WELCOME

SELF-CARE DEFICIT NURSING THEORY

DOROTHEA ELIZABETH OREM

PREPARED BY;
MR.GIREESH S PILLAI
I YEAR MSc NURSING
HCCN,KOTTIYAM
Introduction to the
theorist
Theorist : Dorothea Orem (1914-2007)
• Born 1914 in Baltimore, US
• Received her diploma at Providence Hospital –
Washington, DC in 1934
• 1939 – BSN Ed. And Master of science in nursing
education (1945) from Catholic University of America,
Washington D.C.
 Introduction cont……

 Her clinical practice included staff nurse in the operating room,

pediatrics and adult medical surgical units.

 She also did private-duty nursing in private homes and the

hospital and was an emergency room supervisor.

 She taught biological sciences and later served as director of

nursing service and director of the school of nursing at
Providence Hospital, Michigan.

 Received several honorary degrees.

 Introduction Cont…..

Orem’s concept of nursing as the provision of self- care

was first published in 1959.
 Orem continued to develop her nursing concepts and her
self-care deficit theory of nursing. In 1971 she published
Nursing: Concepts of practice.
 The second, third, fourth, fifth and sixth editions of this
book were published in 1980, 1985, 1991, 1995 and 2001
respectively.
Died on June 2007
Introduction

1st edition: focus on individual

2nd edition: include multiperson units (families, groups
and communities)
3rd edition: Orem’s general theory of nursing, comprised
of three related theoretical constructs: self-care, self-care
deficit and nursing system
4th edition: fully developed the ideas presented
5th edition: Provided an increased emphasis on
multiperson situation
6th edition: continued development of orem’s ideas
USE OF OREM’S SELF CARE DEFICIT THEORY IN
NURSING

It provides a positive frame of reference about nurses,

patients, and the interactions between the two.
 It promotes clear understanding of the nature and scope of
nursing
It provides communication, structure, focus, links relevant
knowledge, provides clarity and specifies outcomes or
goals for nursing
ASSUMPTONS
 People should be self-reliant and responsible for their own care and
others in their family needing care
 People are distinct individuals
 Nursing is a form of action – interaction between two or more
persons
 Successfully meeting universal and development self-care requisites
is an important component of primary care prevention and ill health
 A person’s knowledge of potential health problems is necessary for
promoting self-care behaviors
 Self care and dependent care are behaviors learned within a socio-
cultural context
CONCEPTS:

NURSING
HEALTH
ENVIORNMENT
HUMAN BEING
NURSING CLIENT
NURSING PROBLEM
NURSING PROCESS
NURSING THERAPEUTICS
OREM’S GENERAL THEORY OF NURSING
Self-care is "the practice of activities that individuals initiate and
perform on their own behalf in maintaining life, health, and well-
being"
(Polit & Henderson)
“Overcoming human limitations"
(Orem,1959)
“Man's need for self-care action and the provision and management of
it on a continuous basis in order to sustain life and health, recover from
disease or injury, and cope with their effects"
(Orem, 1959).
Orem’s general theory of nursing Orem’s
general theory of nursing in three related
parts:-
• Theory of self care
• Theory of self care deficit
• Theory of nursing system
OREM’S SELF CARE MODEL
THEORY OF SELF CARE

 SELF-CARE
 SELF-CARE REQUISITE
 SELF-CARE AGENCY
 THERAPEUTIC DEMAND.
SELF CARE
Self –care is the performance or practice of activities that
individuals initiate and perform on their own behalf to
maintain life, health and well- being.

 When self-care is effectively performed, it helps to

maintain structural integrity and human functioning and
contributes to human development.
SELF CARE AGENCY

Self-care agency is the human’s acquired powers and

capabilities to engage in self care.
The ability to engage in self-care is affected by basic
conditioning factors.
The basic conditioning factors are age, gender,
developmental stat, health state, socio-cultural
orientations, health care system factors, pattern of living
etc.
SELF CARE AGENCY Cont…..

