DOROTHEA OREM

Born:1914, Baltimore, Maryland.

Father: construction worker

Mother: homemaker

Youngest of two girls

Died: June 22, 2007

EDUCATION

BSN Ed. (1939) and MSN Ed. (1945), Catholic University of America, Washington DC.

Doctor of Science Georgetown University, (1980)

Doctor of Humane Letters (1988) Illinois Wesleyan University, Bloomington, Illinois.

Doctor of Nursing Honoris Causae, (1998) University of Missouri.

AWARDS AND HONOUR

Catholic University of America Alumni Achievement Award for Nursing Theory (1980)

Linda Richards Award, (1991)

Honorary Fellow of the American Academy of Nursing (1992).

DEVELOPMENT OF THEORY

• Developed between 1959 and 2001

• Known as ‘self care model’ of nursing

• Used in rehabilitation and primary care settings

DOMAINS OF OREM’S THEORY

PERSON

ENVIRONMENT

HEALTH

NURSING

PERSON

“…An integrated whole composed of an internal physical, psychologic, and social nature with varying degrees of self-care ability”

(Chinn & Kramer, 2004)

According to OREM person is

• Recipient of nursing care

• Self care agent

• Potential for learning, development

• Self knowledge

• Learn to meet self care needs

ENVIRONMENT

“…Prevailing internal and external conditions in some time and place frame of reference.”

Client’s surroundings which may affect their ability to perform their self-care activities.

HEALTH

“A state of physical, mental, and social well-being, and not merely the absence of disease or infirmity" (WHO)

Person should be structurally and functionally whole or sound.

IT INCLUDES:

Promotion & maintenance of health,

Treatment of disease,

Prevention of complication.

NURSING

“An art through which the practitioner of nursing gives specialized assistance to persons with disabilities of such a character that greater than ordinary assistance is necessary to

meet daily needs for self care and to intelligently participate in the medical care they are receiving from the physician”

GOALS OF NURSING:

To render the patient or members of his family capable of meeting the patient’s self care needs.

To maintain a state of health.

To regain normal or near normal state of health in the event of disease or injury.

To stabilize, control, or minimize the effects of chronic poor health or disability.

COMPONENTS OF NURSING(eight)

NURSING ART:

The intellectual quality of nurses which allows them to make creative investigations, analyses, and syntheses of variables and conditioning factors in nursing situations.

NURSING PRUDENCE:

The quality that enables the nurse to seek advice in new or difficult situations, to make correct judgments, to decide to act in a particular manner, and/or to act.

NURSING SERVICE:

A human service that focuses on a person’s inabilities to maintain health care.

NURSING CLIENT:

A human being who has "health related /health derived limitations that render him

incapable of continuous self care or dependent care.

NURSING PROBLEM:

These are the deficits in universal, developmental, and health derived or health related conditions.

NURSING PROCESS:

It is a system to determine

(1)why a person is under care.

(2)a plan for care.

(3)the implementation of care.

NURSING THERAPEUTICS:

Deliberate, systematic and purposeful action.

NURSING AGENCY: A complex property of people educated and trained as nurses that enables them to act, to know, and to help others meet their therapeutic self-care demands.

MAJOR ASSUMPTIONS

1.Human beings require continuous, deliberate inputs to themselves and their environments to remain alive and function according to their capacity.

2. Human agency is exercised in the form of care for self and others in identifying and meeting needs.

3. Mature human beings experience privations in the form of limitations for action and care for self and others involving life-sustaining and function regulating inputs.

4.Human agency is exercised in discovering, developing, and transmitting ways and means to identify needs and make inputs to self and others.

5. Groups of human beings with structured relationships of clustered tasks and allocate responsibilities for providing care to group members who experience privations for making required deliberate input to self and others.

OREM’S GENERAL THEORY OF NURSING

• Theory of self care deficit

• Theory of nursing systems

• Theory of self care

THEORY 1: SELF CARE THEORY

Based on the concepts of:

Self care

Self care agency

Self care requisites

Therapeutic self care demand

SELF CARE THEORY CONCEPTS

1. SELF CARE:

The performance of activities that individuals initiate and perform on their behalf to maintain life, health, and well-being.

