Transcript Dorothea Orem’s Self

DOROTHEA OREM’S
SELF-CARE FRAMEWORK
Zachary Medler
Emily Williams
Sara Kinne
Dorothea Orem, 1914-2007
ISSUES AND PURPOSE
Questions or Problems to Solve
oOur assignment is to compare and contrast nursing
models while working effectively in an on-line group. We
also need to demonstrate the use of the critical thinking
process using the elements of reasoning.
oOur group has chosen to analyze Dorothea Orem’s SelfCare Framework, also known as the Self-Care Deficit
Theory of Nursing.
oIn today’s world, people are living longer, becoming sicker
and hospital stays are much shorter then they use to be.
To understand and use Orem’s theory is of great benefit as
the need for self-care to maintain optimal health and the
responsibility of caring for oneself and their dependents is
increasing.
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Orem’s Self-Care Framework is broken down into
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self-care
self-care agency
power components
basic conditioning factors
therapeutic self-care demand
self-care deficit
nursing agency
implications for nursing practice.
SELF-CARE
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Self-care is voluntary activities that people
perform to take care of themselves and their
environment to maintain life, health and wellbeing.
SELF-CARE AGENCY
A self-care agency is an individual’s ability “to
determine the presence and characteristics of
specific requirements for regulating their own
functioning and development, make judgments
and decisions about what to do, and perform care
measures to meet specific self- care requisites”
(Kearney-Nunnery, 2008, p. 59). A self-care
agency is acquired and can be affected by many
variables, such as one’s environment, age,
developmental state, life experience, health and
available resources.
POWER COMPONENTS
According to Kearney-Nunnery (2008) the person’s
ability to perform self-care is influenced by 10
power components:
 Ability to maintain attention and exercise
requisite vigilance with respect to self as self-care
agent, and internal and external conditions and
factors significant for self-care.
 Controlled use of available physical energy that is
sufficient for the initiation and continuation of
self-care operations.
 Ability to control the position of the body and its
parts in the execution of the movements required
for the initiation and completion of self-care
operations.
 Ability to reason within a self-care frame of
reference.
POWER COMPONENTS (CON’T)
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Motivation.
Ability to make decisions about care of self and to
operationalize these decisions.
Ability to acquire technical knowledge about self-care
from authoritative sources, to retain it, and to
operationalize it.
A repertoire of cognitive, perceptual, manipulative,
communication, and interpersonal skills adapted to
the performance of self-care operations.
Ability to order discrete self-care actions or action
systems into relationships with prior and subsequent
actions toward the final achievement of regulatory
goals of self-care.
Ability to consistently perform self-care operations,
integrating them with relevant aspects of personal,
family, and community living.
BASIC CONDITIONING FACTORS
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According Kearney-Nunnery (2008) a person’s ability
to perform self-care is also influenced by 10 internal and
external factors.
These are called basic conditioning factors and include:
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age
gender
developmental state
health state
sociocultural orientation
health-care system factors
family system factors
patterns of living
environmental factors
resource availability and adequacy.
THERAPEUTIC SELF-CARE DEMAND
Therapeutic self-care demands are
actions that individuals need to perform
at certain times or over a course of time
to maintain life, health, and well-being
and to meet all of an individual’s known
self-care requisites.
 There are three types of self-care
requisites:
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universal self-care
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developmental self-care
health deviation self-care
UNIVERSAL SELF-CARE REQUISITES
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Universal self-care requisites are “actions that
need to be performed to maintain life processes,
the integrity of human structure and function,
and general well-being” (Kearney-Nunnery, 2008,
p.60). Examples of universal self-care requisites
include air, water, and food, elimination, balance
between activity and rest and between social
interaction and solitude, prevention of harm and
promotion of normalcy.