Agents:
 Self Care Agent
 Dependent Care Agent
Orem’s Self Care Theory:
Interrelationship among concepts :
THERAPEUTIC SELF-CARE DEMAND :

Total of care activities needed, either at an identified moment or over a

period of time, to meet a person’s known requirements for self-care.
SELF-CARE REQUISITE:

“Requirements” necessary for health and well-being or “The

reasons for which self care is undertaken” (Orem, 2001)

“Needs for self-care …necessary for

maintaining…functional integrity, health and wellbeing”
(Dennis, 1991).
SELF-CARE REQUISITE: Cont……

There are 3 types of self-care requisites:

i) Universal

ii) Developmental

iii) Health deviation

Universal Self Care Requisites :

Associated with life processes and the maintenance of the

integrity of human structure and functioning.

A common term for these requisites is activities of daily

living
Universal Self Care Requisites :
Cont……
 Universal self care requisites Orem identifies self-care requisites as follows:

 The maintenance of a sufficient intake of air, water, food.

 The provision of care associated with elimination processes and
excrements The maintenance of a balance between activity and rest.
 The maintenance of a balance between solitude and social
interaction.
 Promotion of normalcy
 The prevention of hazards to human life, human functioning, and
human well-being
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.

Health deviation self-care requisites :
The health deviation self-care requisites are as follows:
• Seeking and securing appropriate medical assistance.

• Being aware of and attending to the effects and results of

pathologic condition and states.

• Effectively carrying out medically prescribed diagnostic,

therapeutic and rehabilitative measures.
THE THEORY OF SELF-CARE DEFICIT
 BASIC CONDITIONING FACTORS:

 Age – current chronological age of the person

 Gender – as either male or female
 Developmental state – the persons physical, functional, cognitive
and psychosocial level
 Health state – the current and past health states of the person and
their perception of their health
 Sociocultural orientation – the interrelated systems of the person’s
social environment, spiritual beliefs, social relationships and
functioning of the family unit
Basic Conditioning Factors:
 Health care system – the resources in which health care is
accessible and available to the person for medical diagnostic
and treatment modalities
 Family system factors – roles/relationships of family members
and significant others; the Persons role in the family
 Patterns of living – the person’s usual normal activities of daily
living
 Environmental factors – the setting in which the person
normally conducts self-care; the home environment
 Available resources – this includes economic, personnel,
agencies and time
Components Of The Theory Of Self-care
Deficit :
 Attention and vigilance

 Energy

 Control of body position

 Ability to reason

 Motivation
 Cont…
Components Of The Theory Of Self-care
Deficit :
Ability to make decisions
Ability to acquire, retain, and operationalize technical
knowledge
Cognitive, manipulative, communication, and
interpersonal skills
Ability to prioritize and connect actions
Ability to be consistent and integrate
FIVE METHODS SELF-CARE DEFICIT
Acting for and doing for others
Guiding other
Supporting another
Providing an environment promoting personal
development in relation to meet future demands
Teaching another
Functions Self-care Deficit

 To set forth the views of human beings proper to nursing

 To express the specific focus or proper object of nursing in
human society
 To set forth the key concepts of nursing considered as a field of
knowledge and practice and to establish a system of symbols
or language
 To set limits on and orient thinking and practical endeavor in
nursing practice, research, development, and education for
nursing
Functions Self-care Deficit
 To reduce cognitive load by providing subsumes for incoming
information and enable persons who understand the theory to
categorize and form concepts from related insights about
features of concrete nursing situations
 To allow inferences to be made about the articulations of
nursing with other fields of human service and with patterns of
daily living of individuals and families in communities
 To generate in nurses and nursing students a style of thinking
and communicating nursing
 To bring nurses together as communities of scholars engaged
in the continuing development, the structuring, and the
validation of nursing knowledge
THE THEORY OF NURSING SYSTEM

This theory describes how the patient’s self care needs will
be met by the nurse, the patient, or both.

