presentation on self care deficit theory

• Dorothea Orem: Self-Care Deficit Theory

Dorothea Orem is a nurse theorist who pioneered the Self-Care Deficit Nursing Theory . Get to know Orem’s biography and works, including a discussion about the major concepts, subconcepts, nursing metaparadigm, and application of Self- Care Deficit Theory.

Table of Contents

Self-care theory, appointments of dorothea orem, works of dorothea orem, awards and honors of dorothea orem, description, assumptions of the self-care deficit theory, environment, self-care agency, basic conditioning factors, therapeutic self-care demand, self-care deficit, nursing agency, nursing system, self-care requisites, universal self-care requisites, theory of self-care deficit, wholly compensatory nursing system, partial compensatory nursing system, supportive-educative system, nursing diagnosis & care plans, implementation & evaluation, analysis of the self-care deficit theory, limitations, recommended resources, external links, further reading, biography of dorothea e. orem.

Dorothea Elizabeth Orem (July 15, 1914 – June 22, 2007) was one of America’s foremost nursing theorists who developed the Self-Care Deficit Nursing Theory , also known as the Orem Model of Nursing .

Her theory defined Nursing as “The act of assisting others in the provision and management of self-care to maintain or improve human functioning at the home level of effectiveness.” It focuses on each individual’s ability to perform self-care, defined as “the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being.”

Dorothea Orem was born on July 15, 1914, in Baltimore, Maryland. Her father was a construction worker, and her mother is a homemaker. She was the youngest among two daughters.

In the early 1930s, she earned her nursing diploma from the Providence Hospital School of Nursing in Washington, D.C. She completed her Bachelor of Science in Nursing in 1939 and her Master’s of Science in Nursing in 1945, both from the Catholic University of America in Washington, D.C.

Dorothea Orem attended Seton High School in Baltimore and graduated in 1931. She received a diploma from the Providence Hospital School of Nursing in Washington, D.C., in 1934. She went on to the Catholic University of America to earn a B.S. in Nursing Education in 1939 and an M.S. in Nursing Education in 1945.

She had a distinguished career in nursing. She earned several Honorary Doctorate degrees. She was given Honorary Doctorates of Science from Georgetown University in 1976 and Incarnate Word College in 1980. She was given an Honorary Doctorate of Humane Letters from Illinois Wesleyan University in 1988 and a Doctorate Honoris Causa from the University of Missouri in Columbia in 1998.

Dorothea Orem’s Self-Care Deficit Theory focuses on each “individual’s ability to perform self-care, defined as ‘the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being.'”  The Self-Care or Self-Care Deficit Theory of Nursing is composed of three interrelated theories: (1) the theory of self-care, (2) the self-care deficit theory, and (3) the theory of nursing systems, which is further classified into wholly compensatory, partially compensatory and supportive-educative. It is discussed further below.

Dorothea Orem occupied important nursing positions, like the directorship of both the nursing school and the nursing department at Providence Hospital, Detroit, from 1940 to 1949, where she also taught biological sciences and nursing from 1939 to 1941. At the Catholic University of America, Orem served as Assistant Professor from 1959 to 1964, Associate Professor from 1964 to 1970, and Dean of the School of Nursing from 1965 to 1966.

She also served as curriculum consultant to The Office of Education, United States Department of Health, Education and Welfare, Practical Nurse Section in 1958, 1959, and 1960, to the Division of Hospital and Institutional Services, The Indiana State Board of Health from 1949 to 1957, and to the Center for Experimentation and Development in Nursing, The Johns Hopkins Hospital, 1969-1971, and to the Director of Nursing, Wilmer Clinic, The Johns Hopkins Hospital, 1975-1976.

She was a group of nurse theorists who presented Patterns of Unitary Man (Humans), the initial framework for nursing diagnosis , to the North American Nursing Diagnosis Association in 1982.

Dorothea Orem helped publish the “Guidelines for Developing Curricula for the Education of Practical Nurses” in 1959.

In 1971 Orem published Nursing: Concepts of Practice, the work in which she outlines her nursing theory, the Self-care Deficit Theory of Nursing. This work’s success and the theory it presents established Orem as a leading theorist of nursing practice and education.

She also served as chairperson of the Nursing Development Conference Group, and in 1973 edited that group’s work in the book Concept Formalization in Nursing.

She authored many other papers and, during the 1970s and 1980s, spoke at numerous conferences and workshops around the world. The International Orem Society was founded to foster research and the continued development of Orem’s nursing theories.

The second edition of Nursing: Concept of Practice was published in 1980. Orem retired in 1984, but she continued to work on the third edition, published in 1985; the fourth edition of her book was completed in 1991. She continued to work on the conceptual development of Self-Care Deficit Nursing Theory.

Orem continued to be active in theory development. She completed the 6th edition of Nursing: Concepts of Practice, published by Mosby in January 2001.

Dorothea Orem was also given many awards during her career: the Catholic University of America Alumni Achievement Award for Nursing Theory in 1980, the Linda Richards Award from the National League for Nursing in 1991, and an Honorary Fellow of the American Academy of Nursing in 1992.

She also received accolades for her contributions to nursing, including honorary degrees from Georgetown University, Incarnate Word College, Illinois Wesleyan University, and the University of Missouri-Columbia.

She was inducted into the American Academy of Nursing and received awards from the National League for Nursing and the Sigma Theta Tau Nursing Honor Society.

Dorothea Orem died on June 22, 2007, in Savannah, Georgia, where she had spent the last 25 years of her life as a consultant and author. She was 92.

Dorothea Orem’s Self-Care Deficit Theory

There are instances wherein patients are encouraged to bring out the best in them despite being ill for a period of time. This is very particular in rehabilitation settings, in which patients are entitled to be more independent after being cared for by physicians and nurses. Between 1959 and 2001, Dorothea Orem developed the Self-Care Nursing Theory or the Orem Model of Nursing. It is considered a grand nursing theory, which means the theory covers a broad scope with general concepts applicable to all instances of nursing.

Dorothea Orem’s Self-Care Deficit Theory defined Nursing as “The act of assisting others in the provision and management of self-care to maintain or improve human functioning at the home level of effectiveness.” It focuses on each individual’s ability to perform self-care, defined as “the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being.”

“The condition that validates the existence of a requirement for nursing in an adult is the absence of the ability to maintain continuously that amount and quality of self-care which is therapeutic in sustaining life and health, in recovering from disease or injury , or in coping with their effects. With children, the condition is the parent’s inability (or guardian) to maintain continuity for the child the amount and quality of care that is therapeutic.” (Orem, 1991)

Dorothea Orem’s Self-Care Theory assumptions are: (1) To stay alive and remain functional, humans engage in constant communication and connect among themselves and their environment. (2) The power to act deliberately is exercised to identify needs and to make needed judgments. (3) Mature human beings experience privations in the form of action in care of self and others involving making life-sustaining and function-regulating actions. (4) Human agency is exercised in discovering, developing, and transmitting to others ways and means to identify needs for, and make inputs into, self and others. (5) Groups of human beings with structured relationships cluster tasks and allocate responsibilities for providing care to group members.

Major Concepts of the Self-Care Deficit Theory

In this section are the definitions of the major concepts of Dorothea Orem’s Self-Care Deficit Theory:

Nursing is an art through which the practitioner of nursing gives specialized assistance to persons with disabilities, making more than ordinary assistance necessary to meet self-care needs. The nurse also intelligently participates in the medical care the individual receives from the physician.

Humans are defined as “men, women, and children cared for either singly or as social units” and are the “material object” of nurses and others who provide direct care.

The environment has physical, chemical, and biological features. It includes the family, culture, and community.

Health is “being structurally and functionally whole or sound.” Also, health is a state that encompasses both the health of individuals and groups, and human health is the ability to reflect on oneself, symbolize experience, and communicate with others.

Self-care is the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health, and well-being.

Self-care agency is the human’s ability or power to engage in self-care and is affected by basic conditioning factors.

Basic conditioning factors are age, gender, developmental state, health state, socio-cultural orientation, health care system factors, family system factors, patterns of living, environmental factors, and resource adequacy and availability.

Therapeutic Self-care Demand is the totality of “self-care actions to be performed for some duration to meet known self-care requisites by using valid methods and related sets of actions and operations.”

Self-care Deficit delineates when nursing is needed. Nursing is required when an adult (or in the case of a dependent, the parent or guardian) is incapable of or limited in providing continuous effective self-care.

Nursing Agency is a complex property or attribute of people educated and trained as nurses that enables them to act, know, and help others meet their therapeutic self-care demands by exercising or developing their own self-care agency.

Nursing System is the product of a series of relations between the persons: legitimate nurse and legitimate client. This system is activated when the client’s therapeutic self-care demand exceeds the available self-care agency, leading to nursing.

The Self-Care or Self-Care Deficit Theory of Nursing is composed of three interrelated theories: (1) the theory of self-care, (2) the self-care deficit theory, and (3) the theory of nursing systems, which is further classified into wholly compensatory , partially compensatory and supportive-educative .

Theory of Self-Care

This theory focuses on the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health, and well-being.

Self-care Requisites or requirements can be defined as actions directed toward the provision of self-care. It is presented in three categories:

Universal self-care requisites are associated with life processes and the maintenance of the human structure and functioning integrity.

• The maintenance of a sufficient intake of air
• The maintenance of a sufficient intake of water
• The maintenance of a sufficient intake of food
• The provision of care associated with the elimination process 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 limitations, and the human desire to be normal

Normalcy is used in the sense of that which is essentially human and that which is in accord with the genetic and constitutional characteristics and individuals’ talents.

Developmental self-care requisites

Developmental self-care requisites are “either specialized expressions of universal self-care requisites that have been particularized for developmental processes or they are new requisites derived from a condition or associated with an event.”

Health deviation self-care requisites

Health deviation self-care requisites are required in conditions of illness, injury, or disease or may result from medical measures required to diagnose and correct the condition.

• Seeking and securing appropriate medical assistance.
• Being aware of and attending to the effects and results of pathologic conditions and states
• Effectively carrying out medically prescribed diagnostic, therapeutic, and rehabilitative measures.
• Being aware of and attending to or regulating the discomforting or deleterious effects of prescribed medical measures
• 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 pathologic conditions and states and the effects of medical diagnostic and treatment measures in a lifestyle that promotes continued personal development

This theory delineates when nursing is needed. Nursing is required when an adult (or in the case of a dependent, the parent or guardian) is incapable of or limited in providing continuous effective self-care. Orem identified 5 methods of helping:

• Acting for and doing for others
• Guiding others
• Supporting another
• Providing an environment promoting personal development about meet future demands
• Teaching another

Theory of Nursing System

This theory is the product of a series of relations between the persons: legitimate nurse and legitimate client. This system is activated when the client’s therapeutic self-care demand exceeds the available self-care agency, leading to nursing.

