Orem Theory

Prepared by
Chanak Trikhatri
5
Dorothea Elizabeth Orem’s
Self Care Theory
02/07/16 1Chanak

Background of Theorist
One of the foremost Nursing Theorist of the world,
Dorothea E. Orem was born on 1914 at Baltimore,
Maryland.
Her father was a construction worker, And her
mother is a home maker
She was the youngest among two daughters
She died in June 22, 2007.
02/07/16 2Chanak

Education
She started her nursing education by joining at the
Providence Hospital School of Nursing In Washington
D.C. in studied Diploma level of Nursing on early 1930’s
She completed her B.S. in Nursing Education on 1939
From Catholic University of America, Washington D.C.
she had finished her MSN degree on 1945.
She received Honorary Doctorates: Doctors of Science
degree from Georgetown University Washington D.C. on
1976
02/07/16 3Chanak

Honored Award
Orem was decorated with several national award including
 Catholic University of America’s Alumni Achievement
awarded Orem, for her contributation Nursing Theory in
1980.
 Orem was received her second honorary doctor of science
award, by Incarnate Word College 1980.
 Doctor of humane letter, Illinois Wesleyan University, 1988
 Linda Richards award, National League for Nursing, 1991
 Honorary fellow of the American Academy of Nursing, 1992
02/07/16 4Chanak

Experience in Nursing
She involved in nursing practice, nursing service and nursing
education
During her professional nursing career, she has worked as a
staff nurse, private duty nurse, nurse educator, nurse
administrator and nurse consultant.
Occupied important nursing positions, like the directorship of
both the nursing school and the department of nursing at
Providence Hospital, Detroit (1940 to 1949)
02/07/16 5Chanak

Orem work for seven years at the Division of Hospital and
Institutional Services of the Indiana State Board of Health
(1949-1957), Where she was aimed to upgrade the quality
of nursing in general hospitals throughout the state.
During this time, Orem developed her definition of
nursing practice.
In 1957 Orem moved to Washington, D.C., where she was
employed by the office of education, U.S. department of
health, education, and welfare,[HEW] as a curriculum
consultant from 1958 to 1960.
02/07/16 6Chanak
Experience in Nursing Cont…

•While at HEW she worked on Orem participated in a
project to improve practical [vocational] nurse
training.
•This works stimulated her to consider the question,
“what condition exists in a person when that person
or others determine that that person should be nursing
care ?”
•Her answer encompassed the idea that a nurse is
“another self.”
02/07/16 7Chanak

This evolved into her nursing concept of “self care.”
That is, when able, individuals care for themselves.
When the person is unable to provide self care, then the
nurse provides assistance.
In 1959, Orem’s concept of nursing as the provision of
self care was first published.
In 1959, Orem became an assistant professors of nursing
education at the catholic university of America.
02/07/16 8Chanak

She subsequently served as acting dean of the school of
nursing and as associate professor of nursing education.
She continued to develop her concept of nursing and self care
In that period she wrote THE HOPE Of NURSING [1962],
which was published in the journal of nursing education.
In 1965,she joined with several faculty members from the
Catholic University of America to form a Nursing Model
Committee.
In 1968, a portion of the NMC ,including Orem, continued
their work through the nursing development conference group
[NDCG]
02/07/16 9Chanak

This group was formed to produce a conceptual framework for
nursing and to establish the discipline of nursing.
Orem’s further developed her nursing concept of self care and
in 1971 published Nursing : Concept of Practice.
This was followed by concept formalization in nursing :
process and product [1972]
Subsequent editions of nursing concept of Practice were
published in 1980, 1985, 1991 and 1995
Orem retired in 1984 and resides in Savannah, Georgia, where
she enjoy reading, travelling, consulting, and attending nursing
conferences to discuss her theory.
02/07/16 10Chanak

She participates in conferences and prepares papers
about various conceptual elements of the theory.
Her first edition focused on the individual.
The second edition was expanded to include multi
person units [families, group, and communities]
The third edition has evolved to present Orem's general
theory of nursing which is constituted from three related
theoretical construct
1.The Theory of Self care
2.The Theory of self care deficit
3.The Theory of nursing system
02/07/16 11Chanak