If there is a self-care deficit- that is, if there is a difference

between what the individual can do (self-care agency) and
what needs to be done to maintain optimum functioning
(therapeutic self- care demand)- nursing is required.
CLASSIFICATIONS OF NURSING SYSTEM :

There are three basic variations in nursing systems:

Wholly compensatory
Partly compensatory
 Supportive-educative
Wholly compensatory

Is represented by the situation in which the individual is

unable to carry out needed self-care actions, either through
inability to be self-directed or due to a medical
prescription
PARTLY COMPENSATORY

Is represented by a situation in which the patient and nurse

are both physically active in meeting the patient’s self-care
needs and either may perform the majority of the needed
action
SUPPORTIVE – EDUCATIVE SYSTEM

 It is used when a patient can meet self- care requisites but

needs assistance with decision making, behavior control,
or knowledge acquisition skills.
Supportive – educative system
CHARACTERISTICS ESSENTIAL TO NURSING
AGENCY:

 1. Effective repertoire of communication skills

 2. Transformative teaching
 3. Leadership
 4. Ethical practice
 5. Prudent (legal) practice
 6. Cultural sensitivity
 7. Professional behavior
(Keatley, 2008).
OREM’S THEORY AND THE FOUR CONCEPTS
OF THE NURSING META-PARADIGM

PERSON
ENVIRONNMENT
HEALTH
NURSING
PERSON :

Person is defined as the patient (a recipient of nursing

care) a being who functions biologically symbolically and
socially and who has the potential for learning and
development
(Orem)
ENVIORNMENT :

Environment consist of environment factor, environment

elements, environmental conditions (external physical and
psychological surrounding)and developmental
environment.
HEALTH :

A state characterized by soundness or wholeness of bodily

structure and function; illness is it opposite.
It consist of physical, psychological, interpersonal and
social aspects : there aspect are inseparable
NURSING :

Orem defines the art of nursing as an intellectual equality

of the individual nurse; this quality is related to creativity
as well as analysis and synthesis of confirmation, all of
which contribute to development of nursing system to
assist individuals or multiperson units
TECHNOLOGIES IN NURSING SYSTEM

SOCIAL/INTERPERSONAL
REGULATORY TECHNOLOGIES
 OREM’S NURSING PROCESS
Nursing Outcome and Implementation Evaluation
diagnosis plan (control (regulatory operations)
(diagnostic (Prescriptive operations)
operations) operations)
Based on selfOutcome Nurse-patient 1. Effectiveness of the nurse patient
care deficits Nursing goal and actions to action to
objectives - Promote patient - Promote patient as self care agent
Design of nursing as self care agent - Meet self care needs
system - Meet self care - Decrease the self care deficit.
Appropriate needs 2. Effectiveness of the selected
method of helping - Decrease the self nursing system to meet the needs.
care deficit.
Application of Orem’s Theory
CRITIQUE

POSITIVE ASPECT OF THE THEORY:

Provide a comprehensive base to nursing practice

Specifies when nursing is needed
Also includes continuing education as a part of the
professional component of nursing education
CRITIQUE Cont…..

Herself care approach is contemporary with the concepts

of health promotion and health maintenance
Expanded her focus of individual self care to include
multi-person units
Presented in a straightforward manner
Relationship among entities can be presented in a simple
diagram
OREM’S WORK AND THE CHARACTERISTICS
OF A THEORY

Orem's theory
Interrelate concepts in such a way as to create a
different way of looking at a particular phenomenon
Is logical in nature.
Is relatively simple yet generalizable
Is basis for hypothesis that can be tested
 Cont…

OREM’S WORK AND THE CHARACTERISTICS OF A THEORY

Contribute to and assist in increasing the general body

of knowledge within the discipline through the research
implemented to validate them
Can be used by the practitioners to guide and improve
their practice
Must be consistent with other validated theories , laws
and principles
STRENGTHS

Provides a comprehensive base to nursing practice

It has utility for professional nursing in the areas of
nursing practice nursing curricula, nursing education
administration ,and nursing research
Specifies when nursing is needed
Her self-care approach is contemporary with the concepts
of health promotion and health maintenance
LIMITATIONS

In general system theory a system is viewed as a single

whole thing while Orem defines a system as a single
whole, thing.
Health is often viewed as dynamic and ever changing.
The theory is illness oriented.
REFERENCES

Martha Raile Alligood;(2010):Nursing theory ,Utilization

and application: Fourth edition published by Mosby;
Missouri.
Navadeep Kaur Brar: (2014);Text book of Advanced
Nursing Practice;Published by Jaypee;India.