Orem theory

1. BAHIR DAR UNIVERSITY
COLLEGE OF MEDICINE AND HEALTH SCIENCES
SEMINAR PRESENTATION ON :- Orem’s self care deficit Theory
Advisor – Gebrie.Y ( Asst professor, PHD fellow)
JUANUARY , 2012
Bahirdar, Ethiopia
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2. Group memebers
Name ID
1. Sahilu Mitiku 07012PR
2. Gerbrie Kassaw 07008PR
3. Melsew Dagne 07010PR
4. Dessie Temesgen 07006 PR
5. Berihun Bantie 07002PR
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3. Presentation Out line
Background of the Theorist
Introduction of the theory
Major Concepts and Definitions
Principles of the theory
Importance of the theory
Major Assumptions
Metaparadigm in Nursing
Application of the theory
• References
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4. Objectives
Up on the compilation of this lesson the students will able
to
 explain the fundamental principles, assumptions of
Orem's self care theory
 Identify the main components of the theory
 Analyze the strength and limitation of the theory
 Apply the theory concepts on your clinical as well as
teaching experience .
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5. Self-Care Deficit Theory of Nursing
By Dorothea Orem (1914-2007)
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Orem's self care theory

6. Background of the theorist
Biography
• was born (July 22, 1914) in Baltimore, Maryland.
• Obtained her Diploma in Nursing in 1934 at the
Providence Hospital School of Nursing In
Washington D.C.
• In 1939 and 1945 she finished B.S. Nursing
Education ( BSN Ed.) and MSN Ed successively in
Catholic University of America, Washington
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7. Awards -
• 1976- honorary doctorate degree of science from
Georgetown University
• 1980 – honorary doctorate from in Camate world
collage
• 1998-doctors honors causea, university of Missouri
,Colombia
• an assistant professor of nursing education at of
Catholic University America (CUA)
• Received the most prestigious nursing award
from Sigma Theta Tau International in 1997.
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8. Career
• She worked as a staff nurse, private duty nurse, nurse
educator ,nurse administrator and nurse consultant.
• Director of the providence hospital school of nursing
in Detroit , Maryland
• In 1971 she first published her book titled, “Nursing:
Concepts of Practice”. The 2nd, 3rd, 4th, 5th, and 6th
editions were published in 1980, 1985, 1991, 1995,
and 2001 respectively..
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9. Her publications
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10. Origin of the theory
• Dorothea Orem’s general theory of nursing evolved
over a period of four decades from individual work and
through collaboration with students, practitioners,
researchers, educators, administrators, and scholars.
• She began her work by looking for the uniqueness of
nursing. How was it different from other disciplines?
How was it similar? This search for distinctive nursing
knowledge was directed toward answering one
question, “
• What is the domain and what are the boundaries of
nursing as a field of practice and a field of knowledge?
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11. Conti--
• What meaning can and should nurses attach to
persons, things, events, conditions, and
circumstances they encounter?”
• After reflecting upon her own nursing
experiences, Orem says the answer came to
her as a “flash of insight, an understanding that
the reason why individuals could benefit from
nursing was the existence of self care
limitations”.
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12. Introduction to the theory
Orem’s self-care deficit theory involves
around the concept of self care
Orem’s theory has been called
self care deficit theory of nursing, general
theory of nursing
self care deficit nursing theory, and
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13. Theory parts ,concepts and definitions'
Orem's self care deficit theory considered as a grand
theory of nursing, is one of the most widely used
models in nursing today.
includes three interrelated theory:
 Theory of self care
 Theory of self care deficit
 Theory of nursing system
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14. Conti– concepts
Self care deficit theory of Nursing is composed
of six basic concepts.
• Self care, self care agency, therapeutic self care
demand, self care deficit are related to the
patient or the person in need of nursing,
• whereas nursing agency and Nursing system
are related to the nurses and their action (Potter
A Patricia, Perry G Anne (1992)
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15. 1. Theory of Self-Care: Major Concept
 Focus on self care that a person performs
independently to him/her self or their dependant's to
maintain health .
A ) self – care
• Is the performance or practice of activities that
individuals initiate and perform on their own behalf
to maintain life, health, and wellbeing.
• Self-care is learned through interpersonal relations
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16. Conti--
B) Self-Care Agency-
The human’s acquired powers and capabilities
to engage in self-care
The ability to engage in self-care activities are
influenced by “Basic Conditioning Factors (
age, educational status, health status,
enviromental factors.
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17. Conti-
C) Therapeutic Self-Care Demand
• is the totality of self care actions needed be
performed for some duration in order to meet self care
requisites by using valid methods and related sets of
operations and actions.
• Is modeled on deliberate action that is intentional
performed by some members .
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18. Conti--
D) Self-Care Requisites-
• An additional concept that defines it as the reasons for
which self-care activities occur
• These are the self-care needs categorized into three
distinct requirements:
a. Universal Self-care Requisites
b. Developmental Self-care Requisites
c. Health Deviation Self-care Requisites
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19. A. Universal self care requisites/ADLs
 Associated with life processes and the
maintenance of the integrity of human
structure and functioning
Common to all; activities of daily living
Identifies these requisites as:
• Maintenance of sufficient intake of air ,water,
food
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20. B. 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
• It includes life cycle changes like intrauterine
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21. C. Health deviation self care requisites
• 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
 Learning to live with effects of pathologic conditions.
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22. 2.Theory of Self-Care Deficit
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23. Theory of Self-Care Deficit: Major
Concepts
• Is the basic element of the general theory of self-care
• It delineates WHEN nursing is required.
• Nursing is required when adults or parents for their
child are incapable of providing continuous effective
self-care.
• If there are more demands than abilities (Self-Care
Agency), nursing is needed.
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24. Conti --
Nurse can help patient recover from Self-Care deficit by
five methods of helping:
