Dorothea Orem

(1970, 1985)
History and Background
• Born in Baltimore, Maryland in
1914.
• BSN education in 1939 and MSN
in 1945.
• Worked as a staff nurse, private
duty nurse, nurse educator and
administrator, and nurse
consultant.
• Received honorary Doctor of
Science degree in 1976.
• Published first normal articulation at
her ideas in “Nursing: Concepts of
Practice” in 1971, second in 1980
and finally in 1995.
• Developed the SCDNT
• Orem died in June 22, 2007 at age
92.
Overview of Orem’s “Self-
Care Deficit Nursing
Theory” (SCDNT)
• Nursing practice oriented by the
SCDNT represents a caring
approach that uses experiential
specialized knowledge (Science)
to design and produce nursing
care (Art).
• The body of knowledge that
guides the art and science
incorporates empirical and
antecedent knowledge (Orem,
1995).
• Empirical knowledge
• addresses
rooted in experience
specific events
and
and
related conditions that have
relevance for health and well-
being.

• Antecedent knowledge
• includes previously mastered
knowledge and identified fields of
knowledge, conditions, and
situations.
 • EIGHT FIELDS OF
KNOWLEDGE
1.Sociology
2.profession/occupation
3. jurisprudence
4. history
5. ethics
6.Economics
7.Administration
8.nursing science
• Orem’s general theory of nursing is
expressed in three related parts:

A.Theory of Self-Care
B.Theory of Self-Care Deficit
C.Theory of Nursing Systems
A. Theory of Self-Care
This theory includes:
1. Self-Care
2. Self Care Agency
3. Therapeutic Self-Care Demand
4. Self-Care Requisites
The three categories of self care
requisites:
• (1) universal self-care requisites
• (2) Developmental
• (3) health deviation.
B. Theory of Self-Care
Deficit
• 5 METHODS OF HELPING:
1. Acting for and doing for others
2. Guiding others
3. Supporting another
4. Providing an environment to
promote patient’s ability.
5. Teaching another
C. Theory of Nursing
Systems
• Describes how the patient’s self
care needs will be met by the
nurse, the patient or both.
Classifications of nursing
systems to meet the self-care
requisites:
1. Wholly compensatory system

2. Partially compensatory system

3. Supportive-educative system
 CONCEPTS
• Person
• A total being with universal, developmental
needs and capable of continuous self-care.

 Nursing client
 related/health
human being who has
derived limitation
health

 Environment
 Components
 environmental factors
 environmental elements
 conditions
 developmental environment.
 Health
 human beings are structurally
functionally whole or sound.
and
Application of Orem’s Self
Care Deficit Nursing Theory
(SCDNT)
Case History of Mrs. Trinidad
Villarama
Mrs. Trinidad Villrama, a 76-
year old female came to the
hospital with complaints of pain
over all joints, stiffness which is
more in the morning and reduces
ability on performing activities.
She had this complaints since 6
years ago and has taken
treatment from a private
physician’s clinic and herbolario.
 Sometimes she self-medicates. The
symptoms were not reducing, and
came to Briones General Hospital for
further mgt. The pt was able to do the
ADL by herself but the way she
performed and the posture she used
was making her at risk to develop the
complications of the dse. She was also
malnourished and was not having
awareness about the deficiencies and
effects. Medical diagnosis:
Rheumatoid arthritis.
Nurse Jane Salazar was assigned
to care for the pt. She decided to use
Orem’s SCDNT for the patient.
Data Collection for Mrs. Villarama According to
Orem’s Self-Care Deficit Nursing Theory
1. Basic Conditioning Factors

