OREMS self care deficit THEORY for nursing students

PHILOSOPHY AND
THEORIES OF NURSING:
Dorothea Orem’s Theory
of Self Care
3/20/2024
D.Elakkuvana Bhaskara Raj

Conceptual Framework and
Model
3/20/2024
 Conceptual framework: simply a group of
related concepts. It provides an overall view or
orientation to focus thoughts.
 “Conceptual frameworks act as general
guidelines for practice, research, curricula, and
administrative systems (Nicoll, 1999, p. 490).

3/20/2024
 Conceptual model: synonymous to conceptual
framework, system, map, or scheme but is a
graphic illustration of the Conceptual
framework.
 Conceptual models- made up of concepts and
propositions.

3/20/2024
 A conceptual model "gives direction to the
search for relevant questions about the
phenomena of central interest to a discipline
and suggests solutions to practical problems"

Conceptual Models
3/20/2024
Examples :
 Betty Neuman – developed the systems model
for nursing
 Sister Callista Roy – used the adaptation
model for nursing
 Dorothy Johnson – made the behavioral
system model
 Annie Boykin & Savina Schoenhofer –
constructed the nursing as caring: a model for
transforming practice

Theory
3/20/2024
“is an organized, coherent set of concepts and
their relationship (proposition) to each other
that offers, descriptions, explanation, and
predictions about the phenomena” (Parker M,
2001, p. 4).
 Theory- a set of related statements that
describes or explains phenomena in a
systematic way.

Theory in Nursing
3/20/2024
 Nursing theory is a conceptualization of some
aspect of reality (invented or discovered) that
pertains to nursing. The conceptualization is
articulated for the purpose of describing,
explaining, predicting or prescribing nursing
care. (Meleis,1997).

Metaparadigm
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 The term metaparadigm comes from the
Greek prefix "meta," which means more
comprehensive or transcending, and the word
Greek word "paradigm," which means a
philosophical or theoretical framework of a
discipline upon which all theories, laws, and
generalizations are formulated (Merriam-
Webster’s Collegiate Dictionary, 1994).

Dorothea Orem [1914 – June 22, 2007
]
3/20/2024

Dorothea Orem
3/20/2024
Born in Baltimore, Maryland.
One of America’s foremost nursing theorists.
Father was a construction worker
Mother was a homemaker.
Youngest of two daughters.

Dorothea Orem
3/20/2024
 Early 1930’s - AD from Providence School of
Nursing, Washington, D.C.
 1939 – BSN completed
 1945 - MS in nursing education
 1958 - consultant to the Office of Education
where she began working on her SELF-CARE
THEORY

3/20/2024
 1959 - first published her theory in “Guides for
Developing Curricula for the Education of
Practical Nurses” (a government publication)
 1976 - honorary Doctorate of Science from
Georgetown University
 1999 - last edition of her theory was published

Nursing Experience
3/20/2024
Early nursing experience included operating
room nursing, private duty nursing (in home
and hospital), pediatric and adult medical and
surgical units, evening supervisor in the
emergency room, and biological science
technician.
1940-1949 Orem held directorship of both
nursing school and the department of nursing
at Providence Hospital in Detroit.

Origins of the Model
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 Orems’ quest for greater understanding of
 the nature of nursing focused on three
 questions:
 What do nurses do, and what should nurses
 do, as practitioners of nursing?
 Why do nurses do what they do?
 What are the results of nursing interventions?

Orem’s General Theory of
Nursing
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Each person has a need for self care in order
to maintain optimal health and wellness.
Each person possesses the ability and
responsibility to care for themselves and
dependants.
Model is separated into three conceptual
theories which include: self care, self care
deficit and nursing system.

Universal
Self care
needs
Self care
abilities
Health care demands and human
ability
• The idea of balancing demands and abilities is central to Orems
model.

Universal
Self care
needs
Health
deviation
Self care
abilities
Health-deviation self-care requisites
• Individual still able to meet requisites

Universal
Self care
needs
Health
deviation
Self care
abilities
Health-deviation self-care requisites
• Individual unable to meet requisites

Orem’s General Theory of
Nursing
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 Orem’s general theory of nursing in three
related parts:-
 Theory of self care
 Theory of self care deficit
 Theory of nursing systems

Theory of Self Care
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 Self care – practice of activities that individual
initiates and perform on their own behalf in
maintaining life ,health and well being
 Self-care comprises those activities performed
independently by an individual to promote and
maintain personal well-being throughout life.