• Acting for and doing for others
• Guiding and directing
• Providing physical and psychological support
• Providing and promoting an environment that supports
personal development
• Teaching
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25. 3. Theory of Nursing Systems
• Describes how the patient’s self care needs will be met
by the nurse , the patient, or both.
• Orem recognized that specialized technologies are
usually developed by members of the health profession
• Identifies 3 classifications of nursing system to meet the
self care requisites of the patient:-
 Wholly compensatory system
 Partly compensatory system
 Supportive – Educative system
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26. Conti--
Types of
Nursing
Systems
Definitions Example
Wholly
Compensato
ry
Is represented by the
situation in which the
individual is unable to carry
out needed self-care actions,
Patients under coma,
anesthesia, with
fractures
spinal dysfunctions,
Partly
Compensa
tory
when the patient and nurse
are both physically active in
meeting the patient’s self-
care needs
Patients with major
surgeries, and temporal
limitation of physical
activity by casting
Supportive
Educative
Represented by the person
has the capability to perform
independently .
In either case, the person
needs some manner of
assistance
Clients wishing to
know
about contraceptive
Methods, counseling
on breast feeding
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27. Conti--
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28. Conceptual framework of the
theory
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29. Three Steps by Orem versus Nursing
Process
Nursing
process
Orem’s self care theory
ASSESMENT Step 1- collect information on 06 areas of assessment ( The
persons health status, the persons perspective of his health
, the persons health goals in the context of , the persons
requirements , the persons capacity/ agency/ , medical
problem and plan,
NURSING
DIAGNOSIS,
PLANNING
Step 2. design nursing system that is wholly or partly
compensatory or supportive education, plan for
therapeutic self care demand
Implementation
Evaluation
Step 3. A nurse assists a patient or family in self care
matters
 actions are identified based on etiologic component on
nursing matters
 evaluation of the plan.
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30. Principles of the theory
• These statements are foundational to theory and serve
as the basis for theory testing and theoretical
application to practice
Principles self –care Theory
Self-care is intellectualized as a human regulatory
function
Its concreteness is directed and deliberate that is
responsive to persons’ knowing of how human
functioning and development .
Self care that is performed over time can be
understood (intellectualized)
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31. Principles of self –Care Deficit Theory
 Persons who take action to provide their own
self-care or for dependents have specialized
capabilities for action
 The individual‘s abilities to engage in self care or
dependent care are conditioned by age,
developmental status, health status etc..
 Nursing is a legitimate service
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32. Principle of Nursing system theory
• Nurses relate to and interact with persons who
occupy the status of nurse’s patient.
• Nurses determine valid and reliable solutions for
meeting self care requests.
• The action of nurses and patients constitute nursing
system.
• Nurses and patients act together to allocate in the
production and in the regulation of patients’ self
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33. Major assumptions of orem’s theory
Orem (1991) described several sets of general
assumptions
• People should be self-reliant and responsible for their
own care and others in their family needing care.
• People are distinct individuals.
• Nursing is a form of action – interaction between two
or more persons
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34. conti…
• Successfully meeting universal and development self-
care requisites is an important component of primary
care prevention and ill health.
• A person’s knowledge of potential health problems is
necessary for promoting self-care behaviors.
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35. Meta-paradigm
Person (Man):
• Man is the total being who can function
biologically, symbolically and socially….
• Man is self-reliant and responsible for self-care
and wellbeing of his or her dependents.
• Man is a logical organism with rational powers.
• patient is an individual who is in need of
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36. Conti-
Nursing
• is art, a helping service, and a technology
• Actions deliberately selected and performed by
nurses to help individuals or groups under their care
to maintain or change conditions in themselves or
their environments.
• Encompasses patient, physicians and nursing
perspectives of patient condition
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37. Conti,…
• Encompass a wide range of nursing agency
• Goal of nursing – to render the patient or
members of his family capable of meeting the
patient’s self care needs.
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38. Conti-
Health
• State of wholeness or integrity of the
individual human beings, his parts,
and his modes of functioning
• This concept is inherent in her
nursing systems since the goal in
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39. Conti-
Environment
• Encompasses the elements external to man but she
considered man and environment as an integrated
system related to self-care.
• Environment components are enthronement factors,
elements, conditions, and developed environment
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40. Strengths and Limitations Orem's Theory
Strengths
 It provides a comprehensive base to nursing practice
 Specifies when nursing is needed and expanded her
focus of individual self care to include multi person
units
 has utility on the nursing practice ,nursing curricula
,nursing education administration ,and nursing
research
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41. Limitation
• In general system theory a system is viewed as a single
whole thing while Orem defines a system as a single
whole, thing.
• Although the family, community and environment are
considered in self care action, the focus is primarily on
the individual.
• Health is often viewed as dynamic and ever changing
• Appears that the theory is illness oriented rather with
no indication of its use in wellness settings.
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42. Importance of the theory
A) Nursing practice
• Many articles document the use of the self-care theory
as a basis for clinical practice.
• Orem’s self-care deficit theory has been used in the
context of the nursing process
B) education
• Orem’s self-care deficit theory has been the focus of
the curriculum in nursing education at many schools of
nursing.
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43. conti
C) Research
• The self-care theory provided conceptual
framework for many researches.
Ex
 Self-care requirements for activity and rest:
an Orem nursing focus
 Orem's theory in practice. Hospice nursing
care
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44. Applying Orem’s self-care deficit
theory of nursing to continence care