This 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… Persons with these limitations are socially dependent on others for their continued existence and well-being.”

Example: care of a newborn , care of client recovering from surgery in a post- anesthesia care unit

This is represented by a situation in which “both nurse and perform care measures or other actions involving manipulative tasks or ambulation… [Either] the patient or the nurse may have a major role in the performance of care measures.”

Example: Nurse can assist the postoperative client in ambulating, Nurse can bring a meal tray for a client who can feed himself

This is also known as a supportive-developmental system. The person “can perform or can and should learn to perform required measures of externally or internally oriented therapeutic self-care but cannot do so without assistance.”

Example: Nurse guides a mother on how to breastfeed her baby, Counseling a psychiatric client on more adaptive coping strategies.

Dorothea Orem’s Theory and The Nursing Process

The Nursing Process presents a method in determining self-care deficits and defining the roles of persons or nurses to meet the self-care demands.

• Diagnosis and prescription; determine why nursing is needed. Analyze and interpret by making a judgment regarding care.
• Design of a nursing system and plan for delivery of care.
• Production and management of nursing systems.

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 health health
• The health goals within the context of life history, lifestyle, and health status.
• The person’s requirements for self-care
• The person’s capacity to perform self-care
• The nurse designs a system that is wholly or partly compensatory or supportive-educative.
• The two actions are: (1) Bringing out a good organization of the components of patients’ therapeutic self-care demands. (2) Selection of a combination of helping methods will be effective and efficient in compensating for/overcoming the patient’s self-care deficits.
• A nurse assists the patient or family in self-care matters to identify and describe health and health-related results. Collecting evidence in evaluating results achieved against results specified in the nursing system design.
• The etiology component of nursing diagnosis directs actions.

There is a superb focus of Orem’s work which is self-care. Even though there is a wide range of scope seen in the encompassing theory of nursing systems, Orem’s goal of letting the readers view nursing care to assist people was apparent in every concept presented.

From the definition of health which is sought to be rigid, it can now be refined by making it suitable to the general view of health as a dynamic and ever-changing state.

The role of the environment in the nurse-patient relationship , although defined by Orem, was not discussed.

Orem set nurses’ role in maintaining health for the patient with great coherence following every individual’s life-sustaining needs.

Although Orem viewed the parent’s or guardians’ importance in providing for their dependents, the definition of self-care cannot be directly applied to those who need complete care or assistance with self-care activities such as the infants and the aged.

• A major strength of Dorothea Orem’s theory is that it is applicable for nursing by the beginning practitioner and the advanced clinicians.
• Orem’s theory provides a comprehensive basis for nursing practice. It has utility for professional nursing in the areas of nursing practice, nursing education, and administration.
• The terms  self-care, nursing systems,  and  self-care deficit are easily understood by the beginning student nurse and can be explored in greater depth as they gain more knowledge and experience.
• She specifically defines when nursing is needed: Nursing is needed when the individual cannot maintain continuously that amount and quality of self-care necessary to sustain life and health, recover from disease or injury, or cope with their effects.
• Her self-care approach is contemporary with the concepts of health promotion and health maintenance.
• Three identifiable nursing systems were clearly delineated and are easily understood.
• Orem’s theory, in general, is viewed as a single whole thing, while Orem defines a system as a single whole thing.
• Orem’s theory is simple yet complex. The use of self-care in multitudes of terms, such as self-care agency, self-care demand, self-care deficit, self-care requisites, and universal self-care, can be very confusing to the reader.
• Orem’s definition of health was confined to three static conditions, which she refers to as a “concrete nursing system,” which connotes rigidity.
• Throughout her work, there is a limited acknowledgment of the individual’s emotional needs.
• Health is often viewed as dynamic and ever-changing.

Orem’s theory is relatively simple but generalizable to apply to a wide variety of patients. It explains the terms self-care, nursing systems, and self-care deficit essential to students who plan to start their nursing careers.

Moreover, this theory signifies that all patients want to care for themselves. They can recover more quickly and holistically by performing their own self-care as much as they’re able. This theory is particularly used in rehabilitation and primary care or other settings where patients are encouraged to be independent.

Though this theory greatly influences every patient’s independence, the definition of self-care cannot be directly applied to those who need complete care or assistance with self-care activities such as infants and the aged.

Recommended books and resources to learn more about nursing theory:

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy .

• Nursing Theorists and Their Work (10th Edition) by Alligood Nursing Theorists and Their Work, 10th Edition provides a clear, in-depth look at nursing theories of historical and international significance. Each chapter presents a key nursing theory or philosophy, showing how systematic theoretical evidence can enhance decision making, professionalism, and quality of care.
• Knowledge Development in Nursing: Theory and Process (11th Edition) Use the five patterns of knowing to help you develop sound clinical judgment. This edition reflects the latest thinking in nursing knowledge development and adds emphasis to real-world application. The content in this edition aligns with the new 2021 AACN Essentials for Nursing Education.
• Nursing Knowledge and Theory Innovation, Second Edition: Advancing the Science of Practice (2nd Edition) This text for graduate-level nursing students focuses on the science and philosophy of nursing knowledge development. It is distinguished by its focus on practical applications of theory for scholarly, evidence-based approaches. The second edition features important updates and a reorganization of information to better highlight the roles of theory and major philosophical perspectives.
• Nursing Theories and Nursing Practice (5th Edition) The only nursing research and theory book with primary works by the original theorists. Explore the historical and contemporary theories that are the foundation of nursing practice today. The 5th Edition, continues to meet the needs of today’s students with an expanded focus on the middle range theories and practice models.
• Strategies for Theory Construction in Nursing (6th Edition) The clearest, most useful introduction to theory development methods. Reflecting vast changes in nursing practice, it covers advances both in theory development and in strategies for concept, statement, and theory development. It also builds further connections between nursing theory and evidence-based practice.
• Middle Range Theory for Nursing (4th Edition) This nursing book’s ability to break down complex ideas is part of what made this book a three-time recipient of the AJN Book of the Year award. This edition includes five completely new chapters of content essential for nursing books. New exemplars linking middle range theory to advanced nursing practice make it even more useful and expand the content to make it better.
• Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice This book offers balanced coverage of both qualitative and quantitative research methodologies. This edition features new content on trending topics, including the Next-Generation NCLEX® Exam (NGN).
• Nursing Research (11th Edition) AJN award-winning authors Denise Polit and Cheryl Beck detail the latest methodologic innovations in nursing, medicine, and the social sciences. The updated 11th Edition adds two new chapters designed to help students ensure the accuracy and effectiveness of research methods. Extensively revised content throughout strengthens students’ ability to locate and rank clinical evidence.

Recommended site resources related to nursing theory:

• Nursing Theories and Theorists: The Definitive Guide for Nurses MUST READ! In this guide for nursing theories, we aim to help you understand what comprises a nursing theory and its importance, purpose, history, types or classifications, and give you an overview through summaries of selected nursing theories.

Other resources related to nursing theory:

• Betty Neuman: Neuman Systems Model
• Dorothy Johnson: Behavioral System Model
• Faye Abdellah: 21 Nursing Problems Theory
• Florence Nightingale: Environmental Theory
• Hildegard Peplau: Interpersonal Relations Theory
• Ida Jean Orlando: Deliberative Nursing Process Theory
• Imogene King: Theory of Goal Attainment
• Jean Watson: Theory of Human Caring
• Lydia Hall: Care, Cure, Core Nursing Theory
• Madeleine Leininger: Transcultural Nursing Theory
• Martha Rogers: Science of Unitary Human Beings
• Myra Estrin Levine: The Conservation Model of Nursing
• Nola Pender: Health Promotion Model
• Sister Callista Roy: Adaptation Model of Nursing
• Virginia Henderson: Nursing Need Theory

References and sources for this study guide about Dorothea Orem:

• “Obituary: Dorothea Elizabeth Orem ,” Savannah Morning News, June 24, 2007, retrieved June 17, 2014
•  Taylor, Carol R.; Lillis, Carol; LeMone, Priscilla; Lynn, Pamela (2011). Fundamentals of Nursing. Philadelphia: Wolters Kluwer Health. p. 74. ISBN 978-0-7817-9383-4.
• Orem, D. (1991). Nursing: Concepts of practice. (4th ed.). In George, J. (Ed.). Nursing theories: the base for professional nursing practice. Norwalk, Connecticut: Appleton & Lange.
• Orem, D. (1995). Nursing: Concepts of practice. (5th ed.). In McEwen, M. and Wills, E. (Ed.). Theoretical basis for nursing. USA: Lippincott Williams & Wilkins.
• Orem, D. (2001). Nursing: Concepts of practice. (6th ed.). In McEwen, M. and Wills, E. (Ed.). Theoretical basis for nursing. USA: Lippincott Williams & Wilkins.
• Taylor, S.G. (2006).  Dorothea E. Orem: Self-care deficit theory of nursing. 
• Meleis Ibrahim Afaf (1997), Theoretical Nursing: Development & Progress 3rd ed. Philadelphia, Lippincott.
• International Orem Society for Nursing Science and Scholarship
• Self-care requirements for activity and rest: an Orem nursing focus.
• Self-care: a foundational science.
• Self-care–the contribution of nursing sciences to health care  (in German).
• Nursing Concepts of Practice

With contributions by Wayne, G., Ramirez, Q.

13 thoughts on “Dorothea Orem: Self-Care Deficit Theory”

Thanks for the great overview on D. Orem’s theory.

Glad to be of help! Thanks for visiting the site Jinda! Don’t forget to read about other nursing theorists here .

What a wonderful resource. So nicely laid out yet very well detailed. Great job. Wish we had this back in the 70’s. Tatiana Retired RN

This was very helpful for completing a project for my MSN. Thank you!

That’s good to know! Good luck!

Thanks for the wonderful work. Her history will remain forever.

Thank you very helpful information

Thanks alot💪

Very educative and precise content….. helped me pass my assessments….Thanks alot

So educative and rich contents. I have learnt a lot from this page.

Thank you very much. This information was very helpful.

Thank you, thank you, thank you, I’d like to use you as a reference, if that’s ok with you, you deserve it.