DEVELOPMENTAL SELF-CARE REQUISITES
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Developmental self-care requisites are “actions
that need to be performed in relation to human
developmental processes, conditions, and events
and in relation to events that may adversely
affect development (Kearney-Nunnery, 2008,
p.60). Examples of these requisites include death
of a loved one, adjusting to a new job, adjusting
to body changes, toilet training a child and
learning healthy eating.
HEALTH DEVIATION SELF-CARE
REQUISITES
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Health deviation self-care requisites are “actions
that need to be performed in relation to genetic
and constitutional defects, human structural and
functional deviations and their effects, and
medical diagnostic and treatment measures
prescribed or performed by physicians (KearneyNunnery, 2008, p.60). These requisites are
required in conditions of illness, injury, or
disease. Examples are obtaining appropriate
medical care, effectively caring out subscribed
treatments or medications, learning about your
condition and how to deal with it and live with it
if it’s a chronic condition.
SELF-CARE DEFICIT
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The self-care deficit is an imbalance between
the self-care agency and the therapeutic self-care
demand. A person’s self-care agency is unable to
identify and care for all of their self-care
demands. When a person cannot meet their selfcare needs due to limitations there is a deficit.
Nursing interventions are beneficial when a
health related situation limits an individual’s
ability to care for oneself or creates a situation
where the individual’s knowledge is not sufficient
enough to maintain their own health and
wellness. For nursing to be needed there needs
to be a self-care deficit.
NURSING AGENCY
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Nursing agency is a characteristic that allows nurses to
know and help others to know their therapeutic self-care
demands, meet them and positively affect the development
of their self-care agency. When a nursing agency is
activated, a nursing system is produced.
A nursing system is thought out actions carried out by the
nurse or patient in efforts to meet the patient’s therapeutic
self-care demands and positively affect the development of
the patient’s self-care agency or dependent-care agency.
There are 3 types of compensatory systems:
total
 partial
 educative/supportive
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The goal of nursing is to help people meet their therapeutic
self-care demands through the application of nursing
systems.
NURSING AGENCY- TYPES
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Total compensatory support is when the nurse
provides all the care for the patient. The patient
is unable to care for themselves.
NURSING AGENCY- TYPES
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Partial compensatory support is when both the
nurse and the patient provide in the self-care
requirements.
NURSING AGENCY- TYPES
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Educative/ supportive compensatory support is
when the nurse is only the educator, consultant
or resource person and the patient provides all of
their own self-care.
IMPLICATIONS FOR NURSING PRACTICE
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Nurse’s actions are intended to help people meet their own
and their dependents therapeutic self-care demands.
Orem’s practice approach to ensure this is called
Professional-Technologic Operations of Nursing Practice.
It includes case management operations, diagnostic
operations, prescriptive operations, regulatory operations
and control operations.
In case management operations the nurse uses a case
management method to direct each of the nursing
diagnostic, prescriptive, regulatory, and control
operations. The nurse maintains an overview of the
interrelationships between the social, interpersonal, and
professional technological systems of nursing. They also
use appropriate tools to collect and document information,
and to measure the quality of nursing.
IMPLICATIONS FOR NURSING PRACTICE
(CON’T)
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In diagnostic operations the nurse determines the
unit of service for nursing practice and why the
patient needs nursing. They gather demographic
information about the patient and information about
the type and limitations of their health-care situation
and nursing’s authority within those boundaries.
In prescriptive operations the nurse collaborates with
the patient and if appropriate their family to identify
all care measures needed to meet all therapeutic selfcare demands. They also identify the roles to be
played by the nurse or nurses, patient and dependent
or dependents in meeting the therapeutic self-care
demands and in regulating the patient’s development
of self-care agency or dependent-care agency.
IMPLICATIONS FOR NURSING PRACTICE
(CON’T)
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The regulatory operations include design of nursing systems for
performance of regulatory operations, planning for regulatory
operations and production of regulatory care. In regulatory
operations: design of nursing systems for performance of
regulatory operationst he nurse designs systems (actions/
interventions) and chooses whether to use the wholly
compensatory, partially compensatory or supportive-educative
nursing system depending on who can or should perform the selfcare activities. The systems are then implemented using one or
more of the following: acting or doing for the patient, providing a
developmental environment, supporting the patient
psychologically, guiding the patient and teaching the patient.