Age 76 years old

Gender Female
Health State Disability due to joint pains, needs nursing therapeutics.
Developmental state Ego integrity vs. despair.
Sociocultural Elementary graduate, Ilocano.
Orientation
Health Care System Combination of institutional and alternative health care.
Family System Married, husband retired teacher.
Patterns of Living At home with husband, daughter and her family.
Environment Urban area, two-storey home, sleeps in bedroom upstairs,
bathroom downstairs, items for ADL not in easy reach, no
special precautions to prevent injuries.
Resources Husband’s pension, daughter, and son in the U.S.
2. Universal self Care Requisites
Air Breaths without difficulty, no pallor.
Water Drinks 6 to 8 glasses of fluids per day.
Edema present over ankles.
Turgor normal for the age.
Food Food intake is not adequate, diet is not nutritious (mostly
carbohydrates).
Hemoglobin – 9.6 gm%. BMI = 14%
Elimination Occasional urinary incontinence, wears pull-up diapers when
going out of home.
Frequent constipation. Takes laxatives occasionally.
Activity/Rest Frequent rest is required due to pain.
Pain not completely relieved.
Activity level is low.
Deformity of the joints (specially the fingers) secondary to the
disease process.
Social Interaction Communicates well with husband, daughter and family,
neighbors, friends; calls son in the U.S. by phone.
Need for medical care is communicated to the husband and
daughter.
Prevention of Needs instructions on care of joints and prevention of
Hazards falls.
Needs instruction or improvement of nutritional status.
Prefers to walk bare foot inside the home.
Needs shower chair and safety bears in bathroom.

Promotion of Has good relationship with husband, daughter and her

Normalcy family.
3. Developmental Self-Care Requisites

Maintenance of Able to feed self.

Developmental Difficulty in dressing, bathing, toileting, ambulating.
Environment

Prevention/Management Feels that the problems are due to her own

of the conditions behaviors and discusses the problems with husband
threatening the normal and daughter.
development Feels bad for not being able to cook food for the
family anymore.
4. Health Deviation Self-Care Requisites
Adherence to Medical Reports the problem to the physician during clinic visits and
Regimen hospitalization.
Cooperates with the medication.
Inadequate knowledge on the use and side effects of
medicines.
Has difficulty in performing prescribed exercises.
Awareness of potential Not aware about the actual disease process.
problem associated with Not compliant with the diet, claims she has no appetite to
the regimen eat.
Not aware of prevention of hazards.
Not aware of side effects of medicines.
Modification of self- Has adapted to limitations in mobility.
image to incorporate The adoption of new ways for activities leads to deformities
changes in health status and progression of the disease.
Adjustment of lifestyle Adjusted with the deformities.
to accommodate Pain tolerance not achieved, needs frequent medication to
changes in the health relieve pain.
status and medical
regimen.
Nursing System Design for Mrs. Villarama:
Supportive-educative
Diagnostic Operations Prescriptive
Operations
Therapeutic Self-Care Adequacy of Nursing Diagnosis Methods of
Demand Self-Care Helping
Agent
Air Adequate

Water Adequate

Food Inadequate Actual nutritional Guiding

-Increase adherence to deficit related to Supporting
taking sufficient food inadequate intake and Teaching
knowledge deficit
Elimination Inadequate Actual eliminative Teaching
-Establish regular pattern disturbance related to
of elimination (bowel and urinary incontinence
bladder) and constipation
Activity/Rest Inadequate Actual self-care deficit: Guiding
-Cope with/manage pain Dressing, toileting, Supporting
on ambulation. ambulating related to Teaching
-Improve ability to restricted joint Promoting a
perform ADL including movement secondary developmental
dressing and toileting to the inflammatory environment
process in the joints.
Solitude/Social Adequate Potential for social Guiding
Interaction isolation related to Supporting
-Continue to maintain ineffective pain Teaching
family, friends, health control. Promoting the
care contacts developmental
environment
Prevention of Hazards Inadequate Potential for fall and Guiding
-Maintain safe fracture related to: Supporting
ambulation a. Joint pain Teaching
-Prevent falls and injury b. Joint deformities Promoting the
-Improve living and developmental
environment and c. Inability to environment
lifestyle maintain good
body mechanics
 Potential for injury
related to
a. Deficient safety
home devices
b. Knowledge deficit
on safety practices
Promotion of Normalcy

