dorothea orem self-care deficit theory. overview about orem’s theory:- overview about orem’s...
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Dorothea OremDorothea Orem
Self-Care Deficit Self-Care Deficit theory theory
Overview about Orem’s theory:-Overview about Orem’s theory:- Orem's CVOrem's CV Origins – PurposeOrigins – Purpose Philosophy and world view Philosophy and world view Metaparadigm – Concepts Metaparadigm – Concepts Assumptions and Propositions Assumptions and Propositions Theories included in the Theories included in the Self-Care Deficit theory Self-Care Deficit theory Orem’s Theory and Nursing processOrem’s Theory and Nursing process
Time oriented Time oriented
Peplau:Peplau: Published at 1952. Published at 1952.Orem:Orem: Published at 1959. Published at 1959.Roy:Roy: Published at 1960. Published at 1960.Roger’s:Roger’s: Published at 1970. Published at 1970.King:King: Published at 1971 Published at 1971Newman:Newman: Published at 1989 Published at 1989
Dorothea OremDorothea OremC.V.C.V.
19391939 – BSN completed – BSN completed 1945 1945 - MS in nursing education- MS in nursing education 19581958 - consultant to the Office of - consultant to the Office of
Education where she began working on Education where she began working on her SELF-CARE THEORYher SELF-CARE THEORY
19591959 - first published her theory in - first published her theory in “Guides for Developing Curricula for the “Guides for Developing Curricula for the Education of Practical Nurses” (a Education of Practical Nurses” (a government publication)government publication)
Dorothea OremDorothea OremC.V.C.V.
1976 1976 - honorary Doctorate of Science - honorary Doctorate of Science from Georgetown Universityfrom Georgetown University
19801980: Award for nursing theory from : Award for nursing theory from catholic university of America.catholic university of America.
19991999 - last edition of her theory was - last edition of her theory was publishedpublished
PublicationsPublications
1959: Guidelines For Developing 1959: Guidelines For Developing Curricula For The Education Of Practical Curricula For The Education Of Practical NurseNurse
1962: The Hope Of Nursing1962: The Hope Of Nursing 1971: Nursing: Concept And Practices 61971: Nursing: Concept And Practices 6thth
edition in (1999).edition in (1999). 1972: Concept Formalization In Nursing: 1972: Concept Formalization In Nursing:
Process And Product.Process And Product. 1979: Levels of nursing education and 1979: Levels of nursing education and
practicepractice
OriginOrigin While Orem was working in the While Orem was working in the
Department of Health Education and Department of Health Education and Welfare (HEW)Welfare (HEW) as a curriculum as a curriculum consultant she worked to upgrade consultant she worked to upgrade practical nursing training.practical nursing training.
That stimulated the need to address the That stimulated the need to address the questionquestion What is the
subject matter of nursing?
(Curriculum)
Origin Origin cont’d. cont’d.
Orem’s book of “ guidelines for developing Orem’s book of “ guidelines for developing curricula for the education of practical curricula for the education of practical nursing” was the seed for her work nursing” was the seed for her work (Orem,1959 in Fawcett 1995) and (Meleis, (Orem,1959 in Fawcett 1995) and (Meleis, 1998).1998).
To conceptualize a curriculum for a diploma To conceptualize a curriculum for a diploma program by isolating and specifying nursing program by isolating and specifying nursing action.action.
Origin Origin cont’d. cont’d.
Ideas that helped to shape the self-care Ideas that helped to shape the self-care framework were formulated as Orem framework were formulated as Orem experienced a period of intensive exposure experienced a period of intensive exposure to nurses and their endeavors from 1949 to to nurses and their endeavors from 1949 to 1957 (Fawcett, 1995).1957 (Fawcett, 1995).
Philosophical viewPhilosophical view
Orem has identified her philosophical Orem has identified her philosophical view based on the action theory, from the view based on the action theory, from the perspective of the person as a deliberate perspective of the person as a deliberate actor or agent.actor or agent.
Philosophical view Philosophical view cont’d.cont’d.
Orem model is based upon the philosophy Orem model is based upon the philosophy that all “ patients wish to care for themselves that all “ patients wish to care for themselves and its purpose was to define the following:and its purpose was to define the following:
Nursing concern is on the man’s needs for self-care Nursing concern is on the man’s needs for self-care action and the provision and management of it on a action and the provision and management of it on a continues basis in order to sustain life and health, continues basis in order to sustain life and health, recover from disease or injury and cope with their recover from disease or injury and cope with their effect.effect.
