Orem, selfcare theory

OREM’S SELF-CARE
DEFICIT THEORY
A.Masooth mohamed
MSc in Nursing education
1

GOAL
 Enhance knowledge to apply the concepts of self-care
theory to practice
2

CONTENT
 Historical overview of Orem’s work and achievement
 Three nested and interrelated theories presented by
Orem
 Application of Orem’s theory into education, practice, and
research
3

BIOGRAPHY
 Elizabeth Orem was born on 22nd
July 1914, in Baltimore, Maryland
 Diploma in Nursing - Provident
Hospital School of Nursing In
Washington, D.C. -1934
 B.S. Nursing Education - 1939
 MSN Ed in Catholic University of
America, Washington D.C. - 1945
4

CONT………
 Clinical experiences – operating room, Pediatrics,
and Adult Medical/Surgical Units
 Teaching experience – taught biological sciences
 Administrative experience - directors of nursing
services school of nursing at Providence Hospital,
Detroit University, Michigan
5

CONT……
 Honorary Doctorates - 1976
 National and international awards - the most
prestigious nursing award from Sigma Theta Tau
International in 1997
 First published book - “Nursing Concepts of
Practice” - 1971
6

CONT……
 Orem’s work has been further explained by Susan Taylor
and Katie Renpenning
 Orem died in 22nd June, 2007
8

THEORETICAL SOURCES
9
Mentorship
• Eugenia. K.
Spaulding was a great
friend and teacher
Experience
• Learning experiences
with graduate
students and
collaborative works
with colleagues and
nurses
Work of others
• Nightingale,
Abdellah,
Henderson, Johnson,
King, Levine, Hall,
Leininger etc and
many other nursing
theorists.
• Many authors from
other disciplines.
6

THE HISTORICAL EVOLUTION OF OREM’S MODEL
Orem
worked on
developing
nursing
curriculum
and nursing
practice
1949-
1957
Worked for the
Office of
Education, in the
U.S. Dept. of
Health,
Education and
Welfare as a
curriculum
consultant
1958-
1960
Guidelines for
Developing
Curricula for the
Education of
Practical Nurses
was developed
1958-
1960
cont’d
10

CONT……
11
Eventually
served as the
acting dean of
the School of
Nursing at the
Catholic
University of
America
1960-
1970
Published
Nursing:
Concepts of
of Practice
1971

MAJOR ASSUMPTIONS
 Humans require deliberate input to self and
environment to be alive and to function
 The power to act deliberately, is exercised in caring for
self and others
 Mature humans sometimes experience limitations in
their ability to care for self and others
 Humans discover, develop, and transmit ways to care
for self and others
 Humans structure relationships and tasks to provide
self-care 12

CON……..
Person
 Person is an integrated WHOLE - a unity functioning
biologically, symbolically and socially
 Person is self-reliant and responsible for self-care and
wellbeing of his or her dependents and self-care is a
requisite for all
 Person is a logical organism with rational powers
14

PERSON….
 Person’s capacity to reflect own experience and the
environment and use of symbols/ideas/words that
distinguished him/her from other species
 A patient is an individual who is in need of assistance in
meeting specific health-care demands because of lack of
knowledge, skills, motivation, or orientation
15

CONT…
Health
 State of wholeness or integrity of the individual human beings,
his parts, and his modes of functioning
 Health is inherent in her nursing systems since the goal in
each system is optimal wellness relative to that system
 Responsibility of a total society and all its members
 A healthy person is likely to have sufficient self-care abilities
to meet his/her universal self-care needs
16

CONT…..
Environment
 Encompasses the elements external to person but she
considered person and environment as an integrated
system related to self-care
 Environmental conditions conducive to development
include opportunities to be helped
17

CONT…..
Nursing
 Actions deliberately selected and performed by nurses
to help individuals or groups under their care to
maintain or change conditions in themselves or their
environments
 Encompasses the patient’s perspective of health
condition, the physician’s perspective, and the nursing
perspective 18

NURSING…
 Goal of nursing – to render the patient or members of his
family capable of meeting the patient’s self care needs
 To regain normal or near normal state of health in the
event of disease or injury and to stabilize, control, or
minimize the effects of chronic poor health or disability
19

THE THEORETICAL STRUCTURE
Composed of three interrelated middle range theories
1. Self-Care
2. Self-Care Deficit
3. Nursing Systems 20

THEORY OF SELF CARE
Based on the concepts of : –
 Self-care
 Self-care agency
 Self-care requisites
 Therapeutic self-care demand
21

THEORY OF SELF CARE…
Self care
 Practice of activities that an individual initiates and
performs on their own behalf in maintaining life, health
and well being
Self care agency
 "the ability for engaging in self care”
 Abilities to engage in self-care are affected by basic
conditioning factors; age, developmental state, life
experience, sociocultural orientation, health and 22

Self-care needs or requisites
 Actions directed towards provision of self-
care
 Three categories of health care requisites
Three categories
1. Universal self care requisites
2. Developmental self care requisites
3. Health deviation self care requisites 23

Universal self – care requisites
 Associated with life processes and the maintenance
and integrity of human structure and functioning
 Common to all human beings
 Common term for these requisites is the activities of
daily living
24

Universal self – care requisites …
 Maintenance of sufficient intake of air ,water, food
 Provision of care associated with elimination process
 Balance between activity and rest, between solitude
and social interaction
 Prevention of hazards to human life well being
 Promotion of normality
25