Maintain developmental Inadequate Actual deterioration in Guiding

environment health status related Supporting
-Support increased to difficulty in Providing physical
normalcy in the dressing, bathing, and psychological
environment toileting, and support
ambulating
Prevent/manage Inadequate Actual developmental Providing physical
developmental threats deficit related to and psychological
-manage/decrease decreased ability to support
threats by receiving perform ADL
appropriate therapy independently
-keep communication
lines open and clear
with health care
providers
Maintenance of health Inadequate Potential for continued Teaching
status alterations in health Guiding and
-promote health and well status related to directing
being inadequate health-
seeking behaviors,
financial status and
knowledge deficit
Awareness/ management Inadequate Potential for joint Guiding and
of disease process deformities, falls, and directing.
-increase understanding of decreased mobility Providing physical
interrelationships of related disease support
disease process, activity, process in joints Providing/
and hazards maintaining
environment that
supports person’s
development
Adherence to medical Inadequate Nonadherence to Teaching
regimen prescribed medical Guiding and
-increase adherence to treatment related to directing
having sufficient diet lifestyle, and Providing
-regulate use of analgesic knowledge deficit. psychological
-develop understanding of Inadequate pain relief support
side effects of medications related to timing of
analgesics.
Awareness of potential Inadequate Potential for Teaching
problems exacerbations and Guiding and
-gain better increased disability directing
understanding of cause related to knowledge
and prevention of injury deficits concerning
-understand treatment problems.
plan
Modify self-image to Inadequate Actual threats to self- Providing
incorporate changed image related to psychological
health status disease, treatment, support.
-adapt practice of good and inability to do ADL
body mechanics to independently.
prevent deformities and
progression of the
disease.
Adjust lifestyle to Inadequate Actual deficit in ability Guiding and
accommodate health self-care related to directing
status changes and inadequate resources, Providing/
medical regimen knowledge deficit, and maintaining
-adjust performing of ADL lack of recreational environment that
-achieved pain relief and activities supports persons
tolerance development
-develop recreational
activities
 Martha Rogers

Science of Unitary Human

Being
Martha Rogers

University
Doctorate Degree from Hopkins
in 1954
Nursing
Developed Conceptual Model of

Pandimensional
Human beings are
Key Conceptual Terms
• Energy Fields
• the living and nonliving
Fundamental unit of both

• Patterns
• whole
Represents the person’s
existence
(intangible, non-visible
manifestations but
perceptually present in all
interactions
Homeodynamics
person’s
The way in which a
life process
evolves
(homeostasis)
Physiological Equilibrium
of person
consist of:
Resonancy
Helicy
Integrality
Synchrony
Reciprocy
 ROGERS METAPARADIGM
NURSING

Requires specific learning
Profession
andBothart empirical science
being
Promote health and well

people
Exist for the care of
and life process
PERSON
continuously connected
An open system
to
the environment
HEALTH
Wellness
andPerson’s value cultural
system

interpretation
ENVIRONMENT
pandimensional
Irreducible,
sharing
of energy and patterns
Examples of
Homeodynamic Elements in
NPI
A patient in acute pain
Medicating a patient in pain
modalities
Alternative treatment

with
Working collaboratively
the patient
patient
Nurse approaches the
in a calm manner
Case Scenario

Bill is hospitalized for

unrelenting chest pain and
SOB. Bills resonancy level is
quite low, requiring, pain
medication, O2, and
supportive care provided by
nsg. Bill is experiencing
integrality, synchrony and
reciprocy with his env’t. Bill
undergoes a cardiac
catheterization, followed by a
successful CABG proced. and
receives wound care, pain
mgt.,dseand medication educ
Bill tells his nurse he values
having survived his heart
attack and believes he has a
chance to start over. He
wants to quit smoking and
reduce his stress level to
become more healthy. The
nurse educates Bill on
meditation, and guided
imagery. Bill has received
helical interventions and
continues in a state of
integrality with his env’t.
IMOGENE KING
SYSTEMS FRAMEWORK AND GOAL
ATTAINMENT THEORY
 HISTORY AND BACKGROUND

 Received her diploma in nursing from St.