Leave a Comment Cancel reply

• Adult Nursing
• Critical Care Nursing
• Family Nursing
• Holistic Nursing
• Home Health Nursing – visiting nurse
• Neonatal Intensive Care Nursing
• Pediatric Nursing
• Perinatal Nursing
• Psychiatric and Mental Health Nursing
• Public Health or Community Nursing
• Rehabilitation Nursing
• Faye Abdellah
• Phil Barker
• Dr. Patricia Benner
• Helen C. Erickson
• Katie Eriksson
• Lydia E. Hall
• Virginia Henderson
• Dorothy E. Johnson
• Imogene King
• Katharine Kolcaba
• Madeleine Leininger
• Myra Estrine Levine
• Ramona Mercer
• Betty Neuman
• Margaret A. Newman
• Florence Nightingale
• Ida Jean Orlando
• Dorothea E. Orem
• Rosemarie Rizzo Parse
• Nola Pender
• Hildegard Peplau
• Isabel Hampton Robb
• Martha E. Rogers
• Nancy Roper
• Sister Callista Roy
• Henry Stack-Sullivan
• Joyce Travelbee
• Jean Watson
• Ernestine Wiedenbach
• Alfred Adler
• Lawrence Kohlberg
• Robert R. Carkhuff
• Albert Bandura
• Carl O. Helvie
• Dr. Joyce Fitzgerald
• Clarissa Harlowe Barton
• Mary Ann Bickerdyke
• Mary Carson Breckinridge
• Dorothea Lynde Dix
• Sarah Emma Edmonds
• Helen Fairchild
• Eddie Bernice Johnson
• Mary Todd Lincoln
• Mary Eliza Mahoney
• Malinda Ann Judson Richards
• Dr. Lauranne Sams
• Margaret Higgins Sanger
• Dame Cicely Mary Saunders
• Mary Jane Seacole
• Susie King Taylor
• Lillian D. Wald
• Alyce Faye Wattleton
• Walt Whitman
• National Nurses Week
• First Annual Travel Nurse Day
• AACN Synergy Model
• Trans-Cultural Nursing
• Evidence-Based Nursing
• Modern Nursing
• Nursing Techniques
• Methods of Nursing
• Nursing Theories and a Philosophy of Nursing
• Nursing Mentors
• Nursing Leaders
• How to Study and Pass the NCLEX
• How to Study in Nursing School
• Pain Scale 1-10
• Nursing Clinicals and Nursing Theories
• Nursing Program
• Nursing Theory Definition
• Nursing Ethics and the Nursing Process
• History of Nursing
• Definition of Nursing
• The Nursing Process
• Nursing Care Plans in Action
• Nursing Technology
• Nursing Home Jobs and Getting Qualified
• Standards and Criteria Used by the NLNAC
• How Much Does Nursing School Cost
• Unsubsidized Nursing Student Loans
• A Statistical Look at Patient-Centered Care
• Being A Nurse At Christmas
• Nemours Brings Nursing Opportunities to Central Florida
• How Have the Sequester Cuts Affected Nursing and Health Care

Orem's Self-Care Deficit Nursing Theory

The Self-Care Deficit Theory developed as a result of Dorothea E. Orem working toward her goal of improving the quality of nursing in general hospitals in her state. The model interrelates concepts in such a way as to create a different way of looking at a particular phenomenon. The theory is relatively simple, but generalizable to apply to a wide variety of patients. It can be used by nurses to guide and improve practice, but it must be consistent with other validated theories, laws and principles.

The major assumptions of Orem’s Self-Care Deficit Theory are:

• People should be self-reliant, and responsible for their care, as well as others in their family who need care.
• People are distinct individuals.
• Nursing is a form of action. It is an interaction between two or more people.
• 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 needed for promoting self-care behaviors.
• Self-care and dependent care are behaviors learned within a socio-cultural context.

Orem’s theory is comprised of three related parts: theory of self-care; theory of self-care deficit; and theory of nursing system.

The theory of self-care includes self-care, which is the practice of activities that an individual initiates and performs on his or her own behalf to maintain life, health, and well-being; self-care agency, which is a human ability that is “the ability for engaging in self-care,” conditioned by age, developmental state, life experience, socio-cultural orientation, health, and available resources; therapeutic self-care demand, which is the total self-care actions to be performed over a specific duration to meet self-care requisites by using valid methods and related sets of operations and actions; and self-care requisites, which include the categories of universal, developmental, and health deviation self-care requisites.

Universal self-care requisites are associated with life processes, as well as the maintenance of the integrity of human structure and functioning. Orem identifies these requisites, also called activities of daily living, or ADLs, as:

• the maintenance of sufficient intake of air, food, and water
• provision of care associated with the elimination process
• a balance between activities and rest, as well as between solitude and social interaction
• the prevention of hazards to human life and well-being
• the promotion of human functioning

Porno Seyret liseli Porno Resimleri Mobil Porno Full sikiş Türk Sex Sex Hikayeleri Mobil Seks

Developmental self-care requisites are associated with developmental processes. They are generally derived from a condition or associated with an event.

Health deviation self-care is 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 to accept onseself as being in a particular state of health and in specific forms of health care
• Learning to live with the effects of pathologic conditions.

The second part of the theory, self-care deficit, specifies when nursing is needed. According to Orem, nursing is required when an adult is incapable or limited in the provision of continuous, effective self-care. The theory identifies five 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; and teaching another.

The theory of nursing systems describes how the patient’s self-care needs will be met by the nurse, the patient, or by both. Orem identifies three classifications of nursing system to meet the self-care requisites of the patient: wholly compensatory system, partly compensatory system, and supportive-educative system.

Orem recognized that specialized technologies are usually developed by members of the health care industry. The theory identifies two categories of technologies.

The first is social or interpersonal. In this category, communication is adjusted to age and health status. The nurse helps maintain interpersonal, intra-group, or inter-group relations for the coordination of efforts. The nurse should also maintain a therapeutic relationship in light of pscyhosocial modes of functioning in health and disease. In this category, human assistance adapted to human needs, actions, abilities, and limitations is given by the nurse.

The second is regulatory technologies, which maintain and promote life processes. This category regulates psycho- and physiological modes of functioning in health and disease. Nurses should promote human growth and development, as well as regulating position and movement in space.

Orem’s approach to the nursing process provides a method to determine the self-care deficits and then to define the roles of patient or nurse to meet the self-care demands. The steps in the approach are thought of uas the technical component of the nursing process. Orem emphasizes that the technological component “must be coordinated with interpersonal and social pressures within nursing situations.

The nursing process in this model has three parts. First is the assessment, which collects data to determine the problem or concern that needs to be addressed. The next step is the diagnosis and creation of a nursing care plan . The third and final step of the nursing process is implementation and evaluation. The nurse sets the health care plan into motion to meet the goals set by the patient and his or her health care team, and, when finished, evaluate the nursing care by interpreting the results of the implementation of the plan.

• My presentations

Auth with social network:

Download presentation

We think you have liked this presentation. If you wish to download it, please recommend it to your friends in any social system. Share buttons are a little bit lower. Thank you!

Presentation is loading. Please wait.

To view this video please enable JavaScript, and consider upgrading to a web browser that supports HTML5 video

Self-Care Deficit theory

Published by Curtis McCormick Modified over 8 years ago

Similar presentations

Presentation on theme: "Self-Care Deficit theory"— Presentation transcript:

Dorothea Orem Nursing Theory.

Theories of Nursing Practice

Orem’s Self-Care Deficit Nursing Theory

Click HERE to startHERE. Nonpractice disciplines do not utilize theory in development of their focus. Nursing is not considered a practice discipline,

Consistency of Assessment

Presented by: Shoughlah Niaz RN Born in Baltimore, MD in 1914 Began Nursing Career in Providence Hospital in Washington DC, received her nursing diploma.

Assessment Psychosocial Health , Self care & Wellness activities

Theoretical Foundations of Nursing Practice

Developmentally Appropriate Practices (DAP)

Madeleine Leininger’s Theory of Culture Care Diversity & Universality

Scope of Nursing Lecturer/ Hanaa Eisa Rawhia Salah

DED 101 Educational Psychology, Guidance And Counseling

NURSING PROCESS. PRE TEST n 1. Identify all steps of the nsg process n 2. Identify the step of the Nsg process where goals are identified. n 3. Identify.

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 10 — Nursing Diagnosis, Outcome Identification, Planning, Implementation,

INTRODUCTION TO….

MICHELE GILMORE JEAN HARKEN ERIN LUDWICK FERRIS STATE UNIVERSITY Dorothea Orem: Self-care deficit theory.

Objectives: 1. ID purposes & essential elements of nsg theories

Theories and Models of Nursing Chapter Three Catherine Hrycyk, MScN Nursing 50.

NURSING THEORIES & MODELS

Formulating objectives, general and specific

About project

© 2024 SlidePlayer.com Inc. All rights reserved.

Orem's nursing self-care deficit theory: A theoretical analysis focusing on its philosophical and sociological foundation

Affiliation.

• 1 Department of Fundamental Nursing, Nagano College of Nursing, Nagano, Japan.
• PMID: 35037258
• DOI: 10.1111/nuf.12696

Background: The self-care deficit nursing theory (SCDNT) advocated by Dorothea E. Orem is widely known and used in nursing practice worldwide. However, its broader philosophical and sociological context is often ignored.

Design: The theoretical analysis of Orem's SCDNT reported in this article focuses on four aspects of the theory: its essential structure/core values, affirmation of nursing as a practical science, philosophical foundations, and the sociological context surrounding its development.

Results: By interpreting the SCDNT from a philosophical and sociological viewpoint, it can be concluded that Orem established human-to-human nursing as a science premised on the existence of human beings as the central value of the theory. Moreover, Orem emphasized that the human-to-human relationship necessarily precedes the nurse-patient interface.

Conclusion: The new interpretation and evaluation perspectives presented in this report may further the understanding of Orem's SCDNT. Moreover, they highlight the multifaceted aspects of nursing practice and role of person-to-person relationships as the basis of the SCDNT.

Keywords: health literacy; social determinants of health; theory.

© 2022 Wiley Periodicals LLC.

• Nurse-Patient Relations
• Nursing Theory*

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• SAGE Open Nurs
• v.7; Jan-Dec 2021

Theory-Based Advanced Nursing Practice: A Practice Update on the Application of Orem's Self-Care Deficit Nursing Theory

Jeffrey yuk chiu yip.

1 School of Health Sciences, Caritas Institute of Higher Education, Hong Kong, China

Introduction

Many researchers have commended the self-care deficit nursing theory (SCDNT) developed by Orem as a means of improving patients' health outcomes through nurses' contributions. However, experimental research has investigated specific aspects of SCDNT, such as self-care agency and self-care requisites, rather than how the construct is practiced and understood as a whole. The current research presents a case study in which an advanced practice nurse (APN) used SCDNT-led practice within a primary healthcare setting that illustrates how the theory is applied to case management.

A case study was conducted by observing an APN during her work in the asthma clinic of a public hospital in Hong Kong. A comparison was made between the case management of the APN under observation with the nursing processes stipulated by the SCDNT across four key operations: diagnostic , prescriptive , treatment or regulatory , and case management .