Developmental self-care requisites
 More specific to the processes of growth and development
and are influenced by what is happening during the life cycle
stages; such influence may be positive or negative
 Ex: Adjusting to new job or adjusting to body changes
26

Health deviation self-care requisites
 Care is required in conditions of illness, injury, or disease, or may
result from medical measure required to diagnose and correct the
condition (e.g. learning to walk using crutches following fractured
leg)
27

Health deviation self – care…
1. Seeking appropriate medical assistance
2. Being aware of and attending to the effects of pathologic
condition
3. Effectively carrying out medically prescribed measures
4. Being aware of and attending to deleterious effects of
prescribed medical care measures
5. Modifying the self–concept in accepting particular state of
health and specific forms of health care
6. Learning to live with the effects of pathologic condition
28

THEORY OF SELF-CARE DEFICIT
 It is the central focus of Orem’s
general theory
 Specifies when nursing is
needed
 Nursing is required when an adult
is incapable or limited in provision
of continuous effective self-care
 Describes how people can be
helped through nursing 29

SELF CARE DEFICIT EXISTS WHEN, WHAT THE
INDIVIDUAL CAN DO (SELF-CARE AGENCY) IS LESS
THAN WHAT NEEDS TO BE DONE TO MAINTAIN
OPTIMUM FUNCTIONING (THERAPEUTIC SELF-
CARE DEMAND) 30
Theory of self care deficit…

THEORY OF SELF CARE DEFICIT…
Orem identified methods of
helping
 Acting or doing for others
 Guiding or directing
 Providing support
 Providing and maintaining environment
that support personal development
31

NURSING SYSTEMS…
 Describes how the patient’s self care needs will be
met by the nurse, the patient, or both.
 Recognize two categories of technologies
 Social or interpersonal
 Regulatory technologies
33

CON….
 Identifies 3 types of nursing system to meet the self
care requisites of the patient :-
1. Wholly compensatory system
2. Partly compensatory system
3. Supportive – Educative system
34

CON….
Wholly Compensatory
 individual is unable to carry out needed self-care actions,
either through inability to be self-directed or due to a medical
prescription
 Need total nursing care
35

WHOLLY COMPENSATORY
Accomplishes patient’s therapeutic self-care
Nurse Patient Action
limited Action Compensates for patient’s inability to
engage in self-care
Supports and protects patient
36

NURSING SYSTEMS…
Partly Compensatory
patient and nurse are both physically active in
meeting the patient’s self-care needs
37

PARTLY COMPENSATORY SYSTEM
Performs some self-care measures for patient
Compensates for self-care limitations of patient
Nurse Assist patient as required
action
Performs some self-care measures
Patient
Regulate self-care agency action
Accepts care and assistance from nurse
38

CON…
Supportive-Educative
 capability of a person to perform self-care activities
independently or needs to learn to how to meet therapeutic
self-care demands by himself.
 person needs some manner of assistance
39

SUPPORTIVE-EDUCATIVE SYSTEM
Accomplishes self-care
Patient
Nurse
action
action
Regulates the exercise and
development of self-care agency
40

IMPLICATIONS FOR PRACTICE AND
RESEARCH
 Implications for Practice
 Universality of theory
 Application to Nursing Process
Orem’s approach to nursing process consist of three steps
 Possible Research Topics
 Instruments for measuring the conceptual elements (self-
care, self-care deficit)
 Use in specific populations (diabetes, hemodialysis, 42

IMPLICATION TO NURSING
EDUCATION
 Teaches the student to encourage compensatory care in the
patient population
 Conceptualizes patients’ current and potential self-care
deficits
 Supports the nursing process in all three nursing theories
43

STRENGTHS
 The Self Care Deficit Theory is specific to nursing
 Provides a general foundation for the nursing
discipline
 Can be utilized to formulate nursing curriculum
 Can enhance the development of nursing
education, research and administration
 Contemporary with nursing trends in health
promotion and maintenance
 Promote independence 44

CON….
 Associated with life process and the maintenance
of integrity of human structure and functioning
 Can be used in multiple nursing specialties
 The concept of self-care and health maintenance
are congruent with contemporary literature in
healthcare
 The theory creates a coordinated nursing care plan
that adjusts to the patient’s needs throughout
recovery
45

LIMITATIONS
 Repetitive terms can be confusing ( self-care agency
/requisites/deficit etc.)
 Psychological/emotional needs not well developed within
the theory
 Appears that the theory is illness oriented rather with no
indication of it use in wellness setting
 Does not address cultural needs
46

TAKE HOME MESSAGE
Individuals can take
responsibility for their health
and the health of others, and in
a general sense, individuals have
the capacity to care for
themselves and their
dependents
48

REFERENCES
Alligood, M.R. & Tomey, A.M. (2010). Nursing Theory Utilization
and
Application (4th ed.). St. Louis, Missouri: Mosby.
George, J. B. (2011). Nursing theories: The base for professional
nursing
practice (6th ed.). Boston: Pearson
Parker, M.E. & Smith, M.C. (2010). Nursing Theories and Nursing
Practice
(3rded.). Philadelphia: F. A. Davis company
Tomey. M.A. & Alligood, M.R. (2010). Nursing Theorists and Their
Work 49

Orem, selfcare theory

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