Dorothea Orem

1. Dorothea Orem Prepared by Self-Care Deficit theory Prof. Dr. Nefissa A. El-Kader Vice Dean of Education and Student Affairs Faculty of Nursing-Cairo University

2. Outlines • Overview about Orem’s theory:- • Orem's CV • Origins – Purpose • Philosophy and world view • Metaparadigm – Concepts • Assumptions and Propositions • Theories included in the Self-Care Deficit theory • Orem’s Theory and Nursing process

3. Time oriented Peplau: Published at 1952.Orem: Published at 1959.Roy: Published at 1960.Roger’s: Published at 1970.King: Published at 1971Newman: Published at 1989

4. Dorothea OremC.V. • 1939 – BSN completed • 1945 - MS in nursing education • 1958 - consultant to the Office of Education where she began working on her SELF-CARE THEORY • 1959 - first published her theory in “Guides for Developing Curricula for the Education of Practical Nurses” (a government publication)

5. Dorothea OremC.V. • 1976 - honorary Doctorate of Science from Georgetown University • 1980: Award for nursing theory from catholic university of America. • 1999 - last edition of her theory was published

6. Publications • 1959: Guidelines For Developing Curricula For The Education Of Practical Nurse • 1962: The Hope Of Nursing • 1971: Nursing: Concept And Practices 6th edition in (1999). • 1972: Concept Formalization In Nursing: Process And Product. • 1979: Levels of nursing education and practice

7. Origin • While Orem was working in the Department of Health Education and Welfare (HEW) as a curriculum consultant she worked to upgrade practical nursing training. • That stimulated the need to address the question What is the subject matter of nursing? (Curriculum)

8. Origin cont’d. • Orem’s book of “ guidelines for developing curricula for the education of practical nursing” was the seed for her work (Orem,1959 in Fawcett 1995) and (Meleis, 1998). • To conceptualize a curriculum for a diploma program by isolating and specifying nursing action.

9. Origin cont’d. • Ideas that helped to shape the self-care framework were formulated as Orem experienced a period of intensive exposure to nurses and their endeavors from 1949 to 1957 (Fawcett, 1995).

10. Philosophical view • Orem has identified her philosophical view based on the action theory, from the perspective of the person as a deliberate actor or agent.

11. Philosophical view cont’d. • Orem model is based upon the philosophy that all “ patients wish to care for themselves and its purpose was to define the following: • Nursing concern is on the man’s needs for self-care action and the provision and management of it on a continues basis in order to sustain life and health, recover from disease or injury and cope with their effect. • Nursing goal is overcoming human limitations ( Berbelgia, 2002).

12. World View • World view referred to the physiologic assumptions about the nature of person environment relationship. • Orem: adopted the organicism rather than mechaniscism as world view, she proclaimed that man include internal physical, psychological and social nature with the change rather than stability.

13. World View cont’d. • She stated that man and environment interact as a self-care system. • A change in either the system of man and the system of the environment will affect the self-care system. • Orem states: Man functioning is linked to his environment and together man and environment form an integrated whole system. • Keywords that support this view: change, whole, interaction, man and environment.

14. Conceptual Models • Nursing models are categorized according to the discipline or anthropology from which they were derived. • It is clear in Orem’s theory that she used developmental model (Montgomery,2004). Also, Meleis (1998) viewed that Orem’s theory could be categorized as an interaction model.

15. Theory Development Strategy • The theory development strategy used by Orem was induction from practice. • Induction from practice is clearly evident in Orem’s detailed accounts of how concepts in the theory were determined and defined based on “ experience in concrete nursing practice situations or results of analysis of nursing care materials “ (Orem,1991)

16. Theory Development Strategy cont’d. • Orem did however read widely and identified some of major influences on her thinking, suggests that there was an element of deduction in her work (Montgomery,2004). • Sources of influences include ideas about deliberate human actions and motivation.

17. Theory Development Strategycont’d. Factors influencing development: • Practical nursing curriculum development • Women’s movement • Nursing theory conferences

18. Basic Elements in the Model • The structure and components of the self-care framework have undergone various interpretations overtime. • Orem (1991) explained “all of the conceptual elements of the self-care framework were formalized and validated as static concepts by 1970. • Since then, some refinements of expression and further development of substantive structure and continued validation have occurred and changes have been made (Fawcett,1995).

19. Structurally, each theory is presented as a set of assumptions, and a set of propositions.

21. Model Metaparadigm- Nursing Orem viewed nursing as :A community service, an art and a technology. Community ( is a group of individuals and families who share not only a common geographic area but common Interest. As a health service: in the community : It is an interpersonal process that requires the social encounter of a nurse with a patient (transaction process) based on the values of that community. Art:As an art, it is the ability to assist others in the design, provision and management of systems of self-care to improve or to maintain human functioning at some level of effectiveness

22. Model Metaparadigm- Nursing Technology:techniques of practice 1- Communicating with persons in states of health and disease. 2- Maintaining interpersonal, intragroup, and intergroups relationships for cooperative efforts. 3-Giving human assistance adapted to specific human needs & limitations. 4- Maintaining and controlling the positions and movements of persons in physical environment for therapeutic purposes. 5- Promoting process of human growth and development including self or ego development. 6-Sustaining and maintaining life process. 7- Appraising, changing and controlling psycho-physical modes of human functioning in health and disease. 8- Maintaining therapeutic relations based on psychosocial modes of human functioning in health & disease.