During the observed consultation, the APN applied the four key operations. In SCDNT, the role of the APN is to apply practical nursing knowledge by determining how a patient can best undertake self-care within the circumstances of their living arrangements and support facilities. The case study also demonstrated that SCDNT-based nursing practice has strengths and limitations in a primary healthcare setting. The study concluded that Orem's SCDNT serves as an appropriate theoretical framework for nursing practice within primary healthcare settings. One practical consequence of using SCDNT is that it enables APNs to use nurse-sensitive indicators when evaluating their clinical practice. This study offers a practice update to increase the accountability of nursing practice for nurse-led healthcare services.

Advanced nursing practice is based on critical thinking and understanding the required theoretical background ( Parker & Hill, 2017 ). It can be conceptualized as the practice of fostering human health within a social context. Advanced nursing practice is underpinned by discipline-specific theoretical knowledge that draws on philosophical perspectives and ontological, epistemological, and methodological frameworks based on an ethical approach toward humans and the world they inhabit ( Parse et al., 2000 ).

Many researchers have recommended the self-care deficit nursing theory (SCDNT) developed by Orem (1995) to improve patients' health outcomes in terms of the nurses' contributions. Experimental studies on this theory include assessing the value of SCDNT in reducing fatigue in patients with multiple sclerosis ( Afrasiabifar et al., 2016 ) and an evaluation of SCDNT-based care in improving the quality of life of patients suffering from migraines ( Zarandi et al., 2016 ). Both studies confirmed the valuable role played by SCDNT-led advanced nursing practice in primary healthcare settings. However, experimental research investigated specific aspects of SCDNT, such as self-care agency (SCA) and self-care requisites, rather than studying how the construct is practiced and understood ( Younas & Quennell, 2019 ). Consequently, such research has furthered our theoretical understanding rather than offered practical guidelines for clinical application or shed light on how the framework is interpreted in the real world. This emphasis on theory instead of practice has constrained our understanding of SCDNT's application ( Bond et al., 2011 ).

The current research presents a case study in which an advanced practice nurse (APN) used SCDNT-led practice within a primary healthcare setting to illustrate how the theory is applied to case management. The patient described in this case had frequent asthma attacks during the two months before his visit to a nurse-led asthma clinic in a Hong Kong public hospital. The APN who assessed the case had 25 years of experience in respiratory care. This case study offers an opportunity to understand the parameters of the practical application of theory-based advanced nursing practice, specifically that of SCDNT, in primary care settings.

Brief Review

Theory-based advanced nursing practice with orem's self-care deficit nursing theory: an overview of constructs.

This section outlines the four key constructs of SCDNT ( Fawcett & Desanto-Madeya, 2012 ). The first construct, foundational capabilities and dispositions , consists of personal characteristics, such as the skills and traits that impact a person's capacity for action. This construct may be regarded as an umbrella category encompassing other broad constructs, including the ability to know and do (e.g., literacy or numeracy), dispositions that impact the setting and pursuit of goals (e.g., self-identity), and orienting capabilities and dispositions (e.g., attitudes toward health). The second construct consists of basic conditioning factors (BCFs), such as the requirements and ability to undertake self-care regarding patients' characteristics or the environment in which they live. This ability encompasses various factors, such as the patient's state of health, sociocultural setting, gender identity, life habits, and developmental stage. The third construct, self-care requisites, includes actions and items required for the patient to achieve holistic self-care, including health, development, and general well-being.

The last construct, SCA , is the individual's overall ability to meet their self-care needs. The SCDNT distinguishes between two types of knowledge: speculatively practical knowledge , established from theory, and practically practical knowledge , established from real-world practice ( George, 2011 ). The latter is demonstrated, for example, by an APN who has learned to provide primary care to patients who lack social and economic capital. APNs in such cases juggle complex priorities through a system of frequent telephone calls to ensure regular health monitoring. Another example is when a nurse recognizes that a patient is incapable of monitoring their health status properly, and accordingly makes provision to help the patient meet their self-care needs ( Mohammadpour et al., 2015 ); this is crucial as the primary task of an APN is to promote the SCA of each patient.

Furthermore, SCDNT separates four key operations within professional practice— diagnostic , prescriptive , treatment or regulatory , and case management ( De Chesnay & Anderson, 2019 ). Within SCDNT, diagnostic operations refer to the diagnosis and prediction of self-care requisites, which must consider the effect of foundational capabilities and dispositions and BCFs on the patient's self-care ability. The APN then uses this diagnosis to guide their prescriptive operations, determine the practical actions required based on the patient's state of health, manner of daily living, and environmental constraints, and health or other goals. The actions prescribed are realized through treatment or regulatory operations. These are not generally performed by the APN directly, although the APN can offer help and advice in matters such as adjusting a patient's home environment and ensuring that they have the necessary knowledge and skills to accomplish the prescribed actions. Finally, under case management operations, APNs ensure that all actions performed under the previous three operations are properly evaluated and integrated to ensure smooth practice and communication among all links in the health service chain.

Effective case management by APNs rests on their understanding that diagnosis, prescription, and treatment constitute a dynamic process that functions properly only if adapted to each patient's needs ( Doucet, 2013 ). This process requires integrating a feasible course of action for optimal healing into a patient's daily living patterns within the financial and other healthcare service constraints. Within the SCDNT, the role of the APN is to apply practical nursing knowledge by determining how a patient can best undertake self-care within the boundaries of their living arrangements and support facilities. By elaborating on a specific case study, the following section details how nursing operations can be accomplished according to SCDNT-based practice.

I undertook a descriptive case study because this approach enables an in-depth investigation of a contemporary phenomenon within its real-world setting ( Hackel & Fawcett, 2018 ; Yin, 2014 ). I directly observed and recorded how an APN dealt with the physical and other characteristics of a specific real-life situation ( Mulhall, 2003 ). Such systematic observation of individuals performing tasks in a non-laboratory setting can yield richer data than interviewing subjects after the event or asking them to self-report; the latter data collection methods carry the risk of bias and self-selection ( Morse, 2003 ).

The subject of this case study was an APN, observed during her work in the asthma clinic of a public hospital. She has a master's degree in nursing and 25 years of experience in the respiratory nursing specialty (14 years in primary care and 11 in acute care). I observed the APN during a scheduled consultation with a referred patient. This patient visited the emergency room (ER) of a public hospital on multiple occasions over the previous two months due to asthma attacks. The patient gave verbal consent for the observation, and I respected their privacy by taking field notes rather than an audio or video recording of the consultation. After I documented the consultation details, I compared the case management of the APN under observation to the nursing processes stipulated by the SCDNT. Finally, I presented in-depth information on the four operations of the SCDNT within the case study's context in the reflection section of the application.

Case Scenario

The patient, “Mr. Z.,” was 61 years old and had been a smoker for 21 years. He visited the clinic due to his wife's concerns about his recent coughing episodes and general ill health. Mr. Z., however, considered his health to be generally good. When asked about his health goal, he replied that he wanted to work without coughing as much as he usually did. He also stated that although he was diagnosed with asthma eight years ago, he did not renew his medications because he believed that he did not need them.

The initial nursing assessment clearly revealed that Mr. Z.'s wife was more proactive in managing his care than he was. When asked whether he woke up at night coughing, coughed during his morning walks, or coughed while undertaking strenuous activities, he repeatedly turned to his wife for answers. When asked whether he could think of any triggers for the asthma attacks that eventually compelled him to visit the ER, Mr. Z. responded that he believed his dry cough episodes at night worsened since his pet dogs were allowed into the bedroom and on the bed over the past two months. From this initial interaction, the APN concluded that Mr. Z. had the foundational disposition of paying attention to his health only when something interfered with his work.

During Mr. Z.'s physical examination, the APN found only slight wheezing in the right middle lobe. An ER physician who attended to Mr. Z., however, diagnosed him with asthma and referred him to the asthma clinic to discuss options for improving the condition's long-term management.

The Parameters of Theory-Based Practice Concerning Diagnostic Nursing Operations

During the observed consultation, the APN applied diagnostic nursing operations as per the SCDNT—diagnosing how the BCFs may impact the patient's self-care requisites and whether the patient has the necessary SCA to meet the requisites. In this case, the diagnosis of self-care requirements covered Mr. Z.'s ability to identify and avoid situations that he knew could trigger an asthma attack. It also included changing his self-image to acknowledge that he had asthma, recording peak flow measurements to monitor his health status, taking prescribed medications, and being able or willing to monitor the effects of those medications. During the consultation, the APN identified the actions required, ensured Mr. Z. understood them independently and interdependently, and ascertained that he was ready to fulfill the requirements and knew the procedures for fulfilling them.

The APN also evaluated the Mr. Z's SCA (an individual's ability to fulfill self-care requirements for a specific condition and in general). Orem (1995) differentiated between the three types of self-care operations that comprise SCA: investigative-estimative , judgment and decision-making , and productive . To perform these operations, the individual must ask and answer questions such as, What do I need to do? What should I not do? Which actions do I choose to perform? Is my self-care practice giving me the desired outcomes? Direct observation of the APN's asthma discussion with Mr. Z. revealed that he had the necessary knowledge to manage his diagnosed condition. However, it was equally clear that Mr. Z.—given his lack of interest in his health and physical well-being—would require assistance to accomplish his self-care requirements and the ability to work without coughing. Consequently, the APN diagnosed the patient as having limited SCA knowledge due to his lack of concern regarding his physical health and asthma concerns.

Regarding Prescriptive Nursing Operations

The first step is to prescribe all the actions necessary to ensure total self-care. Hence, in the observed consultation, the APN had to ensure Mr. Z. was fully cognizant of the requirements to control his condition to stay in good health. To regulate his asthma, Mr. Z. was advised to monitor his cough, use a peak flow meter to monitor and record his respiratory function, use a metered-dose inhaler four times daily for 14 days and monitor any effects, and identify and avoid triggers. Mr. Z stipulated that his preferred health outcome was reduced cough. Therefore, the discussion focused on how these self-care requirements could be integrated into his everyday life. Ideally, consultation between the APN and patients should result in a partnership and mutual understanding of constraints, desired outcomes, and measures necessary to achieve those outcomes. Mr. Z. demonstrated considerable dependence on his wife when asked questions about his health; therefore, the APN understood that the responsibility for his self-care was shared between the two in their everyday lives. This shared responsibility indicated a collaborative care system ( Geden & Taylor, 1999 ), in which two capable adult partners in a long-term relationship adopt a system of SCA in which each assumes some responsibility for the other's care management. Under such a care system, the APN seeks to help the partners incorporate new self-care requirements into the existing system by clarifying and exploring each partner's roles and responsibilities and facilitating an agreement on how best to modify their living arrangements. The observed APN predicted that if Mr. Z.'s wife did not take responsibility for meeting at least some of her husband's care requirements, he would not adequately monitor his health or take the prescribed course of action.

