Self-Care Deficit theory Dorothea Orem

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Overview about Orems theory:Orem's CV Origins Purpose Philosophy and world view Metaparadigm Concepts Assumptions and Propositions Theories included in the Self-Care Deficit theory

Orems Theory and Nursing process

Time oriented
Peplau: Orem: Roy: Rogers: King: Newman: Published at 1952. Published at 1959. Published at 1960. Published at 1970. Published at 1971 Published at 1989

Dorothea Orem C.V.

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1939 BSN completed 1945 - MS in nursing education 1958 - consultant to the Office of Education where she began working on her SELF-CARE THEORY 1959 - first published her theory in Guides for Developing Curricula for the Education of Practical Nurses (a government publication)

Dorothea Orem C.V.

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1976 - honorary Doctorate of Science from Georgetown University 1980: Award for nursing theory from catholic university of America. 1999 - last edition of her theory was published

Publications
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1959: Guidelines For Developing Curricula For The Education Of Practical Nurse 1962: The Hope Of Nursing 1971: Nursing: Concept And Practices 6th edition in (1999). 1972: Concept Formalization In Nursing: Process And Product. 1979: Levels of nursing education and practice

Origin
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While Orem was working in the Department of Health Education and Welfare (HEW) as a curriculum consultant she worked to upgrade practical nursing training. That stimulated the need to address the question
What is the subject matter of nursing? (Curriculum)

Origin
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contd.

Orems book of guidelines for developing curricula for the education of practical nursing was the seed for her work (Orem,1959 in Fawcett 1995) and (Meleis, 1998). To conceptualize a curriculum for a diploma program by isolating and specifying nursing action.

Origin
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contd.

Ideas that helped to shape the self-care framework were formulated as Orem experienced a period of intensive exposure to nurses and their endeavors from 1949 to 1957 (Fawcett, 1995).

Philosophical view

Orem has identified her philosophical view based on the action theory, from the perspective of the person as a deliberate actor or agent.

Philosophical view contd.

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Orem model is based upon the philosophy that all patients wish to care for themselves and its purpose was to define the following:
Nursing concern is on the mans needs for self-care action and the provision and management of it on a continues basis in order to sustain life and health, recover from disease or injury and cope with their effect. n Nursing goal is overcoming human limitations ( Berbelgia, 2002).
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World View
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World view referred to the physiologic assumptions about the nature of person environment relationship. Orem: adopted the organicism rather than mechaniscism as world view, she proclaimed that man include internal physical, psychological and social nature with the change rather than stability.

World View contd.

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She stated that man and environment interact as a self-care system. A change in either the system of man and the system of the environment will affect the selfcare system. Orem states: Man functioning is linked to his environment and together man and environment form an integrated whole system. Keywords that support this view: change, w hole, interaction, m an and environment.

Conceptual Models
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Nursing models are categorized according to the discipline or anthropology from which they were derived. It is clear in Orems theory that she used developmental model (Montgomery,2004). Also, Meleis (1998) viewed that Orems theory could be categorized as an interaction model.

Theory Development Strategy

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The theory development strategy used by Orem was induction from practice. Induction from practice is clearly evident in Orems detailed accounts of how concepts in the theory were determined and defined based on experience in concrete nursing practice situations or results of analysis of nursing care materials (Orem,1991)

Theory Development Strategy contd.

Orem did however read widely and identified some of major influences on her thinking, suggests that there was an element of deduction in her work (Montgomery,2004). Sources of influences include ideas about deliberate human actions and motivation.

Theory Development Strategy contd.

Factors influencing development:
Practical nursing curriculum development n Womens movement n Nursing theory conferences
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Basic Elements in the Model

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The structure and components of the self -care framework have undergone various interpretations overtime. Orem (1991) explained all of the conceptual elements of the self-care framework were formalized and validated as static concepts by 1970. Since then, some refinements of expression and further development of substantive structure and continued validation have occurred and changes have been made (Fawcett,1995).

Three theories in the model

Self-care Deficit Theory

Theory of Self-care

Theory of Nursing System

Structurally, each theory is presented as a set of assumptions, and a set of propositions.

