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

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

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

Dorothea Orem C.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)

Dorothea Orem C.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

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

What is the subject matter of nursing? 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)

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.

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).

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.

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).

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.

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.

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.

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)

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.

Theory Development Strategy cont’d. Factors influencing development: Practical nursing curriculum development Women’s movement Nursing theory conferences

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).

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

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

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.

Model Metaparadigm 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.

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.

Model Metaparadigm Health

Model Metaparadigm 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.

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.

Model Metaparadigm - 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)

Model Metaparadigm - 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.

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

Self-care Definition Self-care The practice of 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.

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)

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

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.

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

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.

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.

ِAssumptions & Propositions ICDL is an end-user certification. People who are ICDL certified can certainly move on to other IT careers, but over 90% will use ICDL in their ever day, non-IT positions (medical transcription, CPA, architect, etc.)

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

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

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

Assumptions (explicit) Education and culture influence individuals.

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

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

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.

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

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..

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.

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

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

Self-care Definition Self-care comprises those activities performed independently by an individual to promote and maintain personal well-being throughout life.

Orem’s Self-care Deficit Theory Is the central focus of Orem’s Grand Theory of Nursing Explains when nursing is needed Describes and explains how people can be helped through nursing Results when the Self-care Agency (patient) can’t meet her/his self-care needs or administer self-care Nursing meets these self-care needs through five methods of help

Orem’s Nursing Systems Theory Describes... Nursing responsibilities Roles of the nurse and patient Rationales for the nurse-patient relationship Types of actions needed to meet the patient’s demands

Orem’s Nursing Systems Theory Refers to a series of actions a nurse takes to meet a patient’s self-care needs Is determined by the patient’s self-care needs Is composed of THREE systems: Wholly compensatory Partly compensatory Supportive-educative

Three Nursing Systems Wholly Compensatory: a patient’s self-care agency is so limited that s/he depends on others for well-being Partly Compensatory: a pt can meet some self-care requisites but needs a nurse to help for others. Supportive-educative: a pt can meet self-care requisites but needs help in decision-making, behavior control, or knowledge acquisition

Orem's theory, Nursing process &Critical thinking operations Intellectual Phase Step I: the initial and determination of needs Step II: the designing of system (Planning). Practical phase: Step III: Initiation, conduction & controlling of assisting actions. Critical Thinking Operations It includes four cognitive operations Diagnostic Operation Identify self-care practice, its limitation Perspective Operations Select the appropriate therapeutic method and explaining it to client Regulatory operations Design plan and implement it. Control operations Evaluation of the effectiveness of regulatory operations Nursing process Assessment Diagnosis Planning Implementation Evaluation

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