Regarding Treatment or Regulatory Operations

The supportive-educative system developed for long-term implementation by Mr. Z. had four specific goals: 1) to help him acquire the knowledge needed to manage his condition; 2) to help him learn the skills required to understand and accurately describe his symptoms; 3) to help him take the appropriate self-care management decisions and actions; and 4) to complement the existing collaborative care system by ensuring that Mr. Z. and his wife could make the necessary adjustments to their roles and responsibilities to achieve their self-care requirements, both now and in the future.

The supportive-educative system could be complemented by a developmental-supportive system in Mr. Z.'s case to support him in modifying his self-image and integrating the prescribed self-care measures into the couple's daily routine. Specifically, Mr. Z. must develop his self-concept to accept that a chronic health condition requiring constant attention is a part of his identity and that this condition requires him to adhere to his prescribed medications. During the consultation, the APN asked Mr. Z, “How are you managing your asthma?” This question was to determine whether Mr. Z. had taken ownership of the illness and enable the APN to judge how to help him adjust his self-image. Confirmation of this adjustment will involve Mr. Z. describing himself as being asthmatic or having asthma.

The APN drew on both knowledge and experience to design a nursing system tailored to meet Mr. Z.'s needs, specifically seeking to help him develop the skills needed to understand and accurately describe his symptoms. The APN demonstrated the understanding that symptoms are experienced subjectively and can only be described accurately by the patient. Hence, although Mrs. Z. may offer encouragement and support toward her husband's self-care needs, only Mr. Z. can engage in actions to meet those needs. Particularly, the symptoms that Mr. Z. is likely to experience due to his condition were carefully described to him by the APN in an easily comprehensible language. For example, people with asthma commonly suffer from shortness of breath, which the APN described as having trouble catching one's breath, feeling as if the air is too thin or lacks enough oxygen, or feeling suffocated.

Having realized that Mrs. Z. was an important contributor in Mr. Z.'s self-care, the APN invited her to participate in a discussion of ways to effectively implement the actions prescribed for Mr. Z. One of the prescribed requisites was the need for Mr. Z. to identify and avoid his asthma triggers. Therefore, the APN facilitated a discussion on how dog fur may trigger his cough, with which Mrs. Z. agreed. Solutions for avoiding this trigger included not allowing pets in the bedroom and ensuring that Mr. Z. thoroughly washed his hands after touching the pets, as hands are carriers of dander. Mrs. Z. suggested that Mr. Z. should also wash his hands before going to sleep. This discussion on ways to avoid triggers exemplifies the need for prior negotiation to properly implement an action plan for self-care. The discussion allows the patient and their family members to identify the least disruptive and most efficient way of incorporating the new regime into their everyday life.

Regarding Case Management Operations

Case management operations address how diagnostic, prescriptive, and treatment or regulatory operations can be integrated to ensure the smooth delivery of healthcare services. For patients visiting a primary healthcare setting, this range of operations is best integrated through a long-term communication system between the patients and APNs, who can coordinate the services required from a range of providers where necessary. Under the SCDNT, the observed APN had a choice to either manage Mr. Z.'s case within the asthma clinic or refer him elsewhere. However, if the APN decided to refer Mr. Z., she would have continued to direct the overall coordination and communication with him and his wife. Mr. Z. could, for example, be seen by a respiratory physician in the future, which would be arranged by the APN, whose responsibility in such a scenario would be to ensure that Mr. and Mrs. Z. understood why this step was being taken and what outcomes they could expect from it.

Services are appropriately coordinated when each stakeholder's voice is heard—in this case, Mr. and Mrs. Z., the APN, and the specialist to whom Mr. Z. may be referred. This specific case management operation also requires the APN to adopt the role of the patient's advocate, representing Mr. Z. to the specialist by conveying essential information such as his preferred outcomes and self-care abilities and strategies. This information gives the specialist the necessary context to communicate effectively with Mr. and Mrs. Z. and suggest and explain any recommended changes in the ongoing treatment. Advocacy may be aptly described as making the path ready. It aims to ensure patients' smooth transition to different care providers and proper coordination of their overall care management.

Applicability of the Self-Care Deficit Nursing Theory to Advanced Nursing Practice in Primary Healthcare Settings

The case study demonstrated that SCDNT-based nursing practice has both strengths and limitations in a primary healthcare setting. According to the Institute of Medicine (IOM) Committee on the Future of Primary Care (1996), primary care is “the provision of integrated, accessible healthcare services by clinicians who are accountable for addressing a large majority of personal healthcare needs, developing a sustained partnership with patients, and practicing in the context of family and community” (p. 31). However, Geden and Taylor (1997) advocated extending this definition to encompass the integration of prescribed self-care measures into patients' daily lives, given their importance in achieving the desired outcomes. Once this extension has been incorporated, the IOM Committee on the Future of Primary Care (1996) definition essentially described the SCDNT. Hence, the SCDNT offers a framework through which APNs can evaluate specific cases and identify a language in which they can communicate their contribution to patients' health and well-being. Advanced nursing practice in a primary healthcare setting is principally aimed at promoting patients' SCA to construct and perform the necessary self-care practices ( Bal Özkaptan & Kapucu, 2016 ; Hemati et al., 2015 ).

Among the possible challenges to theory-based practice is that the SCDNT addresses specific practical aspects of nursing practice rather than conceptualizing the nature of the nursing activity. Despite this limitation, the SCDNT offers the necessary simplicity, clarity, and logic to serve as the preferred framework for many APNs undertaking chronic disease management in primary healthcare settings ( Afrasiabifar et al., 2020 ), such as the APN observed in the current case study. Moreover, the model offers a clear roadmap for the coordination of nurse–patient relations and establishes the actions to be undertaken by both partners to ensure the mutually desired outcome of boosting the patient's SCA.

However, it must be acknowledged that the SCDNT is restricted by its failure to address every aspect of primary care and all potential patient requirements. For example, Orem (1995) did not clearly define “family.” Moreover, there were weaknesses in her treatment of public education and the relationship between nurses and the society where they practiced, which are important factors for disease prevention, management, and aftercare ( Blok, 2017 ; Rutledge, 2019 ).

Chronic disease management is a key element of primary healthcare and involves attending to the patient's emotional needs, which the SCDNT does not do, thereby reducing its applicability. Further, self-care is not the only construct to be considered when dealing with people living with chronic diseases. Theories addressing this limitation include Jean Watson's theory of caring ( Neil & Tomey, 2006 ) and Roy's adaptation model ( Roy, 2009 ), which can complement the SCDNT. This is especially true for Roy's assertion that the family, rather than the individual patient, is the recipient of care, given that family-centered care is at the heart of today's multidisciplinary approach to primary healthcare ( Kokorelias et al., 2019 ).

This Case Study’s Contribution to the Knowledge of Advanced Practice

The SCDNT offers a robust discipline-specific model to promote high-quality nursing practice by enhancing the client's SCA concerning their health outcomes within a care management plan ( Carroll, 2019 ). For example, in the case of Mr. Z., this occurred through the APN's nursing process incorporating the four key operations: diagnostic , prescriptive , treatment or regulatory , and case management . This case study also demonstrated that SCDNT could be of value within nurse-led primary healthcare services for chronic disease management ( Khademian et al., 2020 ; Pickett et al., 2014 ), a matter of increasing concern, given the sharp rise in lifestyle diseases. Continuous improvements in nursing practice and clear communication and coordination between APNs and patients are critical for such diseases to be managed appropriately. The current study demonstrated how theory-based practice might increase the accountability of APNs in fostering patients' ability to attain the desired outcomes. This is achieved through a practice based on a professional ethos of high-quality, humanistic, and effective care. More importantly, it contributes to our broader understanding of how APNs can integrate aspects of SCDNT to update their practice further.

SCDNT serves as an appropriate theoretical framework for nursing practice within primary healthcare settings. Translating the tenets of the SCDNT into practice offers a way for primary care nurses to care for an individual as an embedded component of a wider family and society. The case study considered in this paper demonstrated how the SCDNT could guide an APN to understand their patient as an agent who can develop, grow, and adopt a self-care regimen. One practical consequence of using the SCDNT is that it enables APNs to use nurse-sensitive metrics when evaluating their clinical practice. Thus, Orem's theory offers a valuable framework for reflection on patient care and enhances our understanding of the ongoing fluidity and adaptability of advanced nursing practice and primary healthcare.

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD: Jeffrey Yuk Chiu Yip https://orcid.org/0000-0002-2353-5433