3/20/2024
 Self care agency – is a human ability which
is "the ability for engaging in self care"
 Conditioned by age developmental state, life
experience socio cultural orientation health and
available resources
 Definition: the individual’s ability to perform self-
care activities
 Consists of TWO agents:
 Self-care Agent - person who provides the self-care
 Dependent Care Agent - person other than the
individual who provides the care (such as a parent)

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 Therapeutic self care demand – "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-action directed towards
provision of self care.
 Orem’s Self-care Requisites (also called Self-
care Needs)

3/20/2024
 3 categories of self care requisites are:--
 Universal
 Developmental
 Health deviation
 Definition: the actions or measures used to
provide self-care
 Consists of THREE categories:
 Universal - requisites/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 & disease or its treatment

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Universal self care requisites
1. Associated with life processes and the
maintenance of the integrity of human structure and
functioning
2. Common to all , ADL
3. Identifies these requisites as:
4. Maintenance of sufficient intake of air ,water,
food
5. Provision of care assoc with elimination process
6. Balance between activity and rest, between
solitude and social interaction
7. Prevention of hazards to human life well being

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Developmental self care requisites
 Associated with developmental processes/
derived from a condition…. Or associated with
an event
 E.g. adjusting to a new job
 adjusting to body changes

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Health deviation self care
 Required in conditions of illness ,injury, or
disease These include:--
 Seeking and securing appropriate medical
assistance
 Being aware of and attending to the effects and
results of pathologic conditions
 Effectively carrying out medically prescribed
measures
 Modifying self concepts in accepting oneself as
being in a particular state of health and in specific
forms of health care
 Learning to live with effects of pathologic
conditions

Theory of self care deficit
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 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 environment promoting personal
development in relation to meet future demands
 Teaching another

Nursing Systems
3/20/2024
“ A continuing series of actions.. That are
directed to meet [the patients] therapeutic self-
care demands or to regulate their self-care
agency” Orem ( 1985)
3 Types of compensatory systems:

Support Modalities
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Total compensatory support encompasses total
nurse care- client unable to do for themselves.
Partial compensatory support involves both the
nurse and the client sharing in the self care
requirements.
Educative/supportive compensatory support
elicits the help of the nurse solely as a
consultant, teacher or resource person. Client
is responsible for their own self care.
A person can fluctuate between support
modalities at any given time throughout life.

Theory of Nursing Systems
3/20/2024
 Describes how the patient’s self care needs
will be met by the nurse , the patient, or both
 Identifies 3 classifications of nursing system to
meet the self care requisites of the patient:-
 Wholly compensatory system
 Partly compensatory system
 Supportive – educative system

Orem’s Theory & Nursing’s
Metaparadigm - PERSON
 The recipient of nursing care
 A being who functions biologically, symbolically,
and socially
 Has the potential for learning & development
 Is subject to the forces of nature
 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)

Metaparadigm - 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

Orem’s Theory & Nursing’s Metaparadigm -
ENVIRONMENT
 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
 Can positively or negatively impact a person’s
ability to provide self-care

Metaparadigm - NURSING
 A service geared towards helping the self and
others
 Is required when self-care demands exceed a
patient’s self-care ability (agency)
 Promotes the patient as a self-care agent
 Has several components

Metaparadigm - NURSING
 ROLE THEORY: the role of the nurse & patient are
complementary as they work together to achieve
self-care
 SPECIAL TECHNOLOGIES:
 Social & Interpersonal technologies -
communicating, coordinating, establishing &
maintaining therapeutic relations, rendering
assistance
 Regulatory technologies - maintaining and
promoting life processes, growth/development, and
psycho-physiologic modes of functioning

Metaparadigm - HEALTH
 Supports health promotion and health
maintenance
 Supports the premises of holistic health in that
both RN and patient promote the individual’s
responsibility for self care

Orem’s Key Contribution To
Nursing
 The continued evolution of original
ideas to further delineate nursing
practice, functions, self-care needs,
and nursing systems based on
research.

Nurse’s Role
The nurse’s role in helping the client to achieve
or maintain a level of optimal health and
wellness is to act as an advocate, redirector,
support person and teacher, and to provide an
environment conducive to therapeutic
development.

Application of Theory To Nursing
Process
Orem’s theory of self-care is applied to many
undergraduate nursing curricula.
The nursing care plan is one example of how
her theory of self-care can be applied to nursing
process

Orem’s Theory and Nursing
Process
3/20/2024
 Orem’s approach to the 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

Comparison of Orem’s Nursing
Process and the Nursing Process
3/20/2024
 Nursing Process
 Assessment
 Nursing diagnosis
 Plans with scientific rationale
 Implementation
 evaluation
 Orem’s Nursing Process
 Diagnosis and prescription ;determine why nursing is
needed. analyze and interpret –make judgment
regarding care
 Design of a nursing system and plan for delivery of care
 Production and management of nursing systems

3/20/2024
 Step 1-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

3/20/2024
 Step 2
 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

3/20/2024
 Step 3
 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.