When self care is effectively performed, it helps to maintain structural integrity and human functioning, and it contributes to human development.

2. SELF CARE AGENCY:

It is the individual’s ability to perform self-care activities

Consists of two agents:

Self-care Agent

Dependent Care Agent

Affected by basic conditioning factors such as age, health state, environmental factors etc.

3. SELF CARE REQUISITES:

The reasons for which self-care is done; these express the intended or desired results

The totality of “self care actions to be performed for some duration in order to meet known self care requisites”

SELF CARE REQUISITES

• Universal

• Developmental

• Health deviation

1.UNIVERSAL SELF CARE REQUISITES:

Associated with life processes and the maintenance of the integrity of human structure and functioning.

Common to all human beings during all stages of the life cycle

Orem identifies universal self-care requisites as follows:

Sufficient intake of air.

Sufficient intake of water.

Sufficient intake of food.

Maintenance of a balance between activity and rest.

Maintenance of balance between solitude and social interaction.

Prevention of hazards to human life, human functioning, and human well-being.

Promotion of human functioning and development within social groups.

Provision of care associated with elimination processes and excrements.

2.DEVELOPMENTAL SELF CARE REQUISITES:

Development self care requisites promote processes for life and maturation, events.

E.g. adjusting to a new job, adjusting to body changes..

3. HEALTH DEVIATION SELF CARE REQUISITES:

These self care requisites are required in conditions of illness, injury, or disease.

4. THERAPEUTIC SELF CARE DEMAND:

The totality of “care measures” necessary at specific times or over a duration of time for meeting an individuals self-care requisites by using appropriate methods and related sets and actions.”

THEORY 2: SELF CARE DEFICIT NURSING THEORY

Central focus of Orem’s grand theory of nursing.

Nursing is required when adults (parent/guardian) are incapable of or limited in their ability to provide continuous effective self-care.

Describes and explains how people can be helped through nursing.

Nursing meets these self-care needs through five methods of help.

FIVE METHODS OF NURSING HELP

1. Acting or doing for another.

2. Guiding and directing.

3. Providing physical or psychological support.

4. Providing and maintaining an environment that supports personal development.

5. Teaching.

From this model it can be seen that at any given time an individual has specific self care abilities as well as therapeutic self care demands.

If there are more demands than abilities, nursing agency is needed.

THEORY 3: THEORY OF NURSING SYSTEM

A nursing system is all of the actions and interactions of nurses and clients in nursing practice.

Designed by the nurse.

Based on the assessment of patient’s ability to perform self-care activities

CLASSIFICATION OF NURSING SYSTEM

Wholly Compensatory system

Partly Compensatory system

Supportive-educative system

1. Wholly Compensatory: a patient’s self-care agency is so limited that he/she depends on others for well-being.

E.g.. Coma patient, patients with orthopedic surgery etc

Nurse Action

• Accomplishes patient’s therapeutic self-care

• Patient action limited

• Compensates for patient’s inability to engage in self-care

• Supports and protects patient

2.Partly Compensatory: a patient can meet some self-care requisites but needs a nurse to help meet others; either the nurse or the patient have the major role in the performance of self-care

E.g. A patient with recent abdominal surgery

3.Supportive-educative: a patient can meet self-care requisites but needs help in decision-making, behavior control, or knowledge acquisition; the nurse’s role is to promote the patient as a self-care agent (teacher/consultant)

E.g. a 16-year-old who is requesting birth control information

• Patient action

• Accomplishes self-care

• Regulates the exercise and development of self-care agency

• Nurse action

• Regulates the exercise and development of self-care agency

OREM’S THEORY AND NURSING PROCESS

STEP 1-collect data in six areas:-

1. the persons health status

2. the physician’s perspective of person’s health status

3. the person’s perspective of his/her health status

4. the health goals within context of life history,life style and health status

5. the persons requirement of self care

6. the person’s capacity to perform self care

STEP-2

1. Wholly Compensatory system

2. Partly Compensatory system

3. Supportive-educative system

STEP-3

• Nurse assists the patient and family

• Actions directed by nursing diagnosis

• Evaluation

•

• APPLICATIONS OF THEORY

PRACTICE

Health promotion and care of the sick

Teaching self-care to individuals

Renal failure, hemo/peritoneal dialysis, renal transplant

Post-stroke conditions

Malignancies

Elderly, neonates and various conditions also such as in study of Paediatric patient controlled analgesia: enhancing self care construct(Vesely.c.(1995), paediatric nursing,21(2), 124-8)

EDUCATION

• Guides for developing curriculum for the educational of practical nurse.