• Afrasiabifar A., Mehri Z., Ghaffarian Shirazi H. R. (2020). Orem's self-care model with multiple sclerosis patients' balance and motor function. Nursing Science Quarterly , 33 ( 1 ), 46–54. 10.1177/0894318419881792 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Afrasiabifar A., Mehri Z., Javad Sadat S., Ghaffarian Shirazi H. R. (2016). The effect of Orem's self-care model on fatigue in patients with multiple sclerosis: A single blind randomized clinical trial study . Iranian Red Crescent Medical Journal , 18 ( 8 ), e31955. 10.5812/ircmj.31955 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bal Özkaptan B., Kapucu S. (2016). Home nursing care with the self-care model improves self-efficacy of patients with chronic obstructive pulmonary disease . Japan Journal of Nursing Science , 13 ( 3 ), 365–377. 10.1111/jjns.12118 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Blok A. C. (2017). A middle-range explanatory theory of self-management behavior for collaborative research and practice: Self-management behavior . Nursing Forum , 52 ( 2 ), 138–146. 10.1111/nuf.12169 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bond A. E., Eshah N. F., Bani-Khaled M., Hamad A. O., Habashneh S., Kataua' H., al-Jarrah I., Kamal A. A., Hamdan F. R., Maabreh R. (2011). Who uses nursing theory? A univariate descriptive analysis of five years' research articles. Scandinavian Journal of Caring Sciences , 25 ( 2 ), 404–409. 10.1111/j.1471-6712.2010.00835.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Carroll K. (2019). Bringing nursing care to patients living with diabetes mellitus. Nursing Science Quarterly , 32 ( 3 ), 187–188. 10.1177/0894318419845402 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• De Chesnay M., Anderson B. (2019). Caring for the vulnerable . Jones & Bartlett Learning. [ Google Scholar ]
• Doucet T. (2013). Philosophical and theoretical perspectives for advanced nursing practice (5th ed.), by W. K. Cody (Ed.). (Burlington, MA: Jones and Bartlett, 2013). Nursing Science Quarterly , 26 ( 2 ), 193–198. 10.1177/0894318413477151 [ CrossRef ] [ Google Scholar ]
• Fawcett J., DeSanto-Madeya S. (2012). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories . FA Davis. [ Google Scholar ]
• Geden E. A., Taylor S. G. (1997). How is nursing expressed by nurse practitioners in the primary health care setting . International Orem Society Newsletter , 5 ( 2 ), 9–11. [ Google Scholar ]
• Geden E. A., Taylor S. G. (1999). Theoretical and empirical description of adult couples' collaborative self-care systems. Nursing Science Quarterly , 12 ( 4 ), 329–334. 10.1177/08943189922107061 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• George J. B. (2011). Nursing theories: The base for professional nursing practice (6th ed.). Pearson Education India. [ Google Scholar ]
• Hackel J., Fawcett J. (2018). Teaching and learning from case studies: The added value of using a nursing conceptual model to construct cases. Nursing Science Quarterly , 31 ( 3 ), 263–271. 10.1177/0894318418774872 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hemati Z., Mosaviasl F. S., Abasi S., Ghazavi Z., Kiani D. (2015). Effect of Orem's self-care model on self-esteem of adolescents with asthma referred to an asthma and allergy clinic in Isfahan . Tanaffos , 14 ( 4 ), 232. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Institute of Medicine Committee on the Future of Primary Care. (1996). Defining primary care. In Donaldson M., Yordy K., Vanselow N. (Eds.), Primary care: America's health in a new era (pp. 27–51). National Academy Press. [ Google Scholar ]
• Khademian Z., Kazemi Ara F., Gholamzadeh S. (2020). The effect of self care education based on Orem's nursing theory on quality of life and self-efficacy in patients with hypertension: A quasi-experimental study . International Journal of Community Based Nursing and Midwifery , 8 ( 2 ), 140–149. 10.30476/IJCBNM.2020.81690.0 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kokorelias K. M., Gignac M. A. M., Naglie G., Cameron J. I. (2019). Towards a universal model of family centered care: A scoping review . BMC Health Services Research , 19 ( 1 ), 564. 10.1186/s12913-019-4394-5 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Mohammadpour A., Rahmati Sharghi N., Khosravan S., Alami A., Akhond M. (2015). The effect of a supportive educational intervention developed based on the Orem's self-care theory on the self-care ability of patients with myocardial infarction: A randomised controlled trial. Journal of Clinical Nursing , 24 ( 11–12 ), 1686–1692. 10.1111/jocn.12775 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Morse J. M. (2003). Perspectives of the observer and the observed. Qualitative Health Research , 13 ( 2 ), 155–157. 10.1177/1049732302239595 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Mulhall A. (2003). In the field: Notes on observation in qualitative research. Journal of Advanced Nursing , 41 ( 3 ), 306–313. 10.1046/j.1365-2648.2003.02514.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Neil R. M., Tomey A. M. (2006). Jean Watson: Philosophy and science of caring. In Tomey A. M., Alligood M. R. (Eds.), Nursing theorists and their work (6th ed.) (pp. 91–115). Mosby. [ Google Scholar ]
• Orem D. (1995). Nursing: Concepts of practice (5th ed.). Mosby. [ Google Scholar ]
• Parker J. M., Hill M. N. (2017). A review of advanced practice nursing in the United States, Canada, Australia and Hong Kong Special Administrative Region (SAR), China. International Journal of Nursing Sciences , 4 ( 2 ), 196–204. 10.1016/j.ijnss.2017.01.002 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Parse R. R., Barrett E., Bourgeois M., Dee V., Egan E., Germain C., King I., Koerner J., Neuman B., Newman M., Roy C., Walker L., Watson J., Wolf G. (2000). Nursing theory-guided practice: A definition . Nursing Science Quarterly , 13 ( 2 ), 177. 10.1177/08943180022107474 [ CrossRef ] [ Google Scholar ]
• Pickett S., Peters R. M., Jarosz P. A. (2014). Toward a middle–range theory of weight management. Nursing Science Quarterly , 27 ( 3 ), 242–247. 10.1177/0894318414534486 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Roy C., Sr.(2009). The Roy adaptation model (3rd ed.). Pearson. [ Google Scholar ]
• Rutledge P. M., Montgomery A. J., Lott S. M., McGee Z. M., Burns D. M. (2019). The relationship between family support, self-care, and health outcomes in selected African–American females with type 2 diabetes . Journal of National Black Nurses’ Association , 30 ( 2 ), 1–9. [ PubMed ] [ Google Scholar ]
• Yin R. K. (2014). Case study research: Design and methods (applied social research methods) . Sage Publications. [ Google Scholar ]
• Younas A., Quennell S. (2019). Usefulness of nursing theory‐guided practice: An integrative review. Scandinavian Journal of Caring Sciences , 33 ( 3 ), 540–555. 10.1111/scs.12670 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Zarandi F. M., Raiesifar A., Ebadi A. (2016). The effect of Orem's self-care model on quality of life in patients with migraine: A randomized clinical trial . Acta Medica Iranica , 54 ( 3 ), 159–164. [ PubMed ] [ Google Scholar ]

Honoring Our Heritage – Building Our Future

Orem’s self-care framework/self-care deficit theory of nursing/the self-care nursing theory/a general theory of nursing.

Contributor: Jacqueline Fawcett August 30, 2018 View FITNE Video of Dorothea Orem Interviewed by Jacqueline Fawcett View FITNE video “”Self-Care Framework Model in Practice”

Author – Dorothea E. Orem, RN, BS, MS

Exemplars –.

• A Pilot Childhood Obesity Study of the Effect of the Nutrition Education Program: Color My Pyramid

Quality Improvement

• Prevention of unplanned postoperative hypothermia

Year First Published – 1971

Major Concepts

• Multiperson Unit

THERAPEUTIC SELF-CARE DEMAND

• Universal Self-Care Requisites
• Developmental Self-Care Requisites
• Health Deviation Self-Care Requisites

SELF-CARE SELF-CARE AGENT DEPENDENT- CARE DEPENDENT-CARE AGENT SELF-CARE AGENCY

• Development
• Operability

DEPENDENT-CARE AGENCY BASIC CONDITIONING FACTORS POWER COMPONENTS

• Self-Care Agency Power Components
• Nursing Agency Power Components

SELF-CARE DEFICIT DEPENDENT-CARE DEFICIT ENVIRONMENTAL FEATURES

• Physical, Chemical, and Biologic Features
• Socioeconomic-Cultural Features

HEALTH STATE WELL-BEING NURSING AGENCY

• Social System
• Interpersonal System
• Professional-Technological System

PRACTICE METHODOLOGY: PROFESSIONAL-TECHNOLOGIC OPERATIONS OF NURSING PRACTICE

• Case Management Operations
• Diagnostic Operations
• Prescriptive Operations
• Regulatory Operations: Design of Nursing Systems for Performance of Regulatory Operations
• Wholly Compensatory Nursing System
• Partly Compensatory Nursing System
• Supportive-Educative Nursing System
• Methods of Helping
• Regulatory Operations: Planning for Regulatory Operations
• Regulatory Operations: Production of Regulatory Care
• Control Operations

A conceptual model of nursing

Brief Description

“Orem’s work focuses on patients’ deliberate actions to meet their own and dependent others’ therapeutic self-care demands and nurses’ deliberate actions to implement nursing systems designed to assist individuals and multiperson units who have limitations in their abilities to provide continuing and therapeutic self-care or care of dependent others. . . . The goal of nursing agency is to compensate for or overcome known or emerging health-derived or health-associated limitations of legitimate patients for self-care or dependent-care” (Fawcett, J., & DeSanto-Madeya, S. (2013). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories (3rd ed., pp. 179-180). Philadelphia, PA: F. A. Davis.)

See also Orem International Society

Primary Sources

Denyes, M.J., Orem, D.E., & Bekel, G. (2001). Self-care: A foundational science. Nursing Science Quarterly, 14, 48-54.

Nursing Development Conference Group. (1973). Concept formalization in nursing: Process and product. Boston< MA: Little, Brown.

Nursing Development Conference Group. (1979). Concept formalization in nursing: Process and product (2nd ed.). Boston, MA: Little, Brown.

Orem, D.E. (1956). Hospital nursing service: An analysis. Indianapolis, IN: Division of Hospital and Institutional Services of the Indiana State Board of Health.

Orem, D.E. (1959). Guides for developing curricula for the education of practical nurses. Washington, DC: US Government Printing Office.

Orem, D.E. (1971). Nursing: Concepts of practice. New York, NY: McGraw Hill.

Orem, D.E. (1980). Nursing: Concepts of practice (2nd ed.). New York, NY: McGraw-Hill.

Orem, D.E. (1981). Nursing: A triad of action systems. In G.E. Lasker (Ed.), Applied systems and cybernetics. Vol. IV. Systems research in health care, biocybernetics and ecology (pp. 1729–1733). New York, NY: Pergamon Press.

Orem, D.E. (1983). The self care deficit theory of nursing: A general theory. In I.W. Clements & F.B. Roberts (Eds.), Family health: A theoretical approach to nursing care (pp. 205–217). New York, NY: Wiley.

Orem, D.E. (1984). Orem’s conceptual model and community health nursing. In M.K. Asay & C.C. Ossler (Eds.), Conceptual models of nursing. Applications in community health nursing. Proceedings of the Eighth Annual Community Health Nursing Conference (pp. 35–50). Chapel Hill, NC: Department of Public Health Nursing, School of Public Health, University of North Carolina.

Orem, D.E. (1985). Nursing: Concepts of practice (3rd ed.). New York, NY: McGraw-Hill.

Orem, D.E. (1987). Orem’s general theory of nursing. In R.R. Parse (Ed.), Nursing science. Major paradigms, theories, and critiques (pp. 67–89). Philadelphia, PA: Saunders.

Orem, D.E. (1990). A nursing practice theory in three parts, 1956–1989. In M.E. Parker (Ed.), Nursing theories in practice (pp. 47–60). New York, NY: National League for Nursing.

Orem, D.E. (1991). Nursing: Concepts of practice (4th ed.). St. Louis, MO: Mosby.

Orem, D.E. (1995). Nursing: Concepts of practice (5th ed.). St. Louis: Mosby.

Orem, D.E. (1997). Views of human beings specific to nursing. Nursing Science Quarterly, 10, 26–31.

Orem, D.E. (2001). Dorothea E. Orem: The self-care deficit nursing theory. In M.E. Parker (Ed.), Nursing theories and nursing practice (pp. 171-178). Philadelphia, PA: F.A. Davis.

Orem, D.E. (2001). Nursing: Concepts of practice (6th ed.). St. Louis, MO: Mosby.