Major Assumption
The Theory was formalized in the early 1970s and were
first presented at Marquette University School of Nursing
in 1973 Orem identifies the five premises underline the
general theory of nursing
1.Human being require continuous deliberate input to them
selves and their environment to remain alive and function
in accord with natural human endowments
2.human agency, the power to act deliberately, is exercised
in the form of care of self and others in identifying needs
for and in making needed inputs
02/07/16 12Chanak

Major Assumption Cont……
3. Mature human beings experiences privations in the form
of limitation for actions in care of self and others
involving and making of life- sustaining and function.
4. Human agency is exercised in discovering, developing
and transmitting to others ways and means to identify
needs for and make inputs to self and other
5. Groups of human beings with structured relationship
cluster tasks and allocate responsibility for providing care
to group members who experience privations for making
required deliberate input to self and other
02/07/16 13Chanak

Orem’s General Theory of Nursing
According to Orem, “nursing has as its special concern
the individual's need for self-care action and the
provision and management of it on a continuous basis
in order to sustain life and health, recover from disease
or injury, and cope with their effects.” She develops her
general theory of nursing in three related parts.
1. The Theory of Self care
2. The Theory of self care deficit
3. The Theory of nursing system
02/07/16 14Chanak

The Theory of Self Sare
The theory of self care includes self care, self care agency
and therapeutic self care demand as well as self care
requisites.
Self care is the “practices of activities that individual
initiates and perform on their own behalf in maintaining
life, health and wellbeing.”
Self care agency – it is a human ability which is “the
ability to perform self care.” -conditioned by age
developmental state, life experience sociocultural
orientation , health and available resources.
02/07/16 15Chanak

The theory consists of four components
1.Self-care is the "practice of activities that individuals
initiate and perform on their own behalf in maintaining
life, health, and well-being." "Self-care…. effectively
performed contributed in specific ways to human structural
integrity, human functioning and human development.“
2.Self-care agency is a human ability, which is "the ability
for engaging in self-care." "The individual's abilities to
engage in self-care are conditioned by age, developmental
state, life experience, sociocultural orientation, health, and
available resources.”
02/07/16 16Chanak
The Theory of Self Care Cont

The therapeutic self-care demand is the “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 or requirements can be defined as
actions directed toward provision of self care. [action or
measure used to provide self care]. Orem’s present 3
categories of self care requisites
1 Universal
2 Developmental
3 Health deviation
02/07/16 Chanak 17
The Theory of Self Care Cont

Universal self care requisites are associated with life
processes and the maintenance of the integrity of
human structure and functioning. They are common
to all human beings during all stages of the life cycle
and should be viewed as interrelated factors, each
affecting the others. Such as
The maintenance of a sufficient intake of air
The maintenance of a sufficient intake of water
The maintenance of a sufficient intake of food
02/07/16 18Chanak
Universal Self Care Requisites

02/07/16 19Chanak
The provision of care associated with elimination
processes and excrements
The maintenance of a balance between activity and rest
The maintenance of a balance between solitude and social
interaction
The prevention of hazards to human life human
functioning and human well-being
The promotion of human functioning and development
within social groups in accord with human potential, known
human limitation, and the human desire to be normal.
Universal Self Care Requisites Cont..

Developmental Self Care Requisites
Developmental self care requisites are specialized
universal self care requisites that results from
maturation or new requisites that develop as a
result of a condition or event such as adjusting to
the loss of a spouse, adjusting to a new job, or
adjusting to body changes such as facial lines or
gray hair.
02/07/16 Chanak 20

Health Deviation Self Care
Health deviation self care is required in conditions
of illness, injury or disease or may result from
medical measures required to diagnose and correct
the condition. E.g. right upper quadrant abdominal
pain when greasy foods are eaten, or learning to
walk using crutches following the casting of a
fractured leg.
Health deviation of self care requisites are
 Seeking and securing appropriate medical
assistance
02/07/16 Chanak 21

Health Deviation Cont..
 Being aware of and attending to the effects and results of
pathologic condition and states
 Effectively carrying out medically prescribed measures. Being
aware of and attending to or regulating the discomforting or
deleterious effects
 Modifying the self concept [and self image] in accepting
oneself as being in a particular state of health and in need of
specific forms of health care
 Learning to live with the effects of pathological conditions and
states and effects of medical diagnostic and treatment
measures in a life style that promotes continued personal
development02/07/16 Chanak 22

