Dorothea Orem’s Theory of Self Care Presented by Sarah Stalmack, Karri Walters, Erica Lambert, Julie Brinkerhoff and Lisa Buckley

Dorothea Orem Historical Evolution of the Model

Dorothea Orem Born in Baltimore, Maryland. One of America’s foremost nursing theorists. Father was a construction worker. Mother was a homemaker. Youngest of two daughters.

Education Studied at Providence Hospital school of Nursing in Washington D.C. in the 1930’s. Achieved he B.S.N.E. in 1939 and her M.S.N.E. in 1946 both from the Catholic University of America 1958-1960 upgraded practical nursing training for the Department of Health, Education and Welfare. Was editor to several texts including Concepts Formalization in Nursing: Process and Production, revised in 1980, 1985, 1991, 1995, 2001.

Nursing Experience Early nursing experience included operating room nursing, private duty nursing, pediatric and adult medical and surgical units, evening supervisor in the emergency room, and biological science technician. 1940-1949 Orem held directorship of both nursing school and the department of nursing at Providence Hospital in Detroit.

Development of Theory 1949-1957 Orem worked for the Division of Hospital and Institutional Services of the Indiana State Board of Health. Her goal was to upgrade the quality of nursing in general hospitals throughout the state. During this time she developed her definition of nursing practice. 1958-1960 U.S. Department of Health, Education and Welfare where she helped publish “ Guidelines for Developing Curricula for the Education of Practical Nurses” 1959.

Development of Theory 1959 Orem served as an assistant professor of nursing education at CUA, subsequently serving as acting dean of the school of nursing. She continued to develop her concept of nursing and self care during this time. Orem’s Nursing: Concepts of Practice was first published in 1971 and subsequently in 1980, 1985, 1991, 1995, and 2001. Continues to develop her theory after her retirement in 1984.

Achievement 1976 and 1980 Honorary Degree of Doctor of Science. 1980 CUA Alumni Association Award for Nursing Theory. 1988 Doctor of Humane Letters from Illinois Wesleyan University. 1988 Linda Richards Award. 1991 National League for Nursing. 1992 Honorary Fellow of the American Academy of Nursing. 1998 Doctor of Nursing Honors Causae from the University of Missouri.

Metaparadigm Concept Person: An individual with physical and emotional requirements for development of self and maintenance of their well-being. Environment : Client’s surroundings which may affect their ability to perform their self-care activities. Health: “Structural and functional soundness and wholeness of the individual” (Orem 1991). Nursing: The acts of a specially trained and able individual to help a person or multiple people deal with their actual or potential self-care deficits.

The Concepts Unique to the Dorothea Orem Model Each person has a need for self-care in order to maintain optimal health and wellness of mind, body and spirit. Orem's theory of self-care is separated into three conceptual theories which include: self-care, self-care deficit and nursing system. The concept of self-care theory is broken into three components: universal self-care needs, development self-care needs and health deviations.

Theory of self-care The components of universal self-care includes activities which are essential to health and vitality including “8” elements. The eight elements are air, water, food, elimination, activity, rest, solitude, social interaction, prevention of harm, and promotion of normality. All of the universal self-care requisites are validating human structure and functional integrity at different stages of the life cycles. a

Developmental self-care Development of self-care includes interventions and teaching designed to promote development and return a person to or sustain a level of optimal health and well being.

Health Deviation of Self-care This encompasses the variations in self-care of people who are injured, ill and/or have disability.

Theory of Self-Care Deficit Self-care deficit is a term used to define the relationship between the actions that are capable by an individual and their demands for care. Self-care deficit is an abstract concept, when expressed in the terms of action limitation. It provides guides in helping and understanding patient role in self-care. The nursing action of self-care deficit focuses on the identification of limitations and implements appropriate interventions to meet the needs of the person.

Theory of Nursing Systems The theory of the nursing system is the ability of the nurse to aid the person in meeting current and potential self-care demands. The nursing system consists of support modalities of which involve how much support will be considered for each person.

Other unique concepts to the model The ultimate uniqueness of this model is that the nurse can only make assessments where there is direct contact between the nurse and the client and or the family. Another uniqueness is that the theory is applied to many undergraduate nursing curriculum and that it helps in the nursing process by creating a nursing care plan specific to the self-care and self-care deficit.

How the model is used in clinical practice Dorothea Orem’s self care model is used everyday in the clinical setting. Patient education and discharge teaching is taught by the nurse to the patient or family member who will be caring for the patient. These include the interventions and teachings that are necessary for a person to sustain or return to a level of good health.

Interventions Wound Care Dressing changes Drain Care PICC line Care Diabetic Teaching Smoking Cessation

How the model is used as a framework for patient assessment There are ten factors that affect a person’s ability to perform self care 1.Age 2.Gender 3.Developmental State 4.Health State 5.Sociocultural Orientation

Cont. factors to perform self care 6. Healthcare system factors: medical diagnostics and treatment modalities 7.Family system factors 8.Patterns of living 9.Enviromental factors 10. Resource availability and adequacy

1. Ability to maintain attention 2.Sufficient physical energy Factors that the nurse needs to assess for when deciding the patients ability for self care 1. Ability to maintain attention 2.Sufficient physical energy 3. Ability to control position of the body and its part 4. Ability to reason within a self care frame of reference 5. Motivation

Cont. factors for assessment 6. Ability to make decisions about care of self 7. Ability to acquire technical knowledge 8. Cognitive, communication, and interpersonal skills 9. Ability to work toward final achievement of goals 10. Ability to consistently perform self care operations

Cont. Assessment As a nurse, we assess our patient’s everyday for their self care needs. We may not even realize we are performing these skills. Nurses communication with physicians regarding patients needs are the following: Physical Therapy Occupational Therapy

Cont. Communication of Needs Speech Therapy Medical-Social Work Extended Care Facility Home Care nurses and/or aides

Additional Framework A person benefits from nursing intervention when their ability to perform self care is inhibited or a situation occurs where theory abilities are not sufficient to maintain their own health. Nursing action focuses on the identification of deficits and implementing appropriate interventions to meet the needs of the person.