Orem, D.E. (2004). Reflections on nursing practice science: The nature, the structure, and the foundation of nursing science. Self-Care, Dependent-Care, and Nursing, 12(3), 4-11.

Orem, D. (2004). Reflections on nursing practice science: The nature, the structure and the foundation of nursing sciences. Self-Care, Dependent-Care, and Nursing, 12, 4-11.

Orem, D.E. (2006). Part One: Dorothea E. Orem’s self-care deficit nursing theory. In M.E. Parker, Nursing theories and nursing practice (2nd ed., pp. 141-149). Philadelphia, PA: F.A. Davis.

Orem, D.E., & Parker, K.S. (Eds.) (1963). Nurse education workshop proceedings. Washington, DC: Catholic University of America.

Orem, D.E., & Taylor, S.G. (1986). Orem’s general theory of nursing. In P. Winstead Fry (Ed.), Case studies in nursing theory (pp. 37–71). New York, NY: National League for Nursing.

Orem, D.E., & Taylor, S.G. (2011). Reflections on nursing practice science: The nature, the structure, and the foundation of nursing sciences. Nursing Science Quarterly, 24, 35-41.

Orem, D.E., & Vardiman, E.M. (1995). Orem’s nursing theory and positive mental health: Practical considerations. Nursing Science Quarterly, 8, 165–173.

Renpenning, K.M., SozWiss, G.B., Denyes, M.J., Orem, D.E., & Taylor, S.G. (2011). Explication of the nature and meaning of nursing diagnosis. Nursing Science Quarterly, 24, 130-136.

Renpenning, K.M., & Taylor, S.G. (Eds.). (2003). Self-care theory in nursing: Selected papers of Dorothea Orem. New York, NY: Springer.

Taylor, S.G. (2007). Tribute to the theorists. Dorothea Orem over the years. Nursing Science Quarterly, 20, 106.

Theories Derived from Orem’s Self-Care Framework

Theory of Self-Care

Theory of Self-Care Deficit

Theory of Nursing System

General Theory of Nursing Administration

Orem, D.E. (1989). Theories and hypotheses for nursing administration. In B. Henry, M. DiVincenti, C. Arndt, & A. Marriner (Eds.), Dimensions of nursing administration. Theory, research, education and practice (pp. 55–62). Boston, MA: Blackwell Scientific.

Theory of Dependent-Care .

Arndt, M.J., & Horodynski, M.A.O. (2004). Theory of dependent-care in research with parents of toddlers: The NEAT project. Nursing Science Quarterly, 17, 345-350.

Taylor, S.G., Renpenning, K.E., Geden, E.Z., Neuman, B.M., & Hart, M.A. (2001). A theory of dependent-care: A corollary theory to Orem’s theory of self-care. Nursing Science Quarterly, 14, 39–47.

Theory of Diabetes Self-Care Management

Sousa, V.D., & Zauszniewski, J.A. (2005). Toward a theory of diabetes self-care management. Journal of Theory Construction & Testing, 9, 61-67.

Theory of Keeping Vigil Over the Patient

Schreiber, R. & MacDonald, M. (2010). Keeping vigil over the patient: A grounded theory of nurse anaesthesia practice. Journal of Advanced Nursing, 66, 552-561.

Theory of Sensing Presence and Sensing Space

Orticio, L.P. (2007). Sensing presence and sensing space: A middle-range theory of nursing. Insight: The Journal of the American Society of Ophthalmic Registered Nurses, 32(4), 7-11.

Theory of Taking Care of Oneself in a High-Risk Environment

Rew, L. (2003). A theory of taking care of oneself grounded in experiences of homeless youth. Nursing Research, 52, 234-241.

Theory of Testicular Self-Examination

Fessenden, C.C. (2003). Adoption of testicular self-examination. Dissertation Abstracts International, 63, 5157B.

Dorothea E. Orem (1914-2007)

Dorothea Elizabeth Orem received her diploma in nursing from Providence Hospital School of Nursing in Washington, D.C. She earned a BS in Nursing Education (1939) and an MS in Nursing Education (1946) from Catholic University of America. She held various staff nursing, private duty nursing, and supervisor positions early in her career. She was the Director of the nursing school and the hospital department of nursing at Providence Hospital in Detroit, MI (1940-1949), and went on to work in the Division of Hospital and Institutional Services of the Indiana State Board of Health (1949-1957). She served as a curriculum consultant to the United Stated Department of Health, Education, and Welfare Office of Education (1957-1960). She held faculty and administration positions at Catholic University of America (1960-1970) and then formed her own consulting firm in 1970. Although she retired in 1984, she continued to work on refining her self-care framework alone and with colleagues. (From Berbiglia, V. A., & Banfield, B. (2010). Self-care deficit theory of nursing. In M..R. Alligood & A. M. Tomey (Eds.) Nursing theorists and their work (7th ed., pp. 265-285). St. Louis, MO: Mosby Elsevier.)

1988 Interview of Dorothea Orem by Jacqueline Fawcett

1993 Video “Self-Care Framework Model in Practice”

Share this:

Dorothea Orem’s Theory of Self Care

Sep 14, 2014

931 likes | 3k Views

Dorothea Orem’s Theory of Self Care. Presented by Sarah Stalmack , Karri Walters, Erica Lambert, Julie Brinkerhoff and Lisa Buckley. Dorothea Orem Historical Evolution of the Model. Dorothea Orem. Born in Baltimore, Maryland. One of America’s foremost nursing theorists.

Share Presentation

• care deficit
• dorothea orem
• nursing education
• nursing systems describing
• dorothea orem historical evolution

Presentation Transcript

Dorothea Orem’s Theory of Self Care Presented by Sarah Stalmack, Karri Walters, Erica Lambert, Julie Brinkerhoff and Lisa Buckley

Dorothea Orem Historical Evolution of the Model

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

Education • Studied at Providence Hospital school of Nursing in Washington D.C. in the 1930’s. • Achieved he B.S.N.E. in 1939 and her M.S.N.E. in 1946 both from the Catholic University of America • 1958-1960 upgraded practical nursing training for the Department of Health, Education and Welfare. • Was editor to several texts including Concepts Formalization in Nursing: Process and Production, revised in 1980, 1985, 1991, 1995, 2001.

Nursing Experience • Early nursing experience included operating room nursing, private duty nursing, 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.

Development of Theory • 1949-1957 Orem worked for the Division of Hospital and Institutional Services of the Indiana State Board of Health. Her goal was to upgrade the quality of nursing in general hospitals throughout the state. During this time she developed her definition of nursing practice. • 1958-1960 U.S. Department of Health, Education and Welfare where she helped publish “ Guidelines for Developing Curricula for the Education of Practical Nurses” 1959.

Development of Theory • 1959 Orem served as an assistant professor of nursing education at CUA, subsequently serving as acting dean of the school of nursing. She continued to develop her concept of nursing and self care during this time. • Orem’s Nursing: Concepts of Practice was first published in 1971 and subsequently in 1980, 1985, 1991, 1995, and 2001. • Continues to develop her theory after her retirement in 1984.

Achievement • 1976 and 1980 Honorary Degree of Doctor of Science. • 1980 CUA Alumni Association Award for Nursing Theory. • 1988 Doctor of Humane Letters from Illinois Wesleyan University. • 1988 Linda Richards Award. • 1991 National League for Nursing. • 1992 Honorary Fellow of the American Academy of Nursing. • 1998 Doctor of Nursing Honors Causae from the University of Missouri.

Metaparadigm Concept • Person: An individual with physical and emotional requirements for development of self and maintenance of their well-being. • Environment : Client’s surroundings which may affect their ability to perform their self-care activities. • Health: “Structural and functional soundness and wholeness of the individual” (Orem 1991). • Nursing: The acts of a specially trained and able individual to help a person or multiple people deal with their actual or potential self-care deficits.

The Concepts Unique to the Dorothea Orem Model • Each person has a need for self-care in order to maintain optimal health and wellness of mind, body and spirit. • Orem's theory of self-care is separated into three conceptual theories which include: self-care, self-care deficit and nursing system. • The concept of self-care theory is broken into three components: universal self-care needs, development self-care needs and health deviations.

Theory of self-care • The components of universal self-care includes activities which are essential to health and vitality including “8” elements. • The eight elements are air, water, food, elimination, activity, rest, solitude, social interaction, prevention of harm, and promotion of normality. • All of the universal self-care requisites are validating human structure and functional integrity at different stages of the life cycles. • a

Developmental self-care • Development of self-care includes interventions and teaching designed to promote development and return a person to or sustain a level of optimal health and well being.

Health Deviation of Self-care • This encompasses the variations in self-care of people who are injured, ill and/or have disability.

Theory of Self-Care Deficit • Self-care deficit is a term used to define the relationship between the actions that are capable by an individual and their demands for care. • Self-care deficit is an abstract concept, when expressed in the terms of action limitation. It provides guides in helping and understanding patient role in self-care. • The nursing action of self-care deficit focuses on the identification of limitations and implements appropriate interventions to meet the needs of the person.

Theory of Nursing Systems • The theory of the nursing system is the ability of the nurse to aid the person in meeting current and potential self-care demands. • The nursing system consists of support modalities of which involve how much support will be considered for each person.

Other unique concepts to the model • The ultimate uniqueness of this model is that the nurse can only make assessments where there is direct contact between the nurse and the client and or the family. • Another uniqueness is that the theory is applied to many undergraduate nursing curriculum and that it helps in the nursing process by creating a nursing care plan specific to the self-care and self-care deficit.

How the model is used in clinical practice • Dorothea Orem’s self care model is used everyday in the clinical setting. • Patient education and discharge teaching is taught by the nurse to the patient or family member who will be caring for the patient. • These include the interventions and teachings that are necessary for a person to sustain or return to a level of good health.

Interventions • Wound Care • Dressing changes • Drain Care • PICC line Care • Diabetic Teaching • Smoking Cessation

How the model is used as a framework for patient assessment • There are ten factors that affect a person’s ability to perform self care • 1.Age • 2.Gender • 3.Developmental State • 4.Health State • 5.Sociocultural Orientation

Cont. factors to perform self care • 6. Healthcare system factors: medical diagnostics and treatment modalities • 7.Family system factors • 8.Patterns of living • 9.Enviromental factors • 10. Resource availability and adequacy

Factors that the nurse needs to assess for when deciding the patients ability for self care • 1. Ability to maintain attention • 2.Sufficient physical energy • 3. Ability to control position of the body and its part • 4. Ability to reason within a self care frame of reference • 5. Motivation

Cont. factors for assessment • 6. Ability to make decisions about care of self • 7. Ability to acquire technical knowledge • 8. Cognitive, communication, and interpersonal skills • 9. Ability to work toward final achievement of goals • 10. Ability to consistently perform self care operations

Cont. Assessment • As a nurse, we assess our patient’s everyday for their self care needs. • We may not even realize we are performing these skills. • Nurses communication with physicians regarding patients needs are the following: • Physical Therapy • Occupational Therapy

Cont. Communication of Needs • Speech Therapy • Medical-Social Work • Extended Care Facility • Home Care nurses and/or aides

Additional Framework • A person benefits from nursing intervention when their ability to perform self care is inhibited or a situation occurs where theory abilities are not sufficient to maintain their own health. • Nursing action focuses on the identification of deficits and implementing appropriate interventions to meet the needs of the person.