John’s Hospital School of Nursing in St.
Louise, Missouri, in 1945
 Bachelor and masters of science degree in
nursing from St. Louise  University in 1948
and 1957.
 Graduated with a doctor of education
degree from The Teachers College of
Columbia university in 1961.
 Received an honorary doctor of
Philosophy degree from southern Illinois
University in 1980.
Association (ANA)
Received the American Nurses
Jessie M. Scott
Award for her contributions to
demonstrating the interrelationships
among nursing practice , education
and research in 1996.
 Her contributions to NANDA
International span for 40 years.
 A participant at the First National
Conference on the Classification of
nursing diagnoses in St Louise in
1973.
 Died on December 24, 2007 at the age
of 84.
 Imogene King’s “Conceptual
System and Theory of Goal
Attainment”
 Goal of nursing:
 1. health promotion maintenance,
and/or restoration;
 2. care of the sick or injured;
 3. care of the dying
needs
Three Fundamental
of a human being:
health

information that
1. the need for health
is usable at the
time when it is needed and can
be used.
 2. the need for care that seeks
to prevent illness
 3. the need for care when
human beings are unable to
help themselves.
THREE INTERACTING SYSTEMS
OF KING’S CONCEPTUAL
FRAMEWORK:

individual
Personal Systems-

Interpersonal Systems
Social System
Five Concepts that are useful
to understand interactions:
1. Organization
2. authority
3. Power
4. Status
5. Decision making
Betty Neuman
 Nursing
To prevent stress
invasion, to protect
the client’s basic
structure and to
obtain or maintain
a maximum level of
wellness.
 Betty Neuman
1924 Born near Lowell, Ohio

Received RN diploma from People’s

1947 Hospital School of Nursing, Akron, Ohio
Hospital staff and head nurse; school nurse
and industrial nurse; and as a clinical
instructor in medical-surgical, critical care
and communicate disease nursing.

1957 Attended University of California at Los

Angeles (UCLA) w/ double major in
psychology and public health.
 Received BS in Nursing from
UCLA
Received Masters Degree in
Mental Health, public Health
1966 Consultation from UCLA
Recognized as pioneer in the
field of nursing involvement
in community mental health.
Began developing her model
while lecturing in community
mental health at UCLA
1972 Her model was first published
as a “Model for Teaching Total
Person Approach to Patient
Problems” in Nursing Research

1985 Received doctorate in Clinical

Psychology from Pacific
Western University

Received second honorary

1998 doctorate- this one from Grand
Valley State University,
Allendale, Michigan.
GOAL of model

Provide a holistic overview

of the physiological,
psychological, socio-
cultural, and developmental
aspects of human beings.
Overview of Neuman’s
“System Model”
The Neumann's system model
has two major components
stress and

reactions to stress
Overview of Neuman’s
“System Model”
The client in the Neuman’s
model is viewed as an open
system in which repeated
cycles of input, process,
output, and feedback,
constitute a dynamic
organizational pattern.
The six major concepts are:

1. the client,
2. variables,
3. environment,
4. stressors,
5. wellness, and
6. nursing intervention.
I. Person variables
Each layer of the concentric circle
of the Neuman’s System Model is
made up of five person variables,
which are as follows:
Physiological Variable
Refers to the “physiochemical
structure and function of the
body”
Psychological Variable
Refers to the “mental
processes and emotions.”
Developmental
Variable

Refers to those processes

related to development
over the lifespan.
Sociocultural Variable

Refers to the
relationships; and social
and cultural expectations
and activities.
Spiritual Variable
Refers to the influence of
spiritual beliefs.
II. Central Core
The basic structure or
central core is made
up of the basic
“survival factors”
III. Flexible Line of Defense
Acts as cushion and is
described as accordion-like as
it expands away from or
contracts closer to the normal
line of defense.
IV. Normal Line of Defense
Represents system
stability over time. It is
considered to be the
usual level of stability in
the system.
V. Lines of Resistance
Protect the basic structure
and become activated when
environmental stressors
invade the normal line of
defense.
VI. Reconstitution
Is the increase in energy
that occurs in relation to
the degree of reaction to
the stressor.