23. Model MetaparadigmNursing Nursing • It is the ability to assist others in design, provision and management of self-care to improve or maintain human function at some level of effectiveness.

24. Methods of Nursing Help • Acting or doing for • Guiding & directing another • Teaching another • Providing psychological and physical support. • Providing a supportive environment to promote the patient’s ability to meet current or future demands.

25. Model MetaparadigmHealth

26. Model MetaparadigmHealth Health • Not only a bodily state but also to how one functions in everyday living and • progressive development that is movement toward higher and higher level of integration and functioning.

27. Model Metaparadigm- ENVIRONMENT • Person and environment are a functional unit in which exchange are reciprocal and influence is mutual. • Persons are viewed as existing in their environments and never isolated from them. • 4 environmental features (physical, chemical, biologic and social) have an impact on the health and well- benign the person and the family.

28. Model Metaparadigm - PERSON 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)

29. Model Metaparadigm - PERSON Person Human beings are distinguished from other living beings by their capacity to: • Reflect upon themselves and their environment • Use symbolic creations (ideas, words) in thinking, communicating, and guiding efforts to make things that are beneficial for themselves and/or for others • Man and environment form an integrated system . A change in either component may affect the self-care system.

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

31. Self-care Definition • Self-care The practiceof activities that mature person initiates and performs independently within time frame, to promote and maintain personal well-being, healthful functioning and continuing development throughout life.

32. Orem’s Self-care Agency • Definition: the individual’s ability to perform self-care activities (capabilities of the person) • It is a complex acquired abilities to meet one’s continuous requirement for care. • Consists of TWO agents: • Self-care Agent - person who provides the self-care and has the power to do so • Dependent Care Agent - person other than the individual who provides the care (such as a parent)

33. Orem’s Self-care Requisites (also called Self-care Needs) • Definition: the expressions of action to be performed by or for individuals for controlling human and environmental factors that affect human functioning and development • Three types of self-care requisites constitute the therapeutic self- care demand: • Universal - requisites/needs that are common to all individuals. 1- Air, water and food 2- elimination and excrements

34. Orem’s Self-care Requisites cont’d. 3- activity/rest 4- solitude (aloneness) /social interaction 5-prevention of hazards to life and well-being (physical , social & psychological hazards). 6-promotion of function and development within social group based on group norms.

35. Orem’s Self-care Requisites (also called Self-care Needs) Developmental– Actions that need to be performed in relation to human developmental processes , conditions and events and relation to events that adversely affect development. Health Deviation – exists for persons who are ill or injured have specific forms of pathologic conditions (including defects and disabilities & who are under medical diagnosis and treatment.. • Needs resulting from illness, injury & disease or its treatment

36. Self-Care Deficit • The relationship between self-care agency (ability to perform self-care) and the therapeutic self-care demand in which self care agency is not sufficient to meet one’s therapeutic self-care demands. • Dependent- care deficit exists when the person’s ability to perform dependent-care (i.e., dependent- care agency) is not sufficient to meet the socially dependent person’s therapeutic self care demand). • Deficit can be complete or partially and as such indicate whether wholly or compensatory system.

37. Therapeutic Self-care Demands • The sum of self-care measures/ actions, required to meet the specific self-care requisites of a person at a point in time.

38. ِAssumptions & Propositions

39. Assumptions (explicit) • Nursing is a deliberate , purposeful helping service performed by nurses for the sake of others over a period of time.

40. Assumptions (explicit) For self • Persons are capable and willing to perform self-care for self or for dependent members of the family.

41. Assumptions (explicit) • Self care is part of life that is necessary for health human development & well-being.

42. Assumptions (explicit) • Education and culture influence individuals.

43. Assumptions (explicit) • Self-care is learned through human interaction and communication.

44. Assumptions (explicit) • Self-care includes deliberate and systematic actions performed to meet needs for care.

45. Assumptions (implicit) • People should be self- reliant and responsible for their own care needs as well as others in the family who are not able to care for themselves.

46. Assumptions (implicit) • People are individuals with entities that are distinct from others and from their environments.

47. Propositions Person and nursing client: • Human beings have capabilities to provide their own self-care or care for dependents to meet universal, developmental and heath deviation self-care requisites. • Self care abilities are influenced by age, developmental state experiences and sociocultural background. • Self-care deficits are to balance between self-care demands and self-care capabilities and an indication of a state of social dependency..

48. Propositions Cont’ Nursing Therapeutic • Therapeutic self-care includes actions of nurses, patients, and others that regulate self care capabilities and meet self-care needs. • Nurses assess the abilities of patients to meet their self-care needs. • Nurses engage in selecting valid and reliable processes , or technologies or action for meeting self-care demands. • Components of therapeutic self-care are wholly compensatory, partly compensatory and supportive educative.

49. Orem’s General Theory of Nursing • Consists of three related theories collectively referred to as “Orem’s General Theory of Nursing”: • Self-care Theory • Self-care Deficit Theory • Nursing Systems Theory

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