edited orem nursing theory

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Dorothea Elizabeth Orem


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"In t e na ty o t eclient to do the

universal, developmentalor health deviation self-

care requisites, thenurse provides wholly orpartially compensatory

or supportive-educativeassistance."Dorothea Elizabeth

Orem


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Who is she?

She was born in Baltimore, Maryland on 1914. Herfather was a construction worker and her mother is ahome maker. She studied Diploma in Nursing in early 1930s atthe Providence Hospital School of Nursing InWashington D.C., In 1939 and 1945 she finished

B.S. Nursing Education ( BSN Ed.) and MSN Edsuccessively in Catholic University of America,Washington D.C.

In 1976 She become Honorary Doctorates: Doctorsof Science from Georgetown University andIncarnate word college in San Antonio in Texas in1980.

In 1988 she finished Doctor of Humane Letters

from Illinois Wesleyan University in Bloomington,Illinois. 1988 She graduated from University ofMissouri in Columbia, Doctor Honoris Causae.


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NURSING CAREER

Occupied important nursing positions, like thedirectorship of both the nursing school and thedepartment of nursing at Providence Hospital,Detroit (1940 to 1949).

Spent seven years at the Division of Hospital andInstitutional Services of the Indiana State Board of

Health (1949-1957), developed her definition ofnursing practiceJoined the Catholic University of America first as

Assistant Professor, then later became AssistantDean and Associate Professor of the School ofNursing.

Her theory was first published in Nursing: Concepts

of Practice in 1971, second in 1980, in 1995, and2001

She received the Catholic University of AmericaAlumni Association Award for Nursing Theory in1980. The second edition of Nursing: Concept ofPractice was published (1980)


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Self-Care Deficit Theory


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Self-Care Deficit Theory

The theory of Orem is considered clientcentered, because it mainly evolves in thepatient as the main focus of care, this is due tothe patients inability and incapacity to performself care which is brought about by health

related problems. Orem views nursing as a complex form ofdeliberate interpersonal action that ultimatelyprovides a helping human health service. Shechose the name deficit as it describes andexplain a relationship between abilities ofindividual, their children or adults for whom they

care. The notion deficit does not refer to aspecifictype of limitation, but to the relationshipbetween the capabilities of the individual and theneed for action.


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Metaparadigm of thetheory

Person Client is an integrated whole; a unity functioning

biologically, symbolically and socially. Client isself-reliant and responsible for self-care and well-being of his or her dependents and self-care is a

requisite for all. Client has capacity to reflect on their own

experience and the environment and they use ofsymbols, ideas and words that distinguishedthem from other species

A client is a holistic individual who is in need of

assistance in meeting specific health-caredemands because of lack of knowledge, skills,motivation, or orientation


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Health A healthy person is likely to have sufficient self-

care abilities to meet their universal self-careneeds.

The client is in a state of wholeness or integrityof the individual human beings, his parts, andhis modes of functioning.

Self careabilities

UniversalSelf Care

needs

Balance


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Environment Encompasses the elements external to man but

she considered man and environment as anintegrated system related to self-care.

Environmental conditions conducive todevelopment include opportunities to be helped:being with other persons or groups where care isoffered; opportunities for solitude andcompanionship; provision of help for personal andgroup concerns without limiting individualdecisions and personal pursuits: shared respect ,belief, and trust; recognition and fostering ofdevelopmental potential.


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Nursing Orem believed that nursing is a community

service, an art, and a technology

As a service

Nursing is a service of deliberately selectedand performed actions to assist individualsor groups to maintain self-care, includingstructural integrity, functioning, anddevelopment. Requirements for nursing are modified

and eventually eliminated when there isprogressive favorable change in the stateof health of the individual, or when helearns to be self-directing daily self-care.


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As an art

Orem says that nursing is also an artbecause of the ability to assist others in thedesign, provision, and management of

systems of self-care to improve or maintainhuman functioning at some level ofeffectiveness Also nursing has an intellectual aspect thediscernment of obstacles to care andplanning how these obstacles can beovercome.


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As a technology

Nursing has formalized methods ortechniques of practice, clearly describedways of performing specific actions so that

some particular result will be achieved. Techniques of nursing must be learned and

skill and expertness in their use must bedeveloped by persons who pursue nursingas career.


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Interrelated theories of

Orem

Theory of Self-Care

Theory of Self-CareDeficitTheory of Nursing

System


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Theory of Self-Care

Self-CareAccording to Orem self-care is the performance orpractice of activities that individuals initiate andperform on their own behalf to maintain life,health and well-being. When self-care is

effectively performed, it helps to maintainstructural integrity and human functioning, and itcontributes to human development (Orem, 1991)

This is the humans ability or power to engage in

self-care. The individuals ability to engage inself-care is affected by basic conditioning factors.