Main Concepts in the Model

Self-care
Self-care agency
Self-care demand

Self-care deficit Nursing Agency Nursing System

Model Metaparadigm- Nursing

Orem viewed nursing as :A community service, an art and a technology. Community ( is a group of individuals and families who share not only a common geographic area but common Interest. As a health service: in the community : It is an interpersonal process that requires the social encounter of a nurse with a patient (transaction process) based on the values of that community. Art: As an art, it is the ability to assist others in the design, provision and management of systems of self-care to improve or to maintain human functioning at some level of effectiveness

Model Metaparadigm- Nursing

Technology: techniques of practice 1- Communicating with persons in states of health and disease. 2- Maintaining interpersonal, intragroup, and intergroups relationships for cooperative efforts. 3-Giving human assistance adapted to specific human needs & limitations. 4- Maintaining and controlling the positions and movements of persons in physical environment for therapeutic purposes. 5- Promoting process of human growth and development including self or ego development. 6-Sustaining and maintaining life process. 7- Appraising, changing and controlling psycho-physical modes of human functioning in health and disease. 8- Maintaining therapeutic relations based on psychosocial modes of human functioning in health & disease.

Model Metaparadigm Nursing

Nu rsin g
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It is the ability to assist others in design, provision and management of selfcare to improve or maintain human function at some level of effectiveness.

Methods of Nursing Help

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Acting or doing for Guiding & directing another Teaching another Providing psychological and physical support. Providing a supportive environment to promote the patients ability to meet current or future demands.

Model Metaparadigm
Health
As a state of being

Sound

whole

Strength

Vigor

Absence of disease

Nothing is Missing

Or Diminished

Model Metaparadigm Health

Hea lt h
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Not only a bodily state but also to how one functions in everyday living and progressive development that is movement toward higher and higher level of integration and functioning.

Model MetaparadigmENVIRONMENT
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Person and environment are a functional unit in which exchange are reciprocal and influence is mutual. Persons are viewed as existing in their environments and never isolated from them. 4 environmental features (physical, chemical, biologic and social) have an impact on the health and well- benign the person and the family.

Model Metaparadigm - PERSON

Per son
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The recipient of nursing care A being who functions biologically, symbolically, and socially Has the potential for learning & development Is subject to the forces of nature Has a capacity for self -knowledge Can engage in deliberate actions, interpret experiences, and perform beneficial actions Can learn to meet self-care needs (requisites)

Model Metaparadigm - PERSON

Per son

Human beings are distinguished from other

living beings by their capacity to:
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Reflect upon themselves and their environment Use symbolic creations (ideas, words) in thinking, communicating, and guiding efforts to make things that are beneficial for themselves and/or for others Man and environment form an integrated system . A change in either component may affect the self -care system.

Orems Self-care Theory

Based on the concepts of: n SELF-CARE n SELF-CARE AGENCY n SELF-CARE REQUISITES n THERAPEUTIC SELF-CARE DEMAND

Self-care Definition
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Self-care
The practice of activities that mature person initiates and performs independently within time frame, to promote and maintain personal well-being, healthful functioning and continuing development throughout life.

Orems Self-care Agency

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Definition: the individuals ability to perform self-care activities (capabilities of the person) It is a complex acquired abilities to meet ones continuous requirement for care. Consists of TWO agents:
Self-care Agent - person who provides the self care and has the power to do so n Dependent Care Agent - person other than the individual who provides the care (such as a parent)
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Orems Self-care Requisites (also

called Self-care Needs)
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Definition: the expressions of action to be performed by or for individuals for controlling human and environmental factors that affect human functioning and development Three types of self-care requisites constitute the therapeutic self- care demand: n Universal - requisites/needs that are common to all individuals. 1- Air, water and food 2- elimination and excrements

Orems Self-care Requisites contd.

3- activity/rest 4- solitude (aloneness) /social interaction 5-prevention of hazards to life and well-being (physical , social & psychological hazards). 6-promotion of function and development within social group based on group norms.

Orems Self-care Requisites

(also called Self-care Needs)
Developmental Actions that need to be performed in relation to human developmental processes , conditions and events and relation to events that adversely affect development. Health Deviation exists for persons who are ill or injured have specific forms of pathologic conditions (including defects and disabilities & who are under medical diagnosis and treatment.. n Needs resulting from illness, injury & disease or its treatment

Self-Care Deficit
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The relationship between self-care agency (ability to perform self-care) and the therapeutic self -care demand in which self care agency is not sufficient to meet ones therapeutic self-care demands. Dependent- care deficit exists when the persons ability to perform dependent-care (i.e., dependentcare agency) is not sufficient to meet the socially dependent persons therapeutic self care demand). Deficit can be complete or partially and as such indicate whether wholly or compensatory system.

