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Chapter 8

Dorothea Orems Self-Care Deficit


Theory
Developed by S. Gordon and C. Kain (2010)
Updated by D. Gullett (2014)

Copyright 2015. F.A. Davis Company

On completion of this chapter, students will be


able to:
1.
2.
3.
4.
5.
6.

Describe Orems Theory of Self-Care Deficit.


Identify the proper object of nursing identified in Orems Theory of
Self-Care Deficit.
List the abilities of humans to affect their health as identified by
Orem.
Compare and contrast self-care agency and dependent-care
agency.
Identify and describe major constructs of the Self-Care Deficit
Nursing Theory.
Describe the theoretical linkages between the Theory of Self-Care,
Theory of Dependent Care, Theory of Self-Care Deficit, and
Theory of Nursing Systems.

Copyright 2015. F.A. Davis Company

Chapter Purpose
Discuss the integration of views of humankind within
views of nursing
Discuss the differentiation between individual and
generally held nurse-specific views of human beings
as part of developing viable nursing science
Provide insight into model building and theory
development using exemplars from the Self-Care
Deficit Nursing Theory

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Nursing is Commonly Viewed


as:
Human health service
Implies two categories of human beings:
Those who need nursing service
Those who produce nursing service

FITNE interview: Dorothea Orem

Copyright 2015. F.A. Davis Company

Nursing as a Human Health


Service

Service implies nursing is a helpful activity


Health indicates that the main objectives of
the service is the structural and functional
integrity of persons served

General Theories of Nursing


Gives names and roles to the two categories of
human beings
Attributes distinct potential and actual human
powers, properties and actions of each human
Identifies the interactions among the types of
human beings and their powers, properties and
actions
Specifies the broad structural features of the
processes that produce nursing
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Integration of Views of Human


Beings
General views
You can study and think about human beings and
their situations without thinking about nursing.

Nurse-specific views
You cannot study and think about nursing without
incorporating nursing-specific views of human beings.

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Nursing Science
Knowing and seeking to extend and deepen
knowing by:
Understanding both the structure of the processes of
nursing
Understanding the internal structure, constitution,
powers, properties, and nature of those who require
nursing

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Comprehensive General Nursing Theories Address

What nurses do
Why they do it
Who does what
How they do it

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Valid General Nursing


Theories
Set forth nursings professional-technical
features specific to the production of nursing
Provides articulation with interpersonal features
of nursing and sets standards for safe effective
interpersonal systems
Point to the legitimacy of, or the need for change
in, societal-contractual systems

Copyright 2015. F.A. Davis Company

Model Building and Theory Development


Nursing-specific views of human beings are
necessary for understanding and identifying
(1) When and why individuals need and can be
helped through nursing
(2) The structure of the processes through which the
nursing help needed is determined and produced

Copyright 2015. F.A. Davis Company

Self-Care Deficit Nursing Theory


(SCDNT)
Began with formulations about the reasons why
individuals (the patient)
Need nursing and
Can be helped through nursing

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Central Idea
Mature human beings have learned and continue to
learn to meet some or all components of their own
Therapeutic Self-Care Demands (TSCDs) and the
TSCDs of their dependents (those for whom the
dependent care agent assumes or has responsibility
for meeting TSCDs).
Self-care and dependent care (i.e., care delivered by
someone other than the individual for the individual)
are time-specific entities produced by individuals.

Copyright 2015. F.A. Davis Company

Self-Care Deficit Nursing


Theory
Human properties and powers:
Individuals have a continuing demand for selfcare
Therapeutic Self-Care Demand (TSCD)
Care for self that must be learned and deliberately
performed

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Theory of Self-Care
Individuals have the human power to develop
and exercise capabilities to know and meet
Therapeutic Self-Care Demands using
Self-Care Agency (SCA)
First, investigate or identify what can or should be done.
Second, decide what can be done.
Third, produce the care
Involves Nursing Judgment

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Theory of Dependent Care


Assumptions relate to the nature of interpersonal
action systems and social dependency.

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Nursing Is Needed:
When Therapeutic Self-Care Demands exceed
an individuals Self-Care Agency because of
health state or health-carerelated conditions
There is a Self-Care Deficit (SCD)

When TSCD > SCA = SCD = Nursing Care is


Required
i.e., Stroke patient with uncontrolled blood
pressureNursing administers prescribed IV antihypertensive medications

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TSCD and SCA


Vary qualitatively and quantitatively over time
Identified as patient variables
Real or potential existence of a health-related
care deficit relationship between care demand
and the power of agency is the reason nursing is
required

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Nurse Agency
Critical power operative in nursing
The power of nurses to think about, design and
produce nursing care for others
Investigation of Nurse Agency and the
capabilities and conditions for its exercise are
critical components of nursing science

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Nurses Must Have Knowledge and


Skills
Investigating and calculating individuals TSCD
Determining degrees and development of SCA
Estimating potential for regulation of the exercise
or development of SCA
Identify, perform, and support an individuals
SCD when indicated

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Nursing Triad of Interrelated Action


Systems
Professional-Technical
Necessary for the production of nursingdependent on the
interpersonal system

Interpersonal
Interaction and communication necessary for design and
production of nursing

Societal
Established by the specifying contracting parties and their
legitimate relationships
Societal-contractual system
i.e. a Hospital system

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Broader Views of Human


Beings
Nurse-specific views of human beings fit within
broader views of human beings.
Orem identifies five broad views of human
beings that support the development of the
constructs of Self-Care Deficit Nursing Theory.
Broader views come into play when nurses think
about and produce nursing.

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View of Person
Human beings are:
Embodied with inherent rights
At once a self and a person
Person-as-agent

Central to understanding and integrating the other


views of human beings
Subsumes all other views
Essential to understanding nursing as a triad of
systems

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View of User of Symbols


Individual human beings are persons who use
symbols to:

Stand for things


Attach meaning to them
Formulate and express ideas
Communicate ideas and information to others

Essential to understanding the nursing interpersonal


system
Necessary for nurse-patient communication

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View of Organism
Individuals viewed as unitary living beings who
grow and develop biological characteristics of
homo-sapiens during known stages of the
human life cycle.
Requires knowledge of biology, psychology,
human physiology, environmental physiology,
pathology, and other sciences.

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View of Object
Human beings are viewed as having the status
of object subject to physical forces whenever
they act to protect themselves against such
forces.
Requirement for protective nursing care.
Taken when nurses provide care for infants,
young children, or adults unable to control their
positions and movements in space and contend
with environmental physical forces.

Copyright 2015. F.A. Davis Company

Conclusion
Nursing-specific views of human beings are
differentiated from general views of human
beings.
General views (human beings as energy fields,
living health, or culture-oriented or as caring
beings) are helpful in understanding humankind
but do not and cannot support viable nursing
science.

Copyright 2015. F.A. Davis Company