Presented by Melissa Kurek, Nicholas Kurek, Kimberly Marino and Heather Nowak Dorothea Orem’s Theory of Self Care Deficit

Born in Baltimore, Maryland in 1914

Orem’s parents Father was a construction worker Mother was a homemaker

1930- graduated from Providence Hospital School of Nursing, Washington, DC 1935- BSN from Catholic University of America 1945-MSN from Catholic University of America

Orem’s World of Academia 1959- Dean of the School of Nursing at Catholic University of America 1976- Doctorate of Science from Georgetown University 1988- Doctor of Humane Letters from Illinois Wesleyan University 1998- Doctor of Nursing Honoris Causae from University of Missouri Retired in 1984

Orem’s nursing experience Operating room nurse Staff nurse Private duty nurse Nurse educator Nurse administrator Nurse consultant

Died June 22, 2007

The Historical Evolution of Orem’s Model Orem worked on developing nursing curriculum and nursing practice 1949-1957 Worked for the Office of Education, in the U.S. Dept. of Health, Education and Welfare as a curriculum consultant 1958-1960 Guidelines for Developing Curricula for the Education of Practical Nurses was developed ( Tomey and Alligood, 2006). 1958-1960 cont’d

Published Nursing: Concepts of Practice Evolution continued Eventually served as the acting dean of the School of Nursing at the Catholic University of America 1960-1970 Published Nursing: Concepts of Practice 1971

Metaparadigms of Orem’s Model Person Environment Health Nursing

Metaparadigm: Person An individual or group of individuals who have the ability to acquire the knowledge necessary to perform tasks of self care. Ability to integrate self-care tasks and family, community and individual needs. Motivation to accomplish self care tasks. Intellectual ability to cognitively perform, delegate and evaluate tasks performed.

Metaparadigm: Health “Promotes function and development within social groups in accordance with human potential, known human limitation, and the human desire to return to normal” (Tomey & Alligood, 2006 p. 279).

Metaparadigm: Environment 4 realms of state are encompassed in Environment: Physical Chemical Biological Socioeconomical

Environment continued Environment – Physical Shelter Security- internal and external Climate Amenities eg. Heat, electricity, indoor plumbing, sanitation…

Environment-Chemical Pollutants: Air Water Physical Lead paints Mercury Asbestos

Environment-Biological Molds Pollens Allergens Mites Animal waste and its by-products

Environment-Socioeconomic Family income Education level Occupation Social status Resources

Metaparadigm: Nursing The skilled professional who evaluates and acknowledges a patient’s health deficit. Nursing plans and implements care based on the actual and potential self-care deficits. Task Performance Self-Care Promotion Demographics Supportive Coordinated

Concepts Unique to Orem’s Model Three Nursing Theories The Theory of Self Care The Theory of Self- Care Deficit The Theory of Nursing Systems

Theory of Self-Care “Self –care comprises the practice of activities that maturing and mature persons initiate and perform, within time frames, on their own behalf in the interest of maintaining life, healthful functioning, continuing personal development and well- being through meeting known requisites for functional and developmental regulations”(Tomey & Alligood, 2006 p.269).

Theory of Self-Care continued The Theory of Self- Care has three components: universal self-care needs, developmental self- care needs and health deviation.

Theory of Self-Care Deficit A self-care deficit occurs when an individual cannot carry out self-care requisites. Examples of self-care requisites are: Wound care Activities of Daily Living Bowel program Glucose monitoring

Universal Self-Care Requisites The 8 elements : Air Food Water Elimination/Excretion Activity & Rest Solitude/Social interaction Functioning/Well-being Normalcy

Developmental Self-Care Requisites Composed of 3 needs Promote development Engage in self-development Preventing or overcoming adverse human conditions and life situations

Health Deviation Self-Care Requisites When a condition permanently or temporarily alters structural, physiological or psychological function. Comatose states Autism Mental Retardation

Theory of Nursing Systems Total compensatory support- patient is unable to complete any self-care independently; nursing compensates for patient’s inability to perform self-care. Partial compensatory support- patient is able to perform self-care tasks with partial or no assistance from nursing. Educative/supportive compensatory– patient able to perform tasks independently. Nursing provides ongoing education and support.

Clinical Practice Models for Patient Assessment Theory applied in order to: Theory applies to multiple clinical settings. Home By the patient alone or with assistance provided Doctor’s office Education provided and care supervised by a nurse Hospital Needs identified, assessed and plan of care implemented Extended care facility Help identify the patient’s ability for self-care deficits that need to be addressed to promote health. Help identify support available to patient such as family and environment. Encourage patient to develop self-care abilities

Orem’s Theory Applied to Nursing Education Teaches the student to encourage compensatory care in the patient population. Conceptualize patients’ current and potential self- care deficits. Supports the nursing process in all 3 nursing theories.

Research Status of Orem’s Model Model used by multiple nursing specialties due to encompassing nature of Orem’s theory. Current research using Orem’s theory would include: Chinese Medicine Battered woman counseling

Orem’s Strengths The Self Care Deficit Theory is specific to nursing. The Theory can be used in multiple nursing specialties. The concept of self-care and health maintenance are congruent with contemporary literature in healthcare. The theory creates a coordinated nursing care plan that adjusts to the patient’s needs throughout recovery.

Orem’s Limitations Time consuming for nurses Direct contact is necessary throughout the nursing process. Multiple levels of the theory to consider Self care, self care deficit and self care deficit potential