The Theory of Self Care Deficit
 The theory of self care deficit is the core of Orem’s general theory
of nursing because it delineates when nursing is needed
 When an adult is incapable or limited in the provision of continuous
effective self care
 Nursing may be provided if the “care abilities are less than those
required for meeting a known self care demand [or] self care or
dependent care abilities exceed or are equal to those required for
meeting the current self care demand but a future deficit relationship
can be foreseen because of predictable decrease in care abilities,
qualitative or quantitative increases in the care demand, or both.”
 The individual needs help “ in recovery from disease or injury, or in
coping with their effects.”
02/07/16 23Chanak

The Theory of Self Care Deficit Cont..
Orem identifies five methods of helping, these are –
1.Acting for or doing for another
2.Guiding another
3.Supporting another [physically or psychologically]
4.Providing an environment that promotes personal
development in relation to becoming able to meet present or
future demand s for action
5.Teaching another
Note - Nurse may help individual by using any or all of these
methods to provide assistance with self care
02/07/16 24Chanak

Orem presents a model to show the relationship
between her concepts. From this model it can be seen
that at a given time an individual has specific self
care abilities as well as self care demand. If there are
more demand than abilities, nursing is needed. Orem
identified five areas of activity for nursing practice
1.Entering into and maintaining nurse patient
relationship with individual, families or groups until
patients can legitimately be discharged from nursing
02/07/16 Chanak 25

2. Determining if and how patients can be helped through
nursing
3. Responding to patient requests, desires and needs for
nurse contacts and assistance
4. Prescribing providing and regulating direct help to
patient and their significant others in the form of
nursing
5. Coordinating and integrating nursing with the patient’s
daily living, other health care needed or being received,
social and educational services needed or being
received
02/07/16 26Chanak

The Theory of Nursing System
The nursing system, designed by the nurse, is based
on the self care needs and abilities of patient to
perform self care activities. Orem has identified 3
classification of nursing system
These are
1.Wholly compensatory system
2.The partly compensatory system
3.The supportive educative system
02/07/16 28Chanak

These systems are the wholly compensatory system, the
partly compensatory system, and the supportive-educative
system. The design and elements of the nursing system
define;
1. The scope of nursing responsibility in health care situation
2. The general and specific roles of nurses and patients
3. Reasons for nurses relationship with patients
4. The 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 therapeutic
self care demand
02/07/16 30Chanak
The Theory of Nursing System Cont..

Wholly Compensatory Nursing System
The wholly compensatory nursing system is
represented by a situation in which the individual is
unable “to engage in those self care actions requiring
self directed and controlled ambulation and
manipulative movement or the medical prescription to
refrain from such activity person with these limitation
are socially dependent on others for their continued
existence and well being
02/07/16 Chanak 31

Wholly compensatory system are nursing systems for people
who are
1.Unable to engage in any form of deliberate action for
example, person in coma
2.Aware and who may be able to make observations, judgments
and decisions about self care and other matters but can not or
should not perform actions requiring ambulation or
manipulative movements
3.Unable to attend to themselves and make reasoned judgments
and decisions about self care and other matters but who can be
ambulatory and may be able to perform some measures of self
care with continuous guidance and supervision
02/07/16 Chanak 32
Wholly Compensatory Cont….

Partly Compensatory Nursing System
The partly compensatory nursing system is represented by a
situation in which “both nurse and patient perform care
measures or other actions involving manipulative tasks or
ambulation…..[either] the patient or the nurse may have the
major role in the performance of care measures.”
 E. g. an individual who has had recent abdominal surgery.
 This patient might be able to wash his or her face and brush
teeth but needs the nurse for help in ambulating and in
changing the surgical dressing
02/07/16 Chanak 33

Supportive Educative System
The third nursing system is the supportive educative
system. In this system the patient is doing all of his
self care and the “patient’s requirements for help are
confined to decision making, behavior control, and
acquiring knowledge and skills.”
The nurse’s role, then is to promote the patient as a
self agent
E.g. a sixteen year old who is requesting birth control
information
02/07/16 Chanak 34

 Orem states that “one or more of the three types [of systems] may be used
with a single patient
 E.g. a women in a labor may move from a supportive-educative system in
early labour to a partly compensatory system as her labor advances
 If she require a cesarean delivery, her care might require her to be in a
wholly compensatory system
 She would then progress to a partly compensatory system as she recovers
from the anesthetics
 Later, as she prepares to go home, a supportive educative system would
again be appropriate
02/07/16 Chanak 35
Supportive Educative System Cont..