Orem’s model in the context of nursing education The focus of Orem’s model of nursing is to enhance the patients ability for self care and extend this ability to care their dependents. A person’s self care deficits are a result of their environment. Three systems exist within the professional nursing model.

Three systems within the nursing model The compensatory system, in which the nurse provides total care. The partial compensatory system, in which the nurse and the patient share responsibilities for care. The educative-development system, in which the patient has the primary responsibility for personal health, with the nurse acting as a consultant. The basic premise of Orem’s model is that individuals can take responsibility for their health and the health of others, and in a general sense, individuals have the capacity to care for themselves and their dependents.

Orem’s self care deficit theory of nursing is composed of three related theories 1. The theory of self care, describing how people care for themselves. 2. The theory of self care deficit, which describes why people can be helped through nursing. 3. The theory of nursing systems describing and explaining relationships that must be initiated and maintained for nursing to be produced. Self care is what a person does to establish and maintain their health, personal development and well-being.

Additional info. on the context of nursing education There is work ongoing for development of the theory of dependent care, the use of the theory in primary care, and development of variations of care systems such as concepts of collaborative care. Orem’s theory is useful in designing curricula for pre-service, graduate, and continuing nursing education. It can also give direction to nursing administration, and be used for guiding practice and research. It gives direction to nurse-specific outcomes related to knowing and meeting the therapeutic self care demands, and establishing self care and self management systems.

Current research status of the model The history of professional nursing begins with Florence Nightingale Later in last century began with a strong emphasis on practice Following that came the curriculum era which addressed the questions about what the nursing students should study in order to achieve the required standard of nursing As more and more nurses began to pursue higher degrees in nursing, there emerged the research era Later graduate education and masters education was given an importance The development of the theory era was a natural outgrowth of the research era

Research cont. With the increased number of researchers it became obvious that the research without theory produced isolated information, however research and theory produced the nursing sciences. Within the contemporary phase there is an emphasis on theory use and theory based nursing practice and lead to the continued development of the theories.

Strengths of the Model The strengths of the model are clarity and simplicity of the model. Clarity involves the terms that are limited precisely defined and used consistently. Consistent language used throughout nursing theory, action theory and philosophy.

Strengths cont. Applies to all instances of nursing. Those engaged in nursing practice. Those engaged in development and validation of nursing knowledge. Those engaged in teaching and learning nursing.

Limitations of the Self Care Deficit Theory Clarity: Readers who lack familiarity with practical science and the field of action science may have difficulty with Orem’s language. Instruments of measurement have not been developed for all entities of the theory. Example: There has been no instrument developed to measure the entity of “nursing agency”.

Overall analysis of the Model Orem’s Theory is based on the single element of self care. Orem describes self care as the practice of activities that an individual initiates and perform on their own behalf in maintaining life, health, and well-being. Orem’s self care deficit theory is used in most hospital setting to which the patient become unable to or needs to learn how to maintain life, health and well-being. The patient is provided with tools and resources directly by the nurse.

Cont. analysis of the model The model also helps in developing and guiding practice and research. It gives direction to nursing –specific outcomes related to knowing and meeting the therapeutic self care demands, regulating the development and exercise of self care agency and establishing self care. Ultimately, the theory describes what a person requires and what actions need to be taken to meet the requirements of well-being.

New insight about the Model It is found that Self care deficit theory of nursing has allowed nurses to see nursing a practical science. The theory has brought unity and the meaning of nursing and the domain action of nursing. Allowing us to have a clearer view on the field. Dorothea Orem feels that all nurses need to understand that theory merely points to the situation you have to deal with in the real world and simply help to understand those situations. Self care deficit is found to fit into any nursing situation related to the fact that it is a general theory and can truly be used in any situation.

Game On!! Next we will play a game and see which team can create a quick care plan and relate it to Dorothea Orem self care deficit. Put your thinking caps on 

The End Thank You, Dr. Jamieson and class!!!

References Alligood,M.R., Tomey, A.M. (2006). Nursing theorists and their work (6th ed.). St.Louis, MO: Mosby-Year Book Inc. Fawcett, J. (2001). Nursing Science Quarterly, Vol.14(1). Pp.34-38. Retrieved November 24th, 2008. Kearnery-Nunnery, R. (2005). Advancing your Career: Concepts of Professional Nursing. In J.P DaCunha, C. Abramowitz, & K. Kern (Eds.), Theoretical Basis of Nursing Practice (pp. 73-76). Philadelphia, PA:F.A. Davis Company Orem, D.E. (1991). Nursing: Concepts of practice (4th ed.). St. Louis, MO: Mosby-Year Book Inc. Whelan, E. G. (1984). Analysis and application of Dorothea Orem’s Self-care Practice Model. Retrieved November 30, 2008.