Dorothea Orem

1. Dorothea Orem Nursing Theory

2. Dorothea Orem • Early 1930’s - AD from Providence School of Nursing, Washington, D.C. • 1939 – BSN completed • 1945 - MS in nursing education • 1958 - consultant to the Office of Education where she began working on her SELF-CARE THEORY

3. Dorothea 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

4. Orem’s Definition of Nursing • 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.

5. Orem’s Nursing Process Consists of 3 steps: • Step 1: determine why a patient needs care • Step 2: design a nursing system & plan the delivery of care • Step 3: management of nursing systems - planning, initiating, & controlling nursing actions

6. Orem’s General Theory of Nursing • Consists of three related theories collectively referred to as “Orem’s General Theory of Nursing”: • Self-care Theory: 3 types of self-care requisites (needs) or categories • Self-care Deficit Theory: 5 Methods of Assistance • Nursing Systems Theory

7. Orem’s Self-care Theory • Based on the concepts of: • SELF-CARE • SELF-CARE AGENCY • SELF-CARE REQUISITES • THERAPEUTIC SELF-CARE DEMAND

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

9. Orem’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)

10. Orem’s Self-care Requisites (also 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

11. Orem’s Self-care Deficit Theory • 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

12. Five Methods of Nursing Help • Acting or doing for • Guiding • Teaching • Supporting • Providing an environment to promote the patient’s ability to meet current or future demands

13. Orem’s Nursing Systems Theory Describes... • Nursing responsibilities • Roles of the nurse and patient • Rationales for the nurse-patient relationship • Types of actions needed to meet the patient’s demands

14. Orem’s Nursing Systems Theory • 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 needs • Is composed of THREE systems: • Wholly compensatory • Partly compensatory • Supportive-educative

15. Three 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

16. Orem’s Theory & Nursing’s Metaparadigm - PERSON • 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)

17. Orem’s Theory & Nursing’s Metaparadigm - PERSON • 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

18. Orem’s Theory & Nursing’s Metaparadigm - ENVIRONMENT • 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

19. Orem’s Theory & Nursing’s Metaparadigm - NURSING • 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 agent • Has several components

20. Components of NURSING • 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

21. Orem’s Theory & Nursing’s Metaparadigm - NURSING • 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

22. Orem’s Theory & Nursing’s Metaparadigm - HEALTH • 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

23. Orem’s Key Contribution To Nursing • The continued evolution of original ideas to further delineate nursing practice, functions, self-care needs, and nursing systems based on research.