Nursing Metaparadigm for Orem’s
PERSON
Human beings are distinguished from other living
beings by their capacity to:
Reflect upon themselves and their environment
Symbolize what they experience
Use symbolic creations (ideas, words) in thinking,
communicating, and guiding efforts to make things
that are beneficial for themselves and/or for others
02/07/16 36Chanak

The Person is recipient of nursing care. Integrated human functioning
includes physical, psychological, interpersonal, and social aspects.
Individual has the potential for learning & development
The way an individual meets his or her self care needs is not
instinctual but is a learned behavior. Has a capacity for self-
knowledge
Can engage in deliberate actions, interpret experiences, and perform
beneficial actions
Can learn to meet self-care needs (requisites), If for some reason, the
person can not learn self care measures, other must provide the care .
Factors that affect learning are age , mental capacity, culture, society,
and emotional state of individuals.
02/07/16 37Chanak

ENVIRONMENT
Environment consists of environmental factors, environmental
elements [not defined by Orem]. Environmental Conditions -
external physical & psychosocial surroundings.
Developmental Environment:- Promotion of personal
development through motivation to establish appropriate goals
& to adjust behavior to meet those goals; concludes formation
of or change in attitudes and values, creativity, self-concept
and physical development. Environment can positively or
negatively impact a person’s ability to provide self-care
02/07/16 38Chanak

HEALTH
Orem’s supports WHO definition of health as the state
of physical, mental, and social well-being and not
merely the absence of disease or infirmity
She states physical, psychological, interpersonal and
social aspects of health are inseparable in the
individual.
Health includes promotion and maintenance of health,
treatment of illness, and prevention of complication
02/07/16 39Chanak

NURSING
In modern society, adults are expected to be self reliant and
responsible for themselves and for wellbeing of their dependents.
Most social groups further accept that person who are helpless, sick,
aged, handicapped or deprived should be helped to attain or regain
responsibility within their existing capacities.
Thus, both self help and help to others are valued by society as
desirable activities
Nursing as a specific type of human service is based on both values.
In most communities people see nursing as a desirable and
necessary service.
02/07/16 40Chanak

Art of Nursing
 Orem speaks about the Nursing: the art and prudence of nursing, nursing
as a service, role theory related to nursing, and technology in nursing
 It includes making a comprehensive determination of the reason why
people can be helped through nursing.
 This decision require a theoretical base in nursing disciplines and in
sciences, art, and humanities.
 Nursing prudence is the quality of nurses that enables them
1. To seek and take counsel in new or difficult nursing situation
2. To make correct judgment
3. To decide to act in a particular way and
4. To take action
 The development of individual nurse’s art and prudence is affected by
unique life and nursing experiences.
02/07/16 41Chanak

Human Service
A mode of helping men, women, and children and not
tangible commodity.
It is a deliberate action, a function of the practical
intelligence of nurses, to bring about humanely desirable
conditions in person and their environments
nursing is distinguished from other human services
The specialized abilities that enables nurses to provide
nursing care to individual or multiperson units when
conceptualized as a unit is termed nursing agency
02/07/16 42Chanak

Role Theory Related to Nursing
The nurse’s and the patients roles define the expected
behavior for each in the specific nursing situation
Factors that influence the expected role behaviors are
culture, environment, age, sex, the health setting and
finances
Roles of nurses and patient are complimentary, i.e.
certain behaviors of the patient elicits a certain response
in the nurse and vice versa. Both work together to
accomplish the goal of self care
02/07/16 43Chanak

Technologies in Nursing
A technology is systematized information about a
process or a method for affecting some desired result
through deliberate practical endeavor, with or without
a use of materials and instruments
Two categories of technologies used in nursing are
social or interpersonal technologies and regulatory
technologies.
02/07/16 44Chanak