Orem’s model in the context of nursing education • The focus of Orem’s model of nursing is to enhance the patients ability for self care and extend this ability to care their dependents. • A person’s self care deficits are a result of their environment. • Three systems exist within the professional nursing model.

Three systems within the nursing model • The compensatory system, in which the nurse provides total care. • The partial compensatory system, in which the nurse and the patient share responsibilities for care. • The educative-development system, in which the patient has the primary responsibility for personal health, with the nurse acting as a consultant. • The basic premise of Orem’s model is that individuals can take responsibility for their health and the health of others, and in a general sense, individuals have the capacity to care for themselves and their dependents.

Orem’s self care deficit theory of nursing is composed of three related theories • 1. The theory of self care, describing how people care for themselves. • 2. The theory of self care deficit, which describes why people can be helped through nursing. • 3. The theory of nursing systems describing and explaining relationships that must be initiated and maintained for nursing to be produced. • Self care is what a person does to establish and maintain their health, personal development and well-being.

Additional info. on the context of nursing education • There is work ongoing for development of the theory of dependent care, the use of the theory in primary care, and development of variations of care systems such as concepts of collaborative care. • Orem’s theory is useful in designing curricula for pre-service, graduate, and continuing nursing education. • It can also give direction to nursing administration, and be used for guiding practice and research. • It gives direction to nurse-specific outcomes related to knowing and meeting the therapeutic self care demands, and establishing self care and self management systems.

Current research status of the model The history of professional nursing begins with Florence Nightingale Later in last century began with a strong emphasis on practice Following that came the curriculum era which addressed the questions about what the nursing students should study in order to achieve the required standard of nursing As more and more nurses began to pursue higher degrees in nursing, there emerged the research era Later graduate education and masters education was given an importance The development of the theory era was a natural outgrowth of the research era

Research cont. • With the increased number of researchers it became obvious that the research without theory produced isolated information, however research and theory produced the nursing sciences. • Within the contemporary phase there is an emphasis on theory use and theory based nursing practice and lead to the continued development of the theories.

Strengths of the Model • The strengths of the model are clarity and simplicity of the model. • Clarity involves the terms that are limited precisely defined and used consistently. • Consistent language used throughout nursing theory, action theory and philosophy.

Strengths cont. Applies to all instances of nursing. Those engaged in nursing practice. Those engaged in development and validation of nursing knowledge. Those engaged in teaching and learning nursing.

Limitations of the Self Care Deficit Theory • Clarity: Readers who lack familiarity with practical science and the field of action science may have difficulty with Orem’s language. • Instruments of measurement have not been developed for all entities of the theory. • Example: There has been no instrument developed to measure the entity of “nursing agency”.

Overall analysis of the Model • Orem’s Theory is based on the single element of self care. • Orem describes self care as the practice of activities that an individual initiates and perform on their own behalf in maintaining life, health, and well-being. • Orem’s self care deficit theory is used in most hospital setting to which the patient become unable to or needs to learn how to maintain life, health and well-being. • The patient is provided with tools and resources directly by the nurse.

Cont. analysis of the model • The model also helps 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 and establishing self care. • Ultimately, the theory describes what a person requires and what actions need to be taken to meet the requirements of well-being.

New insight about the Model • It is found that Self care deficit theory of nursing has allowed nurses to see nursing a practical science. • The theory has brought unity and the meaning of nursing and the domain action of nursing. • Allowing us to have a clearer view on the field. • Dorothea Orem feels that all nurses need to understand that theory merely points to the situation you have to deal with in the real world and simply help to understand those situations. • Self care deficit is found to fit into any nursing situation related to the fact that it is a general theory and can truly be used in any situation.

Game On!! Next we will play a game and see which team can create a quick care plan and relate it to Dorothea Orem self care deficit. Put your thinking caps on 

The End Thank You, Dr. Jamieson and class!!!

References • Alligood,M.R., Tomey, A.M. (2006). Nursing theorists and their work (6th ed.). St.Louis, MO: Mosby-Year Book Inc. • Fawcett, J. (2001). Nursing Science Quarterly, Vol.14(1). Pp.34-38. Retrieved November 24th, 2008. • Kearnery-Nunnery, R. (2005). Advancing your Career: Concepts of Professional Nursing. In J.P DaCunha, C. Abramowitz, & K. Kern (Eds.),TheoreticalBasis of Nursing Practice (pp. 73-76). Philadelphia, PA:F.A. Davis Company • Orem, D.E. (1991). Nursing: Concepts of practice (4th ed.). St. Louis, MO: Mosby-Year Book Inc. • Whelan, E. G. (1984). Analysis and application of Dorothea Orem’s Self-care Practice Model. Retrieved November 30, 2008.

• More by User

Dorothea Orem

Dorothea Orem. Self-Care Deficit Theory of Nursing. Background. Born in 1914 in Baltimore, MD Diploma degree from Providence Hospital School of Nursing Earned a BSN Ed from Catholic University of America

684 views • 27 slides

Self Control Theory

Self Control Theory. Self-control theory. Hirschi collaborated with Gottfredson (1990) to develop the theory with the only one type of control – self-control They did not clarify how their self-control theory relates to Hirschi’s social bonding theory

3.62k views • 15 slides

Nursing Theorist: Dorothea Orem Self-Care Deficit Theory

Nursing Theorist: Dorothea Orem Self-Care Deficit Theory. Presented by MSN Students: Cheryl L Holz RN, BSN Anna Marshall RN, BSN. Dorothea Orem 1914- June 22,2007 Born in Baltimore, Maryland Died at home in Skidaway Island. Education:

1.04k views • 52 slides

OREM. Self-Care Deficit Theory . Self-Care Deficit Theory. “The inabilities of people to care for themselves at times when they need assistance because of their state of personal health” (Orem 1959 Orem described her work as a general theory of nursing: Theory of Self-Care

2.18k views • 13 slides

DOROTHEA OREM:

1.48k views • 43 slides

Theory of self-care

Dorothea Orem. Theorist : Dorothea Orem (1914-2007) Born 1914 in Baltimore, US Earned her diploma at Providence Hospital – Washington, DC 1939 – BSN Ed., Catholic University of America 1945 – MSN Ed., Catholic University of America

511 views • 10 slides

Dorothea Orem’s Self-Care Framework

Dorothea Orem’s Self-Care Framework. Zachary Medler Emily Williams Sara Kinne. Dorothea Orem, 1914-2007. Issues and Purpose. Questions or Problems to Solve.

625 views • 45 slides

Dorothea Orem. Nursing Theory. Dorothea Orem. 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 . Dorothea Orem.

1.66k views • 23 slides

Dialogical Self Theory

Dialogical Self Theory . Dialogical Self Theory State of the Art Hubert Hermans International Institute for the Dialogical Self. Inspired by Mikhail Bakhtin. Inspired by William James. Overview . Overview - Summary Dialogical Self Theory - Different conceptions of dialogue

954 views • 31 slides

Orem’s Self-Care Deficit Nursing Theory

Orem’s Self-Care Deficit Nursing Theory. Orem’s Self-Care Deficit Nursing Theory (SCDNT). Original Source Impetus was to define content for practical nursing curricula for Department of Health, Education, and Welfare

1.4k views • 10 slides

Presented by Melissa Kurek , Nicholas Kurek , Kimberly Marino and Heather Nowak Dorothea Orem’s Theory of Self Care D

Presented by Melissa Kurek , Nicholas Kurek , Kimberly Marino and Heather Nowak Dorothea Orem’s Theory of Self Care Deficit. Born in Baltimore, Maryland in 1914. Orem’s parents. Mother was a homemaker. Father was a construction worker.

977 views • 35 slides

Dorothea Orem Self-Care Deficit Theory

Dorothea Orem Self-Care Deficit Theory. Presented by: Shoughlah Niaz RN. Dorothea Orem . Born in Baltimore, MD in 1914 Began Nursing Career in Providence Hospital in Washington DC, received her nursing diploma Complete BSN in 1939 and her MSN in 1946 at Catholic University of America

11.71k views • 11 slides

Self Care!!!!!!!

Best Practices : Counseling Foreclosure Prevention Clients. Self Care!!!!!!!. Develop boundaries – Stay consistent. Listen to the client! – What are their goals?. Have Empathy and not Sympathy. Have the FACTS. Know your “Role”. Develop Relationships / Network.

208 views • 5 slides

Self Care. By Kelly Amaturo. How to practice self care!. Drink lots of bottled water. Stretch with intention. Whenever you catch yourself feeling tight or stiff, take a few minutes to focus on the area of your body talking to you and stretch in anyway that feels good.

643 views • 10 slides

Dorothea Orem. Jessica Collings Kevin Doan Julie Walker. Purpose and Issues. Why do we need nurses? How did Orem define nursing practice? How does her definition differ from other nursing theorists? What does this look like in daily practice?

1.45k views • 20 slides

Dorothea Orem’s Self-Care Framework. Zachary Medler Emily Williams Sara Kinne. Dorothea Orem, 1914-2007 . Issues and Purpose. Questions or Problems to Solve.

1.59k views • 45 slides

Dorothea Orem. Why do people need nursing?. Jennifer Ames Charles Dietrich Holly Leveille.

4.47k views • 25 slides

Self-Determination Theory

Self-Determination Theory (SDT) has grown out of the research on motivation performed by Richard M. Ryan and Edward L. Deci both of the University of Rochester (Ryan and Deci , 2000a). SDT establishes three internal needs that we seek to satisfy: competence, relatedness and autonomy.

1.82k views • 3 slides

Theology of Self Care

Theology of Self Care. NACC Audio Conference July 29, 2010 (Session Two). Presented by: Elizabeth Berne DeGear, Ph.D. cand., BCC and Mary Winters, R.N. Overview of Jung’s Concept of the Religious Function.

372 views • 12 slides

Self Care. An overview of the national Self Care landscape AWC Health and Well Being Hub 4 March 2014 Tina Butler Self Care Lead. What is Self Care?.

663 views • 11 slides

Dorothea Orem. Nursing Theory. Dorothea Orem. 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. Dorothea Orem.

2.08k views • 23 slides