In regulatory operations: planning for regulatory operations the
nurse determines what is needed to carry out the actions selected
for the patient. Such as what time and place, necessary
environmental conditions, equipment, supplies, the number and
qualifications of nurses and other health-care providers needed to
carry out the systems and evaluate the effects, the organization
and timing of tasks to be performed and designation of who is to
perform the tasks.
IMPLICATIONS FOR NURSING PRACTICE
(CON’T)
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In regulatory operations: production of regulatory care nursing systems are
produced by the actions of the nurses and patients during their encounters.
The nurse produces and manages the selected nursing systems and
methods of helping for as long as the patient has a self-care or dependentcare deficit. They do this by performing and regulating or assisting
patient’s with their self/ dependent-care tasks, coordinating self/ dependent
care tasks performance, helping patients, their families and others bring
about systems of daily living for patients that support the completion of self/
dependent-care. Also by guiding, directing and supporting patients in their
exercise or in their withholding of their self/ dependent-care agency,
stimulating patient’s interests in self/dependent-care, by being available
when questions arise, supporting and guiding patients in learning activities
and as they experience illness or disability and their need for change to
meet new self-care requisites.
In control operations the nurse determines if the nursing system that was
created is produced and if there is a fit between the current subscription for
nursing and the nursing system being used. Nurses ensure the patient’s
functioning is achieved through performance of care measures to meet their
self-care demand and their use of self/dependent- care agency is being
properly regulated. They also determine if developmental change is in the
process and is adequate and the patient is adjusting to any decrease in
powers to participate in self/dependent care.
ASSUMPTIONS AND POINT OF VIEW
Origins of the nursing model
DOROTHEA OREM’S HISTORICAL BACKGROUND
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Born in 1914 in Baltimore, Maryland.
Education:
Received her diploma of nursing at Providence Hospital School of
Nursing in Washington, D.C. in the early 1930s
 Obtained her BS in nursing education from the Catholic University of
America (CUA) in 1939, and in 1946 her MS in Nursing Education,
also from CUA.
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Early nursing experiences
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Private duty nursing (hospital and home)
Operating room nursing
Hospital staff nursing on pediatric and adult med/surg units
Biological science teaching
Evening supervisor in an emergency room
Furthering her career
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Director of the school of nursing and department of nursing at Providence
Hospital in Detroit, MI from 1940 to 1949
Worked for the Division of Hospital and Institutional Services of the
Indiana State Board of Health from 1949 to 1957
DOROTHEA OREM’S HISTORICAL
BACKGROUND- CON’T
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Furthering her career, con’t
 In 1957 took a position as a curriculum consultant at the
Office of Education, U.S. Department of Health, Education,
and Welfare, in Washington, D.C. and for 2 years worked on a
project to upgrade practical nurse training.
 Later in 1957 she became an assistant professor of nursing
education at CUA
 In 1970 Orem moved on from CUA and began her own
consulting firm.
 Orem received many honors in her career, including
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From Georgetown University: Honorary Doctor of Science in 1976
CUA Alumni Association Award for Nursing Theory in 1980
Honorary Doctor of Science, from Incarnate word College, 1980
Doctor of Human Letters, Illinois Wesleyan University, 1988
Linda Richards Award, National League for Nursing, 1991
Honorary Fellow of the American Academy of Nursing, 1992
Doctor of Nursing Honoris Causae from University of Missouri, 1998
DOROTHEA OREM’S HISTORICAL
BACKGROUND- CON’T
While working at CUA Orem continued to
develop and formalize her concepts of nursing
and self care, sometimes alone and sometimes
with others. The group she worked with later
came to be known as the Nursing Development
Conference Group (NDCG).