Social and Interpersonal Technology
Communication adjusted to age and developmental state, to
health state, and to sociocultural orientation
Bringing about and maintaining interpersonal, intragroup, or
intergroup relations for coordination of effort
Bringing about and maintaining therapeutic relations in light
of psychosocial modes of functioning in health and disease
Giving human assistance adapted to human needs and action
abilities and limitation
02/07/16 45Chanak

Regulatory Technologies
Maintaining and promoting life process
Regulating psycho physiological modes of functioning in
health and disease
Promoting human growth and development
The effective integration of social and interpersonal
technologies with regulatory technologies promotes quality
professional nursing.
02/07/16 46Chanak

Orem’s Theory and Nursing process
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.
Orem emphasizes that the technological component
"must be coordinated with interpersonal and social
processes within nursing situations
02/07/16 47Chanak

The steps of Orem’s nursing process
Step 1-the initial and continuing determination of why a person
should be under nursing care
Step 2- the designing of a system of nursing and planning for the
delivery of nursing according to the designed system
Step 3- the initiation, conduction and control of assisting action
to
a.Compensate for the patients self care limitations
b.Overcome when possible self care limitation
c.Foster and protect the patient’s self care abilities
02/07/16 48Chanak

Comparison of Orem's Nursing Process and the
Nursing Process
02/07/16 49Chanak

Application of Orem’s Nursing
Process
Situation
Ms M. a well groomed university faculty member of Italian
Catholic descent, is 48 years old, 5 feet 2 inches, and weighs 175
pounds.
She smoke 1 and ½ packs of cigarettes per day. She was very
happily married for 25 years and has been widowed for six month.
She and her husband enjoyed social activities, including playing
bridge, collecting antiques.
She has not participated in any of these activities since her
husband’s death because of lack of interest and energy.
Currently, she engages in no regular exercise, eats mainly fast-food
during her 12 hour working day, and eats a late evening meal before
retiring.02/07/16 Chanak 50

Situation
Ms. M’s mother died of a stroke and her father had a heart
attack at age 50. during her annual physical 2 weeks ago, her
vital signs were 138/86, P -92, R- 30, T-98.4.
Her laboratory values were all with in normal limits except a
blood cholesterol of 280mg.
 Her physician advised her to loss 40 pounds, but recognize
that she has inadequate knowledge of basic nutrition and has
not been motivated to lose weight.
She foresees potential problems related to cardiovascular
disease.
02/07/16 Chanak 51

Step 1
Specific data are gathered in the areas of individuals universal,
developmental, and health deviation self care needs and their
relationship.
Once the data have been gathered, they must be analyzed.
Analyzing Ms. M’s data: in the category of universal self care
needs, Ms. M demonstrates a deficit in adequate air, water,
and food intake –she is 5’2’’, weight 175 pounds, consumes
excessive calories and cholesterol from fast food and late night
meals.
Ms M shows imbalance between activity and rest since she has
minimal exercise.
02/07/16 Chanak 52

There is also an imbalance between her solitude and social
interaction since her husband’s death
This represents a significant loss for her in the mid life
developmental needs category.
Ms M’s elevated cholesterol levels when interrelated with her
family history of stroke and heart attack present a hazard to
her life, functioning, and well being
Physician gave advise to loss weight 40 pounds
She has limited nutritional knowledge
She has motivational deficit to lose weight because her Italian
cultural tradition associates food with family and love.
02/07/16 53Chanak
Step 1 Cont…

Based on the analysis of data, she has potential hazards to her
health related obesity, high cholesterol, smoking , social
isolation and decreased exercise
Prioritize the self care deficit
Formulate nursing diagnosis and must include response and
etiology pattern.
Within Orem’s frameworks the nursing diagnosis would be
stated as an inability to meet the self-care demand[ response]
related to self care deficit
E.g potentials for impaired cardiovascular functioning
related to lack of knowledge about how her current life
style increases her risk heart attack and stroke
02/07/16 54Chanak
Step 1 Cont…

Step 2
The goals are congruent with the nursing diagnosis enabling
the patient to become an effective self care agent
The goal for Ms M. would be – decrease her risk of
cardiovascular impairment
Once the goals have been determined, the objectives can be
stated e.g. Ms M. will state that high cholesterol levels
increase her risk for cardiac impairment
Other objectives might relate to the risk factors of obesity,
lack of exercise, smoking, and family history.
 The designed nursing system for Ms M. would be the
supportive –educative nursing system
02/07/16 Chanak 55