Exampl
es
3/20/2024
Personal factors Universal self care Developmental self
care
Health deviation Medical problem &
plan
Self care deficits
29 yr.
Female
Early adulthood
transition
32pack /yr
Water-no restrictions
Food –nil
Wt89lb
Wt loss-19%
Nauseated
Teenage pregnancy-2
OC-10 yrs
Husband emotionally
away
Seeks medical
attention for overt s/s
Aware of disease
No evidence
8th grade
Teenage pregnancy
No work
Married
Child-2
Urinary retention
Intermittent self
catheterization
Pain
No BSE
Infrequent physical
examination
No HRT
Poor health
ability to manage
effects
Surgery on
reproductive organs
Difference between
knowledge base &
lifestyle

3/20/2024
Therapeutic self care demand Adequacy of self care agency Nursing diagnosis Methods of helping
Air
Maintain effective respiration
Water
No problem
Food maintain sufficient intake
Inadequate
Adequate
Inadequate
Potential for impaired
respiratory status
P F fluid imbalance
Actual nutritional deficit r/t
ausea
Guiding & directing
Teaching
Providing physical support
Hazards
Prevent spouse abuse
Promotion of normalcy
Inadequate
Inadequate
P/F injury
A/d in environment
Shared housing
Personal development
Guiding & directing
Guiding & directing

Strengths
3/20/2024
 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
 Also includes continuing education as part of
the professional component of nursing education
 Her self care approach is contemporary with
the concepts of health promotion and health
maintenance
 Expanded her focus of individual self care to
include multiperson units

Limitations
3/20/2024
 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 .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

Summary
3/20/2024
Orem’s general theory of nursing is
composed of three constructs .Throughout her
work ,she interprets the concepts of human
beings, health, nursing and society .and has
defined 3 steps of nursing process
It has a broad scope in clinical practice and
to lesser extent in research ,education and
administration

Case Study 1
Bedridden oncology patient arrives via
ambulance for chemotherapy. Family insists
upon keeping patient at home; however, leaves
patient alone with nurse in chemo clinic for
treatment. Patient requires O2 at 2L/min,
continuous tube feeding at 90cc hour, foley
catheter, bedpan. Nurse in clinic administers
chemo premeds and chemo; changes dressing
around g-tube due to leaking; administers O2 at
2L; empties Foley at end of treatment; places
patient on bed pan one time.

Case Study 1
 The wholly compensatory system
accomplishes the client’s therapeutic self-care,
compensates for the client’s inability to
participate in their self-care, provides support
and protects the client.

Case Study 2
 The partly compensatory system has a give
and take system in between the nurse and the
client. The nurse performs, compensates for
limitations, regulates and assists the client as
needed. The client participates in some self-
care procedures, regulates and accepts care
and assistance from the nurse.

Case Study 3
Newly diagnosed diabetic patient received diabetic care
teaching while in hospital. Now, patient visits module and
reports highly variable BS/chemstrip readings. Nurse
suspects patient may be performing procedure
incorrectly. Nurse assesses that patient has been cutting
some of his chemstrips in half to save money.
Additionally, nurse assesses that patient's wife (who
does family cooking) did not receive any nutritional
education while patient was hospitalized.
Nurse begins nutritional counseling and provides wife
with referral to nutritional services department.

Case Study 3
 The supportive-educative role indicates that
the client is participating in most of their self-
care, and the nurse’s role is simply to monitor
and regulate the client’s self-care.

References
Hartweg, D.L. (1995). Dorthea Orem: Self-care deficit
theory. In C.M.
Kalisch, P. A. & Kalisch, B.J. (1987). The Changing
Image of the Nurse. Menlo Park, CA: Addison-
Wesley Publishing Company.
Mayo, A. (1997). Professional nursing web site.
Retrieved October 31, 2006 from
http://members.aol.com/annmrn/nursing_portfolio_I_index
.html
McQuiston & A.A. Webb (Eds.), Foundations of nursing
theory: Contributions of 12 key theorists (pp. 139-202).
USA: Sage Publications Inc.

References
Orem, D.E. (1991). Nursing: Concepts of practice (4th
ed.). St. Louis, MO: Mosby-Year Book Inc.
Taylor, S.G. (2006). Dorthea E. Orem: Self-care deficit
theory of nursing. In A.M.
Tomey, A. & Alligood, M. (2002). Significance of theory
for nursing as a discipline and profession. Nursing
Theorists and their work. Mosby, St. Louis, Missouri,
United States of America.
Whelan, E. G. (1984). Analysis and application of
dorothea orem’s self-care practuce model. Retrieved
October 31, 2006 from
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retri
eve&db=Pubmed&list_uids=6094754&dopt=Abstract

Group presentation
 Brief over view about theorist
 How meta paradigm are defined
 What are the main concepts
 Diagrams, map, model
 Is there a relationship (how it guide nursing
 Application in the nursing practice give
examples

OREMS self care deficit THEORY for nursing students

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