 Retired in 1984, yet continued to work on her
Self-Care Deficit Nursing Theory (SCDNT).
 Dorothea passed away at age 92, after a period of
being bedridden, on June 22, 2007.
 Many of her papers are available for nursing
scholars in an edited compilation.
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PHILOSOPHIC VALUES OF NURSING AND
KNOWLEDGE DEVELOPMENT
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According to Alligood and Tomey, “her goal was to upgrade the
quality of nursing in general hospitals throughout the state,” (pg.
265).
Orem had recognized early in her career that for nursing to advance
as a field of knowledge and field of practice, an organized and
structured knowledge body would be needed.
Her main source of her ideas on nursing, was from her personal
nursing experience.
“The question that directed Orem’s (2001) thinking was “What
condition exists in a person when judgments are made that a nurse(s)
should be brought into the situation?”(p.20). The condition that
indicates the need for nursing assistance is “the inability of persons to
provide continuously for themselves the amount and quality of
required self-care because of situations of personal health” (Orem,
2001, p. 20). It is the proper object or focus that determines the
domain and boundaries of nursing, both as a field of knowledge and
as a field of practice. The specification of the proper object of nursing
marks the beginning of Orem’s theoretical work” (Alligod & Tomey,
2010, p. 266-267).
PHILOSOPHIC VALUES OF NURSING AND
KNOWLEDGE DEVELOPMENT- CON’T
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“Foundational to Orem’s SCDNT is the philosophical
system of moderate realism” (Alligood & Tomey, 2010,
p. 267).
A philosophical inquiry conducted by Banfield in 1997
showed consistency with Orem’s views “regarding the
nature of reality, the nature of human beings, and the
nature of nursing as a science and the ideas and
positions associated with the philosophy of moderate
realism” (Alligood & Tomey, 2010, p. 267).
“Orem (1997) identified “five broad views of human
beings that are necessary for developing
understanding of the conceptual constructs of selfcare deficit nursing theory and for understanding the
interpersonal and societal aspects of nursing systems”
(p. 28). These are view of (1) person, (2) agent, (3)
user of symbols, (4) organism, and (5) object” (Alligood
& Tomey, 2010, p. 267).
PHILOSOPHIC VALUES OF NURSING AND
KNOWLEDGE DEVELOPMENT- CON’T
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Person-as-agent is central to Orem’s SCDNT. “Selfcare, which refers to those actions in which a person
engages for the purpose of promoting and
maintaining life, health, and well-being, is
conceptualized as a form of deliberate action”
(Alligood & Tomey, 2010, p. 267-268). The individual
acts as an agent when participating in deliberate
action.
Orem’s theory of self-care deficit represents her work
regarding the substance of nursing as a field of
knowledge and as a field of practice. She also
identified the form of nursing as a science, a practical
science. There are two components that make up
practical science: the practical and the speculative.
Practically practical is directive of action, and
speculatively practical is theoretical in nature.
SCDNT is speculatively practical knowledge.
PHILOSOPHIC VALUES OF NURSING AND
KNOWLEDGE DEVELOPMENT- CON’T
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“Orem’s articulation of the form of nursing science provided the
framework for the development of a body of knowledge for the
education of nurses and for the provision of nursing care in concrete
situations of nursing practice. The SCDNT with its conceptual
elements and three theories identifies the substance or content of
nursing science” (Alligood & Tomey, 2010, p. 269).
Orem’s theory is used and has developed nursing knowledge all over
the world. “In 1988, nursing theory and its importance to the
development of nursing science were introduced to the graduate
faculty and students at Ramathibodi School of Nursing, Mahidol
University in Bangkok. Orem’s self-care model was introduced as one
of the grand theories and became a popular model for use especially
by a number of graduate faculties who were clinical experts. These
individuals became very active in application of Orem’s theory to
practice and guided masters’ nursing students in application to both
practice and research. These faculty and students became the
advocates of Orem’s work and were the primary reasons for
advancement of Orem’s theory” (Hanucharurnkul, 2009, p. 16).