Step 3
Etiology component - lack of knowledge about how her current
life style increases her risk heart attack and stroke when nurse and
patient implement this supportive educative system, each has
specific roles e.g. together they would develop contract that would
relate to the goal of cholesterol reduction
Ms M. keep a 3 day food diary
The nurse would provide information about cholesterol and its
effect on cardiovascular function.
The nurse would provide information about specific foods that are
low in cholesterol, those food items that help reduce cholesterol ,
and a list of fast food restaurant that offer low cholesterol food items
Together they analyze 3 day food diary and decide how Ms. M.
modify her diet to reduce her cholesterol intake

02/07/16 Chanak 56

They will determine which Italian dishes are low in cholesterol
or how these recipes can be adopted
 During this implementation, the nurse teaches, guides, and
supports Ms. M. while providing a developmental environment
Includes evaluation- together do the evaluation
Question might ask are – does she understand that her present
life style may increase her risk of developing a heart attack or
stroke ?
Did she select low cholesterol fast foods ?
Did she attain her goal of reducing her cholesterol levels ?
Evaluation is an on going process. It is essential that the nurse
and patient continually evaluate any changes in the data that
would affect the self care deficit, self care agent, and the nursing
system.
02/07/16 57Chanak
Step 3 Cont….

Characteristics of a Theory
 Theories can interrelate concepts in such a way as to create a
different way of looking at a particular phenomenon
 Theories must be logical in nature
 Theories should be relatively simple yet generalizable
 Theories are the base for hypothesis that can be tested
 Theories contribute to and assist in increasing the general body of
knowledge within the discipline through the research implemented
to validate them
 Theories must be consistent with other validated theories, laws and
principles
 Theories can be used by the practitioners to guide and improve their
practice
02/07/16 62Chanak

Relevance of Orem’s Theory Nursing
Education
The second stage of development - the nursing models
committee at the Catholic University of America.
Guidelines for developing Curriculum for the Education of
Practice Nurses (1959)
Number of reports- Basis for the curriculum.
At least 45 schools of nursing are known to use this theory
Taylor (1985)- described the use of the theory in pre-service
nursing education and in teaching
First articulated in 1950’s
02/07/16 63Chanak

Nursing Education Contd….
Formalized and published in 1972 for the purpose of “laying
out the structure of nursing knowledge and explicating the
domains of nursing knowledge”
Sinclair School of Nursing University of Missouri at Columbia
since 1978
Some Nursing schools in the United States
Useful in developing and guiding practice, research, and
education
Used at all levels of the curriculum as well as continuing
education and elective undergraduate course
02/07/16 64Chanak

Nursing Education Contd….
Useful in designing curricula for pre-service,
graduate, and continuing nursing education
Give direction to nursing and nurse-specific
outcomes
Indicates most of the skills, techniques and methods
that an individual must learn to become a nurse
practitioner
02/07/16 65Chanak

Nursing Profession
 The first documented use of Orem’s theory - Johns Hopkins
Hospital in 1973
 Variety of age groups
 Number of ethnically and culturally diverse populations
 Variety of clinical populations
o Endocrinology
o Nephrology
o Oncology
o Psychiatry and Mental Health
o Cardiology and Pulmonology
o Pain Management
o Occupational Health Nursing
o Neurology
02/07/16 66Chanak

Nursing Profession Contd…
The Vancouver Health Department - Designing community
population
Newark Beth Israel - Structure the delivery of nursing and the
documentation system
Binghamton General hospital- Orientation process for their new
graduate nurses
Future uses- User friendly intuitive computerized information
systems
Define and describe various roles for nurses within multiple
settings
o Clinical nurse specialist role
o Management role
o Administrative role
02/07/16 67Chanak

Teaching this theory to multi-skilled workers and nurse aides
Use of this theory in the development of clinical measurement
approaches
Horn and Swain- developed criteria measures of nursing care
Number of other clinical instruments have been developed based
on this theory
o Moore and Gaffney , 1989 - the dependent Care Agent (DCA)
o Hayward et. Al. - Kidney Transplant Recipient Stress scale
(KTRSS)
o Appraisal of self care Agency (ASA) scale
02/07/16 68Chanak