Nursing goal is overcoming human limitations Nursing goal is overcoming human limitations ( Berbelgia, 2002).( Berbelgia, 2002).
World ViewWorld View
World view referred to the physiologic World view referred to the physiologic assumptions about the nature of person assumptions about the nature of person environment relationship.environment relationship.
Orem: adopted the organicism rather than Orem: adopted the organicism rather than mechaniscism as world view, she mechaniscism as world view, she proclaimed that man include internal proclaimed that man include internal physical, psychological and social nature physical, psychological and social nature with the change rather than stability.with the change rather than stability.
World View World View cont’d.cont’d.
She stated that man and environment interact She stated that man and environment interact as a self-care system.as a self-care system.
A change in either the system of man and the A change in either the system of man and the system of the environment will affect the self-system of the environment will affect the self-care system.care system.
Orem states: Man functioning is linked to his Orem states: Man functioning is linked to his environment and together man and environment and together man and environment form an integrated whole system.environment form an integrated whole system.
Keywords that support this view: Keywords that support this view: change, change, whole, interaction, man and environmentwhole, interaction, man and environment..
Conceptual ModelsConceptual Models
Nursing models are categorized according Nursing models are categorized according to the discipline or anthropology from to the discipline or anthropology from which they were derived.which they were derived.
It is clear in Orem’s theory that she used It is clear in Orem’s theory that she used developmental model developmental model (Montgomery,2004). Also, Meleis (1998) (Montgomery,2004). Also, Meleis (1998) viewed that Orem’s theory could be viewed that Orem’s theory could be categorized as an interaction model.categorized as an interaction model.
Theory Development Theory Development StrategyStrategy
The theory development strategy used by The theory development strategy used by Orem was induction from practice.Orem was induction from practice.
Induction from practice is clearly evident in Induction from practice is clearly evident in Orem’s detailed accounts of how concepts Orem’s detailed accounts of how concepts in the theory were determined and defined in the theory were determined and defined based on “ experience in concrete nursing based on “ experience in concrete nursing practice situations or results of analysis of practice situations or results of analysis of nursing care materials “ (Orem,1991)nursing care materials “ (Orem,1991)
Theory Development Strategy Theory Development Strategy cont’d.cont’d.
Orem did however read widely and identified Orem did however read widely and identified some of major influences on her thinking, some of major influences on her thinking, suggests that there was an element of suggests that there was an element of deduction in her work (Montgomery,2004).deduction in her work (Montgomery,2004).
Sources of influences include ideas about Sources of influences include ideas about deliberate human actions and motivation.deliberate human actions and motivation.
Factors influencing development:Factors influencing development:
Practical nursing curriculum developmentPractical nursing curriculum development Women’s movementWomen’s movement Nursing theory conferencesNursing theory conferences
Theory Development StrategyTheory Development Strategy cont’d.cont’d.
Basic Elements in the ModelBasic Elements in the Model
The structure and components of the self-care The structure and components of the self-care framework have undergone various interpretations framework have undergone various interpretations overtime.overtime.
Orem (1991) explained “all of the conceptual Orem (1991) explained “all of the conceptual elements of the self-care framework were formalized elements of the self-care framework were formalized and validated as static concepts by 1970.and validated as static concepts by 1970.
Since then, some refinements of expression and Since then, some refinements of expression and further development of substantive structure and further development of substantive structure and continued validation have occurred and changes continued validation have occurred and changes have been made (Fawcett,1995).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
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
Model Metaparadigm- Metaparadigm- NursingNursing
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 MetaparadigmModel MetaparadigmNursingNursing
It is the ability to It is the ability to assist othersassist others in in design, provision and design, provision and management of self-management of self-care to improve or care to improve or maintain human maintain human function at some function at some level of effectiveness.level of effectiveness.
Nursing
Methods of Nursing HelpMethods of Nursing Help Acting or doing for Acting or doing for Guiding & directing another Guiding & directing another Teaching another Teaching another Providing psychological and Providing psychological and
physical support.physical support. Providing a supportive environment Providing a supportive environment
to promote the patient’s ability to to promote the patient’s ability to meet current or future demands.meet current or future demands.
Model MetaparadigmModel MetaparadigmHealthHealth
As a state of being
Sound whole
Strength VigorAbsence of
diseaseNothing is
MissingOr
Diminished
Model MetaparadigmModel MetaparadigmHealthHealth
Not only a bodily state but Not only a bodily state but also to how one functions also to how one functions in everyday living andin everyday living and
progressive development progressive development that is movement toward that is movement toward higher and higher level of higher and higher level of integration and integration and functioning.functioning.