Therapeutic Self-care Demands

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The sum of self-care measures/ actions, required to meet the specific self-care requisites of a person at a point in time.

Assumptions & Propositions

Assumptions (explicit)
deliberate For the sake Of others Nursing

purposeful

Performed By nurses

Helping service

Nursing is a deliberate , purposeful helping service performed by nurses for the sake of others over a period of time.

Assumptions (explicit)
Capable & willing

Dependent member

Person

Perform Self-care

For self

Persons are capable and willing to perform selfcare for self or for dependent members of the family.

Assumptions (explicit)

Health

Self care necessity Well being Human development

Self care is part of life that is necessary for health human development & well-being.

Assumptions (explicit)
Education

Individual

Culture

Education and culture influence individuals.

Assumptions (explicit)
Human interaction

Self-care is learned through

communication

Self-care is learned through human interaction and communication.

Assumptions (explicit)
deliberate

Needs for care

Self-care

Systematic actions

Performed To meet

Self-care includes deliberate and systematic actions performed to meet needs for care.

Assumptions (implicit)
Self-reliant

Dependent others in the family

People Should be

Responsible for

Own care needs

People should be self - reliant and responsible for their own care needs as well as others in the family who are not able to care for themselves.

Assumptions (implicit)
Entities

people Environment
Distinct from others

People are individuals with entities that are distinct from others and from their environments.

Propositions
Person and nursing client:
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Human beings have capabilities to provide their own self-care or care for dependents to meet universal, developmental and heath deviation self-care requisites. Self care abilities are influenced by age, developmental state experiences and sociocultural background. Self-care deficits are to balance between self-care demands and self-care capabilities and an indication of a state of social dependency..

Propositions Cont
Nursing Therapeutic
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Therapeutic self -care includes actions of nurses, patients, and others that regulate self care capabilities and meet self -care needs. Nurses assess the abilities of patients to meet their self-care needs. Nurses engage in selecting valid and reliable processes , or technologies or action for meeting selfcare demands. Components of therapeutic self-care are wholly compensatory, partly compensatory and supportive educative.

Orems General Theory of Nursing

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Consists of three related theories collectively referred to as Orems General Theory of Nursing:

1. 2. 3.

Self-care Theory Self-care Deficit Theory Nursing Systems Theory

Orems Self-care Theory

Based on the concepts of:
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SELF-CARE SELF-CARE AGENCY SELF-CARE REQUISITES THERAPEUTIC SELF-CARE DEMAND

Self-care Definition
Self-care comprises those activities performed independently by an individual to promote and maintain personal well-being throughout life.

Orems Self-care Deficit Theory

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Is the central focus of Orems Grand Theory of Nursing Explains when nursing is needed Describes and explains how people can be helped through nursing Results when the Self-care Agency (patient) can t meet her/his self-care needs or administer self-care Nursing meets these self-care needs through five methods of help

Orems Nursing Systems Theory Describes...

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Nursing responsibilities Roles of the nurse and patient Rationales for the nurse-patient relationship Types of actions needed to meet the patients demands

Orems Nursing Systems Theory

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Refers to a series of actions a nurse takes to meet a patients self-care needs Is determined by the patients self-care needs Is composed of THREE systems:
Wholly compensatory n Partly compensatory n Supportive-educative
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Three Nursing Systems

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Wholly Compensatory: a patients self-care agency is so limited that s/he depends on others for well-being Partly Compensatory: a pt can meet some self-care requisites but needs a nurse to help for others. Supportive-educative: a pt can meet selfcare requisites but needs help in decisionmaking, behavior control, or knowledge acquisition

Orem's theory, Nursing process &Critical thinking operations

Critical Thinking Operations It includes four cognitive operations

Nursing process Assessment Diagnosis Planning

Intellectual Phase Step I: the initial and determination of needs Step II: the designing of system (Planning). Practical phase: Step III: Initiation, conduction & controlling of assisting actions.

Diagnostic Operation
Identify self-care practice, its limitation Perspective

Operations
Select the appropriate therapeutic method and explaining it to client

Implementation

Regulatory operations
Design plan and implement it.

Evaluation

Control operations
Evaluation of the effectiveness of regulatory operations