Self-Care

Agency

Basic conditioning factors are age, gender,developmental state, health state, socioculturalorientation, health care system factors, family systemfactors, patterns of living, environmental factors, and


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Theory of Self-Care

Self-Care AgencyAgents

1. Self-care agent: person who provides the self-care2. Dependent Care Agent - person other than the

individual who provides the care

Self-CarerequisitesThese are the actions or measures used to provide

self-care.

1. Universal requisites or needs that are common toall individuals

2. Developmental - needs resulting from maturationor develop due to a condition or event

3. Health Deviation - needs resulting from illness,injury & disease or its treatment


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Theory of Self-CareDeficitThe core of Orem's grand theory is the Self-Care Deficit

Theory because it delineates when nursing is needed.Nursing is required when a client is incapable of orlimited in the provision of continuous effective self-care(George 1995). The term "deficit" refers to a particularrelationship between self-care agency and self-caredemand that is said to exist when capabilities for

engaging in self-care are less than the demand for self-care (Parker, 2005, p. 149).

D A

Self-Care

D

A

Self-CareDeficit

D: Demand for self careA: Ability to meet demand for self care


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Theory of Self-CareDeficit

2 Classifications of Self-CareDeficit

1. Actual

2. Potential

Orem identifies 6 methods of helping:1. Doing for or acting for another2. Guiding or directing another3. Providing physical support

4. Providing psychological support5. Providing an environmentsupportive of development6. Teaching another


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Theory of NursingSystems

Describes nursing responsibilities, roles of the nurseand patient, rationales for the nurse-patientrelationship, and types of actions needed to meet thepatients demands.

A series of actions a nurse takes to meet a patientsself-care needs, is determined by the patients self-careneeds, is composed of three systems.

1. Wholly Compensatory

2. Partly Compensatory

3. Supportive-EducativeCompensatory


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Assumptions

Human beings require continuous deliberate inputs tothemselves and their environments to remain aliveand functions in accord with natural humanendowments.

Human agency, the power to act deliberately, isexercised in the form of care of self and others in

identifying needs for and in making neededinputs.

Human agency is exercised in discovering,developing, and transmitting to others ways andmeans to identify needs for and make inputs to selfand others.

Groups of human beings with structuresrelationships cluster tasks and allocateresponsibilities for providing care to groupmembers who experience privation for makingrequired deliberate input to self and others


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Strengths

The Orem theory is as applicable for nursing by thebeginning practitioner as much as the advancedclinician(George JB., 1995)

The major strength of Orems theory is its advocacy for

the use of the Nursing Process (Balabagno, et.al, 2006).Orem specifically identified the steps of this process. Shealso mentioned that the nursing process involvesintellectual and practical phases


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Limitations

Orems theory dont have an unclear definition offamily, the nurse-society relationship and publiceducation areas. These issues are essential in themanagement and treatment plan in caring forpatients. Although the family, community andenvironment are considered in self care action, the

focus is primarily on the individual (Balabagno,et.al, 2006)

One of the most obvious limitations of Oremstheory is that throughout her work, it can besaid that a limited recognition of an individualsemotional needs is present within the theory(George JB., 1995). It focuses more on physicalcare and gives lesser emphasis to psychologicalcare.


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THANK YOU


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References1. Henderson v: The Nature of Nursing: A Definition and ItsImplications, Practice, Research, and Education. MacmillanCompany, New York, 1966. (Pages 16-17)

2.http://currentnursing.com/nursing_theory/Henderson.html

3. http://en.wikipedia.org/wiki/Virginia_Henderson

4.http://www.angelfire.com/ut/virginiahenderson/concepts.html

5. http://www.nytimes.com/1996/03/22/arts/virginia-henderson-98-teacher-of-nurses-dies.html

6. www.youtube.com/watch?v=AbuNz7RLHS8

7. www.youtube.com/watch?v=t89beHi7Xxw


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8. Henderson v: The Nature of Nursing: A Definition and ItsImplications, Practice, Research, and Education. MacmillanCompany, New York, 1966. (Pages 16-17)

9. Nursing theorists and their workBy Ann Marriner-Tomey, Martha Raile Alligood pp. 54-57

10. Henderson v: The Nature of Nursing: A Definition and ItsImplications, Practice, Research, and Education. MacmillanCompany, New York, 1966. (Pages 16-17)

11. http://nursing-theory.org/nursing-theorists/Virginia-Henderson.php

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