Health
ModelModel Metaparadigm- Metaparadigm- ENVIRONMENTENVIRONMENT
Person and environment are a Person and environment are a functional unit in which exchange functional unit in which exchange are reciprocal and influence is are reciprocal and influence is mutual.mutual.
Persons are viewed as existing in Persons are viewed as existing in their environments and never their environments and never isolated from them.isolated from them.
4 environmental features 4 environmental features (physical, chemical, biologic and (physical, chemical, biologic and socialsocial) ) have an impact on the have an impact on the health and well- benign the health and well- benign the person and the family.person and the family.
Model Metaparadigm - Model Metaparadigm - PERSONPERSON
The recipient of nursing careThe recipient of nursing care A being who functions biologically, A being who functions biologically,
symbolically, and socially symbolically, and socially Has the potential for learning & Has the potential for learning &
developmentdevelopment Is subject to the forces of natureIs subject to the forces of nature Has a capacity for self-knowledge Has a capacity for self-knowledge Can engage in deliberate actions, Can engage in deliberate actions,
interpret experiences, and perform interpret experiences, and perform beneficial actionsbeneficial actions
Can learn to meet self-care needs Can learn to meet self-care needs (requisites)(requisites)
Person
Model Metaparadigm - Model Metaparadigm - PERSONPERSON
Human beings areHuman beings are distinguished from distinguished from other living beings by their capacity to:other living beings by their capacity to:
Reflect upon themselves and their Reflect upon themselves and their environmentenvironment
Use symbolic creations (ideas, Use symbolic creations (ideas, words) in thinking, communicating, words) in thinking, communicating, and guiding efforts to make things and guiding efforts to make things that are beneficial for themselves that are beneficial for themselves and/or for othersand/or for others
Man and environment form an Man and environment form an integrated system . A change in integrated system . A change in either component may affect the either component may affect the self-care system.self-care system.
Person
Orem’s Self-care TheoryOrem’s Self-care Theory
Based on the concepts of:Based on the concepts of: SELF-CARESELF-CARE SELF-CARE AGENCYSELF-CARE AGENCY SELF-CARE REQUISITESSELF-CARE REQUISITES THERAPEUTIC SELF-CARE DEMANDTHERAPEUTIC SELF-CARE DEMAND
Self-care DefinitionSelf-care Definition Self-care Self-care
The The practicepractice of activities that of activities that mature person initiates and performs mature person initiates and performs independently within time frame, to independently within time frame, to promote and maintain personal well-promote and maintain personal well-being, healthful functioning and being, healthful functioning and continuing development throughout continuing development throughout lifelife..
Orem’s Self-care AgencyOrem’s Self-care Agency
DefinitionDefinition:: the individual’s the individual’s abilityability to to perform self-care activities (perform self-care activities (capabilitiescapabilities of the person)of the person)
It is a complex acquired It is a complex acquired abilitiesabilities to meet to meet one’s continuous requirement for care.one’s continuous requirement for care.
Consists of TWO agents:Consists of TWO agents: Self-care AgentSelf-care Agent - person who provides the - person who provides the
self-care and has the power to do soself-care and has the power to do so Dependent Care AgentDependent Care Agent - person other than - person other than
the individual who provides the care (such as a the individual who provides the care (such as a parent) parent)
Orem’s Self-care Requisites Orem’s Self-care Requisites (also (also called Self-care Needs)called Self-care Needs)
Definition:Definition: the expressions of action to be the expressions of action to be performed by or for individuals for controlling performed by or for individuals for controlling human and environmental factors that affect human and environmental factors that affect human functioning and development human functioning and development
Three types of self-care requisites constitute Three types of self-care requisites constitute the therapeutic self- care demand:the therapeutic self- care demand: UniversalUniversal - requisites/needs that are - requisites/needs that are
common to all individuals.common to all individuals.1- Air, water and food1- Air, water and food2- elimination and excrements2- elimination and excrements
Orem’s Self-care Requisites Orem’s Self-care Requisites cont’d.cont’d.
3- activity/rest3- activity/rest
4- solitude (aloneness) /social interaction4- solitude (aloneness) /social interaction
5-prevention of hazards to life and well-being 5-prevention of hazards to life and well-being (physical , social & psychological hazards).(physical , social & psychological hazards).
6-promotion of function and development 6-promotion of function and development within social group based on group norms.within social group based on group norms.
Orem’s Self-care Orem’s Self-care Requisites Requisites (also called Self-(also called Self-
care Needs)care Needs)
DevelopmentalDevelopmental – Actions that need to be – Actions that need to be performed in relation to human developmental performed in relation to human developmental processes , conditions and events and relation processes , conditions and events and relation to events that adversely affect development.to events that adversely affect development.