Translated into Italian, French, Spanish, Dutch and
Japanese
 Practitioners of nursing use of Orem’s theory.
Little work on the theory of nursing system
Orem’s theory of nursing systems is also evident in
the current practice
02/07/16 69Chanak

Nursing Research
The research related to or derived from Orem's theory
can be classified as relating to:
Development of research instruments for measuring
the conceptual elements of the theory
Studies the test element of theory in specific
populations.
First instrument – exercise the self-care agency
(ESCA), (Kearney & Fleisher's 1979)
DSCAI (Denye's Self Care Agency Instrument) –
1980
02/07/16 70Chanak

Nursing Research Contd….
 Hanson and Bickel's Perception of Self Care Agency – 1981
 Self-As-Carer Inventory (SCI)
 Comparative analysis of above mentioned instruments -
McBride
 Results supported the multidimensionality of Orem's concept
of self care agency.
 Appraisal of Self-Care Agency (ASA), (Diabetes Self-Care
Practice Instrument) DSCPI (McCaleb and Edgil ), SCI,
Maieutic Dimensions of Self Care Agency Scale (MDSCAS)
02/07/16 71Chanak

Critique
1. Clarity
The terms used by Orem are precisely defined.
The language of the theory is consistent with the
language used in action theory and philosophy.
There are no created words
The terminology of the theory is congruent throughout.
The term self care has multiple meanings across
disciplines
Orem has defined the term and elaborated the substantive
structure of the concept in a way that is unique but also
congruent with other interpretation .
02/07/16 72Chanak

2. Simplicity
 Orem’s general theory comprise 3 constitute theories, that of
self care, self care deficit, and nursing system.
 Self care deficit theory of nursing is a synthesis of knowledge
about the theoretical entities self care ( and dependent care ),
self care agency (dependent care agency), therapeutic self care
demand, the relational entity self care deficit and nursing
agency.
 The entity nursing system is also included
 The development of the theory using these six entities is
parsimonious.
 The relationship between among these entities can be
presented in a simple diagram
02/07/16 73Chanak
Critique Contd…

3. Generality
Orem herself commented on the generality or universality of
the theory
The self care deficit theory of nursing is not an explanation of
the individuality of a particular concrete nursing practice
situation, but rather the expression of a singular combination
of conceptualized properties or features common to all
instances of a nursing.
As a general theory, it serves nurses engage in nursing
practice, in development and validation of nursing knowledge
and in teaching and learning nursing
A review of the research and other literature attests to the
generality of theory
02/07/16 74Chanak
Critique Contd…

4. Empirical precision
Orem’s theory has been used for research using both
qualitative and quantitative methodologies.
The theoretical entities are well define and lend themselves to
being measurable ; however, instrument have not been
develop for all of the entities, for e.g. nursing agency
Furthermore the values of the theoretical entities are not
constant across population
The most appropriate methods of inquiry for this theory, as
well as for all nursing theories, are yet to be determine
The beauty of Orem’s theory lies in the scope, complexity,
and clinical usefulness; it is useful for generating hypotheses
and adding to body of knowledge i.e. nursing
02/07/16 75Chanak
Critique Contd…

5. Derivable consequences
The SCDNT differentiates the focus of nursing from other
disciplines
While other disciplines find the theory of self care helpful and
contributes to its development, the theory of nursing system
provides unique focus for nursing
There is ample evidence in the literature that the theory is
useful in developing and guiding practice and research
It gives direction to nursing- specific outcomes related to
knowing and meeting the therapeutic self care demands,
regulating the development and exercise of self care agency ,
establishing self care and self management system, and others.
02/07/16 76Chanak
Critique Contd…

The theory is also useful in design of curriculum for pre service,
graduate and continuing nursing education
The theory also gives direction to nursing administration
The development of theory base computer system, assessment form
and the over all structuring of the delivery of care attests to the
usefulness of the theory
The significance of Orem’s work extends far beyond the
development of the SCDNT
In her works she has provided us with the expression of the form of
nursing sciences as practical science, with a structure for on going
development of nursing knowledge in the stages of development of
theory
She has presented a visionary view of contemporary nursing
practices, and knowledge development expressed through the
general theory.
02/07/16 77Chanak
Critique Contd…

