanceofbalancebetween
solitudeandsocialinteraction.
 Promotionofhumanfunctioning
anddevelopmentwithinsocial
groups.
 Social isolation related to
diminished social relationships as
manifested byfeeling ofuselessness.
 Ineffective copingrelated to lifestyle
changes stress asmanifested by
inability toexpress feelings of
concerns.

55. Developmental Selfcare requisites
 PromoteDevelopment
 Selfdevelopment
 Disturbed self esteemrelated toaltered body
image asmanifested byverbalization ofnegative
feelings regarding personalappearance.-
 Distributed body image related topresence of
Ostomy.-
 Powerlessness related tosudden change inlife
styleasmanifested byverbalization ofinability to
copewithstress.

56.  HealthDeviationrequisites
 Therapeutic Selfcare demand
 Riskfor impairedskin integrityrto
irritationfrom fecaldrainagearound
peri ostomalarea.
 -Riskfor infection ofthe surgical wound
/relatedtopresence of colostomy.-
 DelayedSurgical recoveryrelatedtoPop
complications.

57. SelfCareDeficit
 SelfCare Deficit  Selfcaredeficitrelatedtoincisionpainas
manifestedbyinabilitytoperformall
activitiesofDailyliving.
 Self-caredeficit:–
 Bathing/hygiene
Dressing/grooming
Feeding/Toileting

58. WhollyCompensatorySystem
 Immediate Post-OPperiodtofirst2days.
 NurseAgencytomeettheself-caredeficitand therapeuticcare
demands.
 Patientfullydependent.
 Post-OPCare – Airway,Fluid&Electrolyte,therapeuticcare,Self
care needs.

59. PartlyCompensatorySystem
 From3rdPop day-7thPopday
 Patientperformsself-careactivitieswithassistance
 Ambulation,SelfSpongebath,grooming
 AcceptstherapeuticcaredemandsfromNurseAgency-
Medicationsand Dressings.

60. Supportive – Educative System:- Discharge phase
 Ineffective therapeuticregimenmanagementrelatedtolackof
Knowledge.
 Knowledgedeficitrelatedtocolostomycare.
 Ostomyself-care
 Dietary& fluidintakeguidelines
 Colostomyirrigation

61. Followupcare
 Patientperformsselfcare activities
 Learntochangecolostomybags
 Gainknowledgeonhomecare