Health DeviationHealth Deviation – exists for persons who are – exists for persons who are ill or injured have specific forms of pathologic ill or injured have specific forms of pathologic conditions (including defects and disabilities & conditions (including defects and disabilities & who are under medical diagnosis and who are under medical diagnosis and treatment..treatment.. Needs resulting from illness, injury & Needs resulting from illness, injury &
disease or its treatment disease or its treatment
Self-Care DeficitSelf-Care Deficit
The relationship between self-care agency (ability The relationship between self-care agency (ability to perform self-care) and the therapeutic self-care to perform self-care) and the therapeutic self-care demand in which self care agency is not sufficient demand in which self care agency is not sufficient to meet one’s therapeutic self-care demands.to meet one’s therapeutic self-care demands.
Dependent- care deficit exists when the person’s Dependent- care deficit exists when the person’s ability to perform dependent-care (i.e., ability to perform dependent-care (i.e., dependent- care agency) is not sufficient to meet dependent- care agency) is not sufficient to meet the socially dependent person’s therapeutic self the socially dependent person’s therapeutic self care demand).care demand).
Deficit can be complete or partially and as such Deficit can be complete or partially and as such indicate whether wholly or compensatory system. indicate whether wholly or compensatory system.
Therapeutic Self-care Therapeutic Self-care DemandsDemands
The sum of self-care measures/ actions, The sum of self-care measures/ actions, required to meet the specific self-care required to meet the specific self-care requisites of a person at a point in time.requisites of a person at a point in time.
6ِAssumptions & Propositions
Assumptions (explicit) Assumptions (explicit)
For the sakeOf others
Performed By
nurses
Helping service
purposeful
deliberate
Nursing
Nursing is a deliberate , purposeful Nursing is a deliberate , purposeful helping service performed by nurses for helping service performed by nurses for the sake of others over a period of time.the sake of others over a period of time.
Assumptions (explicit) Assumptions (explicit)
Dependent member
For self
PerformSelf-care
Capable & willing
Person
For self
Persons are capable and willing to Persons are capable and willing to perform self-care for self or for dependent perform self-care for self or for dependent members of the family.members of the family.
Well beingHuman
development
Health
Self care necessity
Self care is part of life that is necessary for Self care is part of life that is necessary for health human development & well-being.health human development & well-being.
Assumptions (explicit) Assumptions (explicit)
Culture
Education
Individual
Assumptions (explicit) Assumptions (explicit)
Education and culture influence individuals.Education and culture influence individuals.
Assumptions (explicit)Assumptions (explicit)
communication
Humaninteraction
Self-care is learned through
Self-care is learned through human interaction Self-care is learned through human interaction and communication.and communication.
Assumptions (explicit)Assumptions (explicit)
Needs for care
PerformedTo meet
Systematicactions
deliberate
Self-care
Self-care includes deliberate and systematic Self-care includes deliberate and systematic actions performed to meet needs for care.actions performed to meet needs for care.
AssumptionsAssumptions (implicit) (implicit)
Dependent others in the family
Own careneeds
Responsible for
Self-reliant
People Should be
People should be self- reliant and responsible for their 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 as well as others in the family who are not able to care for themselves. themselves.
Assumptions (implicit)Assumptions (implicit)
EnvironmentDistinct from
others
Entities
people
People are individuals with entities that are People are individuals with entities that are distinct from others and from their environments. distinct from others and from their environments.
Person and nursing client:Person and nursing client: Human beings have capabilities to provide their own Human beings have capabilities to provide their own
self-care or care for dependents to meet universal, self-care or care for dependents to meet universal, developmental and heath deviation self-care developmental and heath deviation self-care requisites.requisites.
Self care abilities are influenced by age, Self care abilities are influenced by age, developmental state experiences and sociocultural developmental state experiences and sociocultural background. background.
Self-care deficits are to balance between self-care Self-care deficits are to balance between self-care demands and self-care capabilities and an indication demands and self-care capabilities and an indication of a state of social dependency..of a state of social dependency..
Propositions
Nursing TherapeuticNursing Therapeutic Therapeutic self-care includes actions of nurses, Therapeutic self-care includes actions of nurses,
patients, and others that regulate self care patients, and others that regulate self care capabilities and meet self-care needs.capabilities and meet self-care needs.
Nurses assess the abilities of patients to meet Nurses assess the abilities of patients to meet their self-care needs.their self-care needs.
