Dorothea Orem

1. Dorothea Orem Self-Care Deficit Theory of Nursing

2. Background • Born in 1914 in Baltimore, MD • Diploma degree from Providence Hospital School of Nursing • Earned a BSN Ed from Catholic University of America • Held faculty positions at Catholic University of America & Provident Hospital School of Nursing in Detroit • Earned a MSN Ed at Catholic University • Held position of Director of Nursing Service & Education at Provident in Detroit after receiving her MSN Ed Parker & Smith, 2010

3. Influences • Personal life experiences • Formal education • Employment experiences • Works of Aristotle, Thomas Aquinas, Harre & Wallace Parker & Smith, 2010

4. Assumptions • People should be self-reliant & responsible for their own care • People are individuals • Nursing is a form of action – interaction between two or more persons • Successfully meeting universal & development self-care requisites is an important component of primary care prevention & ill health • Person’s knowledge of potential health problems is necessary for promoting self-care behaviors • Self care & dependent care are behaviors learned within a socio-cultural content Current Nursing, 2011

5. Theory Overview • Began developing her concept of nursing while working as assistant professor and dean of CUA nursing school. • Nursing Development Conference Group (NDCG) at CUA, all contributed to the development of her nursing theory. • Nursing : Concepts of Practice in 1970 • Published again in ‘80, ‘85, ‘91, ‘95, ’01 Tomey & Alligood, 2002

6. Theory overview • No particular nursing leader had a direct influence in theory development • Credits her theory to all the nurses she worked with and graduate students she taught. • Identified her philosophical view as that of a moderate realism

7. Foundations of SCDNT • “the view of human being as dynamic, unitary beings who exist in their environments, who are in the process of becoming, and who possess free-will as well as other essential human qualities” Tomey & Alligood, 2002

8. Orem’s Beliefs • Believed that individuals engage in actions required for functioning in life • People Self-determine and have the ability to grow in life • People have the capacity and right to so • The nurse collaborates with the patient to meet their needs

9. SCDNT Expressed in three theories • Theory of self-care • Expresses the purpose, methods, and outcome of taking care of self • Theory of self-care deficit • Demonstrates why people need nurses • Theory of nursing systems • The three theories together constitute the Self Care Deficit Nursing Theory

10. Definitions • Self Care- caring for one’s self to maintain life, health and well-being • Self-care agency- Provider to supplement or replace self care needs • Self-care deficit- demand on the patient is greater than the ability to meet the demands of human functioning

11. Self-care • The practice of activities that maturing and mature persons initiate and perform within time frames, on their own behalf, and in the interest of maintaining life and healthful functioning and continuing personal development and well being. • Human regulatory function that individuals must, with deliberation, perform themselves or have performed for them to maintain life, health, development, and well being. Tomey & Alligood, 2002

12. Self-Care • Self care is learned and deliberate • Self care may vary in different cultures • Dependent care may occur when self care has not been learned or is not operable • Injury • Trauma Denyes, Orem & Bekel, 2001

13. Development of Self Care • Interventions and teachings to return a person to a level of optimal health and well-being • Examples of this include toilet training a child or teaching a diabetic patient about healthy eating patterns

14. Universal self-care requisites • Six common requisites for men, women, and children • 1. sufficient intake of air, water and food • 2. elimination • 3. balance between activity and rest • 4. balance between solitude and social interaction • 5. prevention of hazards to human life • 6. promotion of human functioning and development with social group in accordance with human potential Tomey & Alligood, 2002

15. Self-care requisites • Actions that are important to human functioning • Factors to be controlled to keep life within norms compatible with life and health and person well being • The nature of the action which expresses the intended or desired results of the individual

16. Theory of self-care deficit • People are affected by limitations that make it difficult to meet human self care needs • Disease • Age • Mental • These limitations deem them unable to know the extent of regulatory care for themselves or a dependent • AKA inability to care for self or their dependent

17. Theory of Self Care Deficit • A person benefits from nursing intervention when their state of health inhibits their ability to provide self care • Nursing actions focused on identifying the limitations or deficits and implementing interventions to meet needs of the patient

18. Theory of nursing systems • Nursing is human action, focused on a person • The ability of the nurse to aid the person to meet current and future self care needs. • Nursing Systems are action systems formed by nurses through the exercise of their nursing agency for person with health-derived or health-associated limitations of self-care • Current Nursing, 2011

19. Theory of Nursing System • Nursing Agency includes concepts of deliberate action • Intentionality and operations of diagnoses • Prescription • Regulation • 3 Support Modalities identify the theory of nursing system • Totally or whole compensatory • Partially Compensatory • Supportive/Educative compensatory

20. Modalities of Support • W/C – wholly or totally compensatory • Nurse is to complete the care • Client unable to care for themselves • P/C- partially compensatory • Nurse and patient meet needs • Patient and nurse collaboration to meet self care needs • S/E- Supportive/educative • Assistance with decision making, behavior control, acquires knowledge and skills • Client is responsible for self care needs Tomey & Alligood, 2002

21. Self-care Deficit model

22. Parsimony • Very easy concept to follow • Requires a smart and educated nurse • Not all nurses could identify the need for self-care • Orem did a great job of explaining her theory without the use of several different models or diagrams • Easily applied to practice • Required very little “new knowledge” • Applying the nursing knowledge we all know already • Language was easy to understand • Simple concepts to follow

23. Implementation of Orem’s Theory • Can be applied to numerous different aspects of nursing • Several Nursing Programs apply Orem’s theory as the bases of their nursing education • Easily applied to the nursing care plan

24. The Dreaded Nursing Care Plan • Assessment • NANDA Nursing Diagnoses • Identification of Outcomes • Nursing Intervention • Rationale • Evaluation

25. Implementation • Can be seen in nearly all facets of nursing • Especially seen in home health, hospice, and hospital nursing • Great teaching method for young nurses

26. Conclusion • A very easy to follow method • Focuses on the basic care needs of the patients • Encourages the patients to do as much work for themselves as possible • Easily applied to nursing practice • Any nurse can easily adapt this theory into their everyday nursing • Questions/Comments????

27. References • Denyes, M. J., Orem, D. E., & Bekel, G. (2001). Self-care: a foundational science. Nursing Science Quarterly, 14(1), 48-54. DOI: 10.1177/089431840101400113 • Dorothea Orem’s self-care theory. (n.d.). Retrieved from http://currentnursing.com/nursing_theory/self_care_deficit_theory.html • Parker, M. E. & Smith, M. C. (2010). Nursing theories and nursing practice (3rd ed.). Philadelphia, PA: F.A. Davis Company. • Tomey, A. M., & Alligood, M. R. (2002). Nursing theorist and their work. (5 ed., pp. 189-211). St. Louis, Missouri: Mosby. Retrieved from http://www.elsevier.com