Strengths of Orem’s Theory
The theory of nursing provides a compressive base for nursing
practice. It has utility of professional nursing in the areas of
nursing education curricula, clinical nursing practice ,nursing
administration ,and nursing research .
A major strength of Orem's theory is that she specifies when
nursing is needed.
She also includes counting education as part of the
professional component of nursing education .
Theory promotes the concepts of professional nursing ,so she
defines the roles of vocational ,technical, professional nurses,
and recognizes the importance of each besides that ,she also
emphasizes nurse are educated ,not trained .
02/07/16 78Chanak

Her self care premise is contemporary with the concepts of
health promotion and health maintenance. self care in Orem
‘s theory is comparable to holistic health in that both
promote the individual ‘s responsibility for health care it is
relevant with today’s emphasis on early hospital discharge,
home care ,and out patient services .
Orem has expanded her focus of individual self care to
include multiperson units (families , groups , and community
). she recognizes the value of family members and
significant others for the individual’s provision of self care
02/07/16 79Chanak
Strengths of Orem’s Theory Contd…

Orem ‘s theory to be more clinically applicable when
more than one system is used currently .
Orem recognizes the term “client” as regular seeker of
services but prefer the term “patient “one who is
under the care of nurses, physicians ,or other direct
health care providers .
 Orem defines a system as a “single” ,whole thing. in
general system theory , a system viewed as a dynamic
flowing process .
 Health is often viewed as dynamic and ever-changing
02/07/16 80Chanak
Strengths of Orem’s Theory Contd…

Limitations of Orem’s Theory
The ambiguity of applying theory to nursing practice may lie in the fact
that one theory does not always specifically support all aspects of
nursing care
 Orem’s self care deficit theory may not encompass all aspects of care
and needs of a specific client. For e.g. having an unclear definition of
family, the nurse-society relationship and public education areas are
weak.
 These issues are essential in the management and treatment plan in
caring for patients. Although the family, community and environment
are considered in self care action, the focus is primarily on the individual
(Balabagno, et.al, 2006).
 Another limitation is the definition of health as being dynamic and ever
changing with states ranging from health or non health, wellness or
illness (Fitzpatrick JJ, 2005). This definition of health directly
contradicts the experience of some patients with varying needs and
levels of care requirements.
02/07/16 81Chanak

Limited recognition of an individual’s emotional needs is
present within the theory (George JB., 1995).
It focuses more on physical care and gives lesser emphasis
to psychological so, there is a limited acknowledgement of
the emotional needs of humans
There are no self created words
There is no clarification e.g. diagnosis, prescription,
technologist, and other therapeutic self care deficit
demands
02/07/16 82Chanak
Limitations of Orem’s Theory Cont..

The term self care is used with Nemours connections, this
multitude of terms ,such as self care , self care agency ,self
care demand ,self care premise ,self care deficit, and
universal self care can be confusing to read
When third edition was published in1985, some of her
references could be out dated . for e.g. articles many of the
journals in her lists of selected reading are from the 1960
are not accompanied by companion or articles from the
1980s
02/07/16 83Chanak
Limitations of Orem’s Theory Cont..

Summary
Orem’s general theory of nursing is composed of three
constructs self care, self care deficit and nursing
system. It has utility for professional nursing in the
areas of nursing practice nursing curricula, nursing
education administration, and nursing research. Health
is often viewed as dynamic and ever changing.
Orem’s visual presentation of the boxed nursing
systems implies three static conditions of health.
Appears that the theory is illness oriented rather with
no indication of its use in wellness settings.
02/07/16 84Chanak

References
George, B. Julia (1990), Nursing Theories The base for
professional Nursing Practice (3rd edn). Norwalk,
Appleton & Lange. 91-110
George, B. Julia (2011), Nursing Theories The base for
professional Nursing Practice (6rd edn). Norwalk,
Appleton & Lange. 91-110
Tomey, A. M.(1998).Nursing Theorist and Their Work.
(4th
edn). Mosby Year Book, St. Louis. 175-187
02/07/16 87Chanak

Orem Theory

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (8)

Similar to Orem Theory

Similar to Orem Theory (20)

More from Chanak Trikhatri

More from Chanak Trikhatri (9)

Recently uploaded

Recently uploaded (20)

Orem Theory