Nurses engage in selecting valid and reliable Nurses engage in selecting valid and reliable processes , or technologies or action for processes , or technologies or action for meeting self-care demands. meeting self-care demands.
Components of therapeutic self-care are wholly Components of therapeutic self-care are wholly compensatory, partly compensatory and compensatory, partly compensatory and supportive educative. supportive educative.
Propositions Cont’
Orem’s General Theory of Orem’s General Theory of NursingNursing
Consists of three related theories Consists of three related theories collectively referred to as “Orem’s collectively referred to as “Orem’s General Theory of Nursing”:General Theory of Nursing”:
1.1. Self-care TheorySelf-care Theory
2.2. Self-care Deficit TheorySelf-care Deficit Theory
3.3. Nursing Systems TheoryNursing Systems Theory
Orem’s Self-care TheoryOrem’s Self-care Theory
Based on the concepts of:Based on the concepts of:
SELF-CARESELF-CARE SELF-CARE AGENCYSELF-CARE AGENCY SELF-CARE REQUISITESSELF-CARE REQUISITES THERAPEUTIC SELF-CARE DEMANDTHERAPEUTIC SELF-CARE DEMAND
Self-care DefinitionSelf-care Definition
Self-care comprises those Self-care comprises those activities performed activities performed independently by an individual to independently by an individual to promote and maintain personal promote and maintain personal well-being throughout life.well-being throughout life.
Orem’s Self-care Deficit Orem’s Self-care Deficit TheoryTheory
Is the central focus of Orem’s Grand Theory of Is the central focus of Orem’s Grand Theory of NursingNursing
Explains when nursing is neededExplains when nursing is needed Describes and explains how people can be Describes and explains how people can be
helped through nursinghelped through nursing Results when the Self-care Agency (patient) can’t Results when the Self-care Agency (patient) can’t
meet her/his self-care needs or administer self-meet her/his self-care needs or administer self-carecare
Nursing meets these self-care needs through five Nursing meets these self-care needs through five methods of helpmethods of help
Orem’s Nursing Systems Orem’s Nursing Systems Theory Describes...Theory Describes...
Nursing responsibilities Nursing responsibilities Roles of the nurse and patientRoles of the nurse and patient Rationales for the nurse-patient Rationales for the nurse-patient
relationshiprelationship Types of actions needed to meet the Types of actions needed to meet the
patient’s demandspatient’s demands
Orem’s Nursing Systems Orem’s Nursing Systems TheoryTheory
Refers to a series of actions a nurse takes Refers to a series of actions a nurse takes to meet a patient’s self-care needsto meet a patient’s self-care needs
Is determined by the patient’s self-care Is determined by the patient’s self-care needsneeds
Is composed of Is composed of THREE systemsTHREE systems:: Wholly compensatoryWholly compensatory Partly compensatoryPartly compensatory Supportive-educativeSupportive-educative
Three Nursing SystemsThree Nursing Systems Wholly CompensatoryWholly Compensatory:: a patient’s self- a patient’s self-
care agency is so limited that s/he depends care agency is so limited that s/he depends on others for well-being on others for well-being
Partly CompensatoryPartly Compensatory:: a pt can meet a pt can meet some self-care requisites but needs a nurse some self-care requisites but needs a nurse to help for others.to help for others.
Supportive-educativeSupportive-educative:: a pt can meet a pt can meet self-care requisites but needs help in self-care requisites but needs help in decision-making, behavior control, or decision-making, behavior control, or knowledge acquisitionknowledge acquisition
Orem's theory, Nursing process Orem's theory, Nursing process &Critical thinking operations&Critical thinking operations
Critical Thinking OperationsIt includes four cognitive operations
Diagnostic OperationDiagnostic OperationIdentify self-care practice,Identify self-care practice,
its limitation its limitation Perspective Perspective
OperationsOperationsSelect the appropriate therapeutic Select the appropriate therapeutic methodmethod and explaining it to clientand explaining it to client
Regulatory operationsRegulatory operationsDesign plan and implement it.Design plan and implement it.
Control operationsControl operations
Evaluation of the effectivenessEvaluation of the effectiveness of regulatory operationsof regulatory operations
Nursing processAssessment Diagnosis
Planning
ImplementationEvaluation
Intellectual PhaseIntellectual Phase
Step IStep I: : the initial andthe initial and determination of needsdetermination of needs Step II:Step II: the designingthe designing of system (Planning)of system (Planning)..
Practical phasePractical phase::Step IIIStep III: : InitiationInitiation,,
conductionconduction & & controllingcontrolling
of assisting actionsof assisting actions . .