Begins at any point

following initiation of
treatment for invasion of
stressors.
 SISTER CALLISTA
ROY

“ADAPTATION MODEL”
 History and Background
• Sister Callista Roy is a prominent
nurse theorist, writer, lecturer,
researcher and teacher.
• Professor and Nurse Theorist at
the Boston College of Nursing in
Chestnut Hill.
• Born in Los Angeles on October
14, 1939 as the 2nd child of Mr.
and Mrs. Fabien Roy.
• She entered the Sisters of Saint
Joseph Carondelet.
• with
She earned a Bachelor of Arts
Major in Nursing from
Mount St. Mary’s College, Los
Angeles in 1963.
• She earned her Master’s Degree
in Pediatric Nursing from the
University of California, Los
Angeles in 1966.
• She also earned a Masters
Degree and PhD in Sociology in
1973 and 1977 respectively.
• Sister Callista Roy had the
significant opportunity of
working with Dorothy E.
• Johnson’s work with focusing
knowledge for the discipline of
nursing convinced Sister Callista
Roy of the importance of
describing the nature of nursing
as a service to society and
prompted her to begin developing
her model with the goal of
nursing being to promote
adaptation.
• She joined the faculty of Mount
St. Mary’s College in 1996,
teaching both pediatric and
maternity nursing.
• She organized course content
according to a view of person and
family as adaptive systems.
• She introduced her ideas about
“Adaptation Nursing” as the basis for
an integral nursing curriculum.
• Model as a basis of curriculum
impetus for growth---Mount St.
Mary’s College.
• 1970- The model was implemented in
Mount St. Mary’s College.
• 1971- She was made chair of the
Nursing Department at the College.
Overview of Roy’s
Adaptation Model (RAM)
• The RAM provides a useful
framework for providing
nursing care for persons in
health and in acute,
chronic, and terminal
illness.
• The RAM views the
person as an adaptive
system in constant
interaction with an internal
and external environment.
• Roy categorizes environmental
stimuli as:
1. Focal stimulus
2. Contextual stimuli
3. Residual stimuli
• Roy categorizes the coping
mechanisms into regulator or the
cognator subsystems.
1. regulator subsystem occur
through neutral, chemical, and
endocrine processes. These are
automatic responses to stimuli.
2. cognator subsystem occur
through cognitive-emotive
processes - perceptual and
information processing, learning,
judgment, and emotion.
• Four adaptive modes:
1. The physiological adaptive
mode- refers to the “way a person
response as a physical being to
stimuli from the environment”.
2. The self-concept adaptive mode-
refers to psychological and
spiritual characteristics of a
person. It incorporates two
components:
3. The role function adaptive
mode-
refers to the primary,
secondary, or tertiary roles
the person performs in
society.
4. The interdependence
adaptive mode- refers to the
coping mechanisms arising
from close relationship that
result in “the giving and
receiving of love, respect, and
value”.
• Health:
being
a state and process of
and becoming
integrated and whole that
reflects person and
environmental mutuality.
• Adaptation: the process and
outcome whereby thinking
and feeling persons, as
individuals an in groups, use
conscious awareness and
choice to create human and
environmental integration.
Critical Thinking in the Roy’s
Adaptation Model (RAM)
• Roy has conceptualized the
nursing process to comprise the
following six simultaneous,
ongoing, and dynamic steps:
1. Assessment of behavior
2. Assessment of stimuli
3. Nursing diagnosis
4. Goal setting
5. Intervention
6. Evaluation
 Dorothy Johnson

“Behavioral System Model”

Goal : ”Restore, maintain, or attain
behavioral integrity, system stability,
adjustment and adaptation, efficient
and effective functioning of the
system
History and Background
 Dorothy E. Johnson was born August
21, 1919, in Savannah Georgia
 BSN from Vanderbilt University in
Nashville, Tenessee, in 1942; MPH
from Harvard University in Boston in
1948
 From 1949 until her retirement in
1978 she was an assistant Professor
of pediatric nursing, an associate
professor of nursing, an a professor
of nursing at the University of
California in Los Angeles.
 has had an influence on nursing
through her publications since the
1950’s .
 Died in February,1999
SEVEN SUBSYSTEMS OF
BEHAVIOR
1.Attachment of affiliative
subsystems
2.Dependency subsystem
3. Ingestive subsystem
4.Eliminative subsystems
5.sexual subsystem
6.Aggressive subsystem
7.Achievement subsystem
8.Restorative(added)
NURSING PROCESS AND
JOHNSONS BEHAVIORAL
SYSTEM MODEL
1. Assessment
focus on activities of daily living:
Affiliation
Dependency
Sexuality
Aggression
Elimination
Ingestion
Achievement
Restorative
2. Diagnosis
3,4&5. Outcomes,
planning and
implementation
6. Evaluation
THANK
YOU!!!