Dorothea OremDorothea Orem

Nursing Theory

Dorothea OremDorothea Orem

Early 1930’s - AD from Providence School of Nursing, Washington, D.C.

1939 – BSN completed1945 - MS in nursing education1958 - consultant to the Office of Education

where she began working on her SELF-CARE THEORY

Dorothea OremDorothea Orem

1959 - first published her theory in “Guides for Developing Curricula for the Education of Practical Nurses” (a government publication)

1976 - honorary Doctorate of Science from Georgetown University

1999 - last edition of her theory was published

Orem’s Definition of Orem’s Definition of NursingNursing

Nursing is the provision of self-care which is therapeutic in sustaining life and health, in recovering from disease or injury, or coping with their effects.

Nursing is a service to people, not a derivative of medicine.

Nursing promotes the goal of patient self-care.

Orem’s Nursing ProcessOrem’s Nursing Process

Consists of 3 steps:Step 1: determine why a patient needs careStep 2: design a nursing system & plan the

delivery of careStep 3: management of nursing systems -

planning, initiating, & controlling nursing actions

Orem’s General Theory of Orem’s General Theory of NursingNursing

Consists of three related theories collectively referred to as “Orem’s General Theory of Nursing”:

1. Self-care Theory: 3 types of self-care requisites (needs) or categories

2. Self-care Deficit Theory: 5 Methods of Assistance

3. Nursing Systems Theory

Orem’s Self-care TheoryOrem’s Self-care Theory

Based on the concepts of:SELF-CARESELF-CARE AGENCYSELF-CARE REQUISITESTHERAPEUTIC SELF-CARE DEMAND

Self-care DefinitionSelf-care Definition

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

Orem’s Self-care AgencyOrem’s Self-care Agency

Definition: the individual’s ability to perform self-care activities

Consists of TWO agents:– Self-care Agent - person who provides the self-

care– Dependent Care Agent - person other than the

individual who provides the care (such as a parent)

Orem’s Self-care Requisites Orem’s Self-care Requisites (also (also called Self-care Needs)called Self-care Needs)

Definition: the actions or measures used to provide self-care

Consists of THREE categories:– Universal - requisites/needs that are common to all

individuals– Developmental - needs resulting from maturation or

develop due to a condition or event– Health Deviation - needs resulting from illness,

injury & disease or its treatment

Orem’s Self-care Deficit Orem’s Self-care Deficit TheoryTheory

Is the central focus of Orem’s 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

Five Methods of Nursing Five Methods of Nursing HelpHelp

Acting or doing for Guiding Teaching SupportingProviding an environment to promote the

patient’s ability to meet current or future demands

Orem’s Nursing Systems Orem’s Nursing Systems Theory Describes...Theory Describes...

Nursing responsibilities Roles of the nurse and patientRationales for the nurse-patient relationshipTypes of actions needed to meet the

patient’s demands

Orem’s Nursing Systems Orem’s Nursing Systems TheoryTheory

Refers to a series of actions a nurse takes to meet a patient’s self-care needs

Is determined by the patient’s self-care needsIs composed of THREE systems:

– Wholly compensatory– Partly compensatory– Supportive-educative

Three Nursing SystemsThree Nursing Systems

Wholly Compensatory: a patient’s 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 meet others

Supportive-educative: a pt can meet self-care requisites but needs help in decision-making, behavior control, or knowledge acquisition

Orem’s Theory & Nursing’s Orem’s Theory & Nursing’s Metaparadigm - Metaparadigm - PERSONPERSON

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)

Orem’s Theory & Nursing’s Orem’s Theory & Nursing’s Metaparadigm - Metaparadigm - PERSONPERSON

Human beings are distinguished from other living beings by their capacity to:– Reflect upon themselves and their environment– Symbolize what they experience– Use symbolic creations (ideas, words) in thinking,

communicating, and guiding efforts to make things that are beneficial for themselves and/or for others

Orem’s Theory & Nursing’s Orem’s Theory & Nursing’s Metaparadigm - Metaparadigm - ENVIRONMENTENVIRONMENT

Environmental Conditions - external physical & psychosocial surroundings

Developmental Environment - promotion of personal development through motivation to establish appropriate goals & to adjust behavior to meet those goals

Can positively or negatively impact a person’s ability to provide self-care

Orem’s Theory & Nursing’s Orem’s Theory & Nursing’s Metaparadigm - Metaparadigm - NURSINGNURSING

A service geared towards helping the self and others

Is required when self-care demands exceed a patient’s self-care ability (agency)

Promotes the patient as a self-care agentHas several components

Components of Components of NURSINGNURSING

NURSING ART: the theoretical base of nursing and other disciplines such as sciences, art, humanities

NURSING PRUDENCE: the quality that enables the nurse to seek advice in new or difficult situations, to make correct judgements, to decide to act in a particular manner, and/or to act

NURSING SERVICE: a helping service NURSING AGENCY: the ability of the RN

Orem’s Theory & Nursing’s Orem’s Theory & Nursing’s Metaparadigm - Metaparadigm - NURSINGNURSING

ROLE THEORY: the role of the nurse & patient are complementary as they work together to achieve self-care

SPECIAL TECHNOLOGIES:– Social & Interpersonal technologies -

communicating, coordinating, establishing & maintaining therapeutic relations, rendering assistance

– Regulatory technologies - maintaining and promoting life processes, growth/development, and psycho-physiologic modes of functioning

Orem’s Theory & Nursing’s Orem’s Theory & Nursing’s Metaparadigm - Metaparadigm - HEALTHHEALTH

Supports health promotion and health maintenance

Supports the premises of holistic health in that both RN and patient promote the individual’s responsibility for self care

Orem’s Key Contribution To Orem’s Key Contribution To NursingNursing

The continued evolution of original ideas to further delineate nursing practice, functions, self-care needs, and nursing systems based on research.