• Orem book of Foundations of nursing and its practice which was published and used at Morris Harvey College.

• Orem’s self care deficit theory is) used in Evaluation of education material (Faleta.E.Alison and et al, nursing science quarterly, 2003

RESEARCH

• The development of research instruments for measuring the conceptual elements of the theory:

• The first instrument to measure the exercise of self care agency (ESCA) was published in 1975.

• A self care questionnaire was developed and tested by Moore (1995) for the special purpose of measuring the self care practice of children and adolescents.

• Orem’s theory of self care deficit was used in design of the Self –As-Carer Inventory(SCI)

• Used for various operational definitions as a basis for research.

• Used theoretical framework such as self care or therapeutic self care demand, to guide for the research.

• Author • Year • Topic • Results

• Moore, Jean Burley

Kaur , Manpreet

• Nursing

• Science quarterly, 2006

NINE, PGIMER, 2005

• self care operations and nursing interventions for children with cancer and their parents.

An operational study on maintenance of hair hygiene among women at resettlement colony, U.T., Chandigarh

• Children and parents performed estimative, productive operations to meet self care requisites following various nursing interventions.

•

• Supportive education and compensatory roles as carried out by nursing agency helped the subjects in maintenance of hair hygiene and strengthened their self care ability

POSITIVE ASPECTS OF THE THEORY

Provides a comprehensive base to nursing practice.

Presented in a straightforward, simple manner.

Relationship among entities can be presented in a simple diagram.

Specifies when nursing is needed.

Also includes continuing education as part of the professional component of nursing education.

Her self care approach is contemporary with the concepts of health promotion and health maintenance

Expanded her focus of individual self care to include multiperson units.

LIMITATIONS OF THE THEORY:

Health is often viewed as dynamic and ever changing .Orem’s visual presentation of the boxed nursing systems implies three static conditions of health.

RESEARCH STUDIES

Appears that the theory is illness oriented rather with no indication of its use in wellness settings.

Term Therapeutic self care demand needs more explanation.

 SUMMARY

Orem’s general theory of nursing is one of the major theories. It composed of three constructs. It is based upon the philosophy that all "patients wish to care for themselves".

They can recover more quickly and holistically if they are allowed to perform their own self cares to the best of their ability.

Throughout her work, she interprets the concepts of human beings, health, nursing and society and has defined 3 steps of nursing process.

It has a broad scope in clinical practice and to lesser extent in research, education and administration.

 REFERENCES

Tomey. Ann mariner(2001):conceptual models and grand theories, nursing theorists and their work: pg no. 189-200

Hartweg l. Donna(1991), Dorothea Orem(self care deficit theory): notes on nursing theories: sage publications, 1-39

http//www.google.com(Orem model of nursing From Wikipedia, the free encyclopaedia)

Taylor.G.susan(2007).tribute to the theorist:Dorothea Orem over the years, nursing science quarterly, vol. 20 no. 2, April, 106.

Basford .Lynn, Jlevin Oliver. An integrated approach to caring practices. Theories and practices of nursing, 2nd edition, 266-267.

REFERENCES contd…..

Sarah E. Allison(2007) Self care requirements for activity and rest: An Orem Nursing focus, Nursing Science Quaterly,vol 20,pg 68-76

Jean Burley Moore, Asher E. Beckwitt(2006) Self care operations and nursing interventions for children with cancer and their parents, nursing Science Quaterly,vol 19,147-156

Feleta Wilson, Darlene W.Wood(2003) Evaluation of education materials using Orem’s self care deficit theory, Nursing science Quaterly,vol 16,68 

Richardson Alison (1992). Studies exploring self care for the person coping with cancer treatment; a review, international journal of nursing studies., vol 29, no. 2, 191-204