45. Base line data
Name- Demeke Ambachew
Age- 30 years old
Sex- Male
Occupation- Farmer
Marital status- married
Religion- orthodox Christian
Dx. – Tibular Fracture
Theory applied- Orem’s theory

46. Case history
• He came to Debre-tabor general hospital with
complaints of pain, loss of function ,deformity
of extremity, oedema on right lower leg after
sustaining crashing force accident .
• He was apparently healthy before this injury.
• He was unable to do ADL by him-self after
injury

47. Assessment using Orem's model
1) Heath care status the patient
• Health status –acutely ill due to fracture
• Socio-cultural orientation- no formal education
• Health care system- institutional health care
• Family system- married, farmer and lead the home
• Patterns of living- at home with partner
• Environment- rural area, items for activity of daily
living not easy

48. 2) Universal self care requisites
• Air- breath without difficulty
• Water- fluid intake sufficient
• Food- loss appetite , non nutritious food intake
• Elimination- Can void, but assisted
• Activity/rest- Impaired activity, rest is required
due to pain, deformity over there
• Social interaction- communicates well, good
• Prevention of hazards- needs counsel on bed
rest, on diet, on immobilization

49. 3) Developmental self-care requisites
Maintenance of developmental environment
 sociable, able to communicate
Impaired performance of daily activity
Disturbed self image
Free of any risk personal behaviors.
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50. 4) Health deviation self care requisites'
• Adherence to medical regimen- he needs continuity of
care and cooperates with the medicines
• Not much aware about the treatment options for his
problem
• Not aware about the side effect of the management
• Needs counseling about body self image modification
until healing

51. 5) Medical problem and plan
• medical diagnosis- right leg tibular fracture
• medical Treatment- immobilization using cast
application, anti-pain( Tramadol 50 mg Iv TD)
• Supportive therapy- Physiotherapy and
Nutritional

52. 6. Areas of inadequacy ( self care demand and
agency
• Food Intake –Imbalanced
• Elimination- assisted elimination
• Activity- frequent rest is required, activity level has
come down , pain is not completely removed
• Activity of daily living- impaired
• stress and coping- He feels stressed.
Self care agency/ ability - inadequate
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53. Nursing diagnosis
• Altered self care activity related to injury of
the arm and leg
• Acute pain related to fracture
• Disturbed body self image related to injury .
• Lack of knowledge about disease condition
re/to patient verbalization

54. Outcome and plan
The patient needs whole compensatory care
such as
Relieve pain,
Improve dieting
Improved nutrition
Improve self image
• Method of helping
Teaching , counseling
Treating
Immobilizing him for short period of time .

55. Implementation
• Teaching
• Treating pain
• Assisting in dress, bath, toileting,
• Immobilizing the patient with cast…

56. Evaluation
• The pt. understood importance the best
treatment options
• The patients self image improves
• The patients self care activities improved.
• He verbalized that “I will take proteinous diet”
• He stated that relative pain free period

57. Acknowledgment
• Our deepest gratitude and appreciation goes to
our instructor Gebre. y( Asst professor, PHD
fellow ) for his excellent teaching skill &
guidance on the course theoretical foundation
of nursing and for giving this chance to present
nursing theory
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58. Summary
• Orem describes nursing as a creative effort of
one human being to help another human being
• Orem’s general self care deficit theory of
nursing has three interrelated theories.
• The general Self care deficit theory is
composed of six basic concepts
• Orem’s theory is applied in various models of
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59. References
• Alligood, M.R. & Tomey, A.M.
(2010).Nursing Theory Utilization and
Application(4th ed.).St. Louis, Missouri:
Mosby.
• George, J. B. (2011).Nursing theories: The
base for professional nursing practice(6thed.)
Boston: Pearson
• Parker, M. (2001).Nursing Theories and
Nursing Practice. Philadelphia: F. A. Davis.
• Taylor, S.G. (2006). Dorthea E. Orem: Self-
care deficit theory of nursing
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