INFORMATION AND CONCEPTS
Human Being
Environment
Health
Nursing
OREM’S SELF-CARE MODEL DEFINES THE
FOUR GLOBAL CONCEPTS BY
Human being relates to the patient and/or
family support system
 Environment can be physical or emotionally
influenced depending on the setting/situation
 Health is the state of wellness
(physical/emotional) of the patient and family,
including associated needs or deficits
 Nursing is the degree of care relative to
patient/family deficits requiring to bring
patient/family to the fullest possible level of
function
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INTERPRETATION & INFERENCE
AND IMPLICATIONS &
CONSEQUENCES
Evaluation of the nursing model
CLARIFICATION OF ORIGINS. IS THIS
PHILOSOPHY UNIQUE TO NURSING? IS IT CLEAR
WHAT INFLUENCED THIS MODEL?
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The theory of self-care is accomplished on a daily
basis by mature individuals in order to maintain
a healthy lifestyle (Orem, 2001). According to
Banfield (1997), Orem’s Self-Care Theory was
influenced by the “philosophical system of
moderate realism”.
CONTENT. DOES THIS MODEL ADEQUATELY DESCRIBE
THE FOUR GLOBAL CONCEPTS? –OR- DOES THIS
MODEL ADD TO THE GLOBAL CONCEPTS?
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Orem’s Self-Care Model states that each of the
global concepts can influence, or be influenced by
factors/needs in any and all of the remaining
concepts, for example an individual’s physical
health can be affected by their environment; lack
of appropriate nursing care or problems with
family members, and poor living conditions.
NARROW VIEW? (CAN THIS MODEL BE USED IN OB
AND OR?) HAVE OTHER THEORIES BEEN GENERATED
FROM THIS MODEL? ARE THE CONCEPTS ABSTRACT OR
SPECIFIC?
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Orem’s self-care nursing theory can be used in
various settings as well as OB and OR. The nurse
would select the nursing system as according to the
patients needs. According to Kearney-Nunnery
(2008) the systems are referred to as
Wholly compensatory nursing system – patient is
unable to perform self-care actions
-Partly compensatory nursing system – patient is able
to perform in some but not all self-care actions
Supportive-education nursing system – patient is able
to perform all self-care actions
The concepts to this model are abstract which allows
for multiple settings to apply it. The theory of
planned behavior is associated with Orem’s Self-Care
Framework (Villarruel, et al, 2001).
WHAT PRACTICE SITUATIONS CAN/HAS
THIS MODEL BEEN USED IN?
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“Dorthea Orem's Self Care Theory is one of the
general theories that can be applied to multiple
settings in nursing practice. The dialysis arena is
one area of nursing practice in which the
application of this theory would be appropriate
because it is crucial for patients to be actively
involved in self care” (Simmons 2009). “Nurses,
can be invaluable sources of support and
providers of education for new caregivers of
stroke survivors; they are often in an ideal
position to address the needs and concerns of
caregivers due to their close contact with patients
and their families” Bakas et al., 2002; Dorsey &
Vaca, 1998).
CASE STUDY
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Sarah S. is a 45-year-old single American woman who
has had type 2 diabetes for 7 years. She recently had
a scab to her right big toe from stubbing it that wasn’t
healing. Sarah was referred to a vascular surgeon
from her primary care physician. The surgeon ruled
out peripheral vascular disease and referred Sarah to
his office’s diabetes educator. Sarah is a secretary at
a local school and struggles to pay her bills as she is
the sole provider for herself and her mother. She
enjoys eating out, watching movies and being with
her family. She is an only child who lives in an
apartment with her 80 year old widowed mother who
has limited mobility due to her chronic rheumatoid
arthritis.
CASE STUDY (CON’T)
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Sarah’s mother is dependent on her for all of her
activities, house work, shopping, etc. With Sarah
being overweight, heavy cleaning is exhausting for
her. She tells the diabetes educator, “I’m so tired all
the time, but my mother doesn’t think we need to hire
a cleaning lady. She was so good to me growing up,
now I need to return the favor.” When the nurse
questioned her about her blood glucose monitor she
stated “I have one somewhere, I don’t have time to
use it, but I try avoiding foods I shouldn’t eat.” Sarah
also stated that she is too exhausted to participate in
an exercise program. Through assessment of Sarah
and her family, the diabetes educator was able to
identify Sarah’s needs and discussed and carried out
actions to help Sarah meet her self-care demands and
enhance her self-care agency.
CASE STUDY QUESTIONS
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Q: What is affecting Sarah’s self-care agency?
Q: As a diabetic what should some of Sarah’s
therapeutic self-care demands be?
Q: Does Sarah have a self-care deficit, if so why?
Q: What type of compensatory system was the
diabetes educator using?
ZACHARY MEDLER’S REFERENCES
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Bakas, T., Austin, J., Okonkwo, K., Lewis, R., & Chadwick, L. (2002).
Needs, concerns, strategies, and advice of stroke caregivers the
first 6 months after discharge. Journal of Neuroscience Nursing,
34, 242-251.
Banfield, B. E. (1997). A philosophical inquiry of Orem’s self-care deficit in
nursing theory. Dissertation Abstracts International, 58, 5885B.
Dorsey, M. & Vaca, K. (1998). The stroke patient and assessment of caregiver
needs. Journal of Vascular Nursing, 16(3), 62-67.
Nunnery-Kearney, R. (2008). Advancing Your Career: Concepts of
Professional Nursing (4th.ed., pp.61-70). Philadelphia: F.A. Davis.
Orem, D.E. (2001). Nursing: Concepts of practice (6th ed., p.522). St. Louis,
MO: Mosby.
Simmons, L. (2009). Dorothy Orem’s self-care theory as related to nursing
practice in hemodialysis. Nephrology Nursing Journal, 36, 419
Villarruel, A. M., Bishop, T. L., Simpson, E. M., Jemmot, L. S., & Fawcett, J.
(2001). Borrowed theories, shared theories, and the advancement of
nursing knowledge. Nursing Science Quarterly, 14, 158-163.
EMILY WILLIAMS’ REFERENCES
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Kearney-Nunnery, R. (2008). Advancing Your Career:
Concepts of Professional Nursing.Philadelphia, PA: F.
A. Davis Company.
Kumar, C. (2007). Application of Orem’s Self-Care Deficit
Theory and Standardized Nursing Languages in a
Case Study of a Woman with Diabetes.International
Journal of Nursing Terminologies and Classifications,
18(3), 103-110. doi:10.1111/j.1744-618X.2007.00058.x
Alligood, M.R. &Tomey, A.M. (2006).Nursing
Theorists and Their Work (6thed.). St Louis, MO:
Mosby Elsevier.
Nursing Theories: A Companion to Nursing Theories and
Models. (2010). Dorothea Orem's Self-Care
Theory. Retrived from
http://currentnursing.com/nursing_theory/self_care_d
eficit_theory.html
SARA KINNE’S REFERENCES
Alligood, M.R. &Tomey, A.M. (2010).Nursing
Theorists and Their Work (7thed.). St Louis,
MO: Mosby Elsevier.
 Banfield, B. E. (1997). A philosophical inquiry of
Orem’s self-care deficit in nursing theory.
Dissertation Abstracts International, 58,
5885B.
 Hanucharurnkul, S. (2009). Self-Care Deficit
Nursing Theory in Research and Practice in
Thailand. Self-Care, Dependent-Care &
Nursing, 17 (1), 16-20.
 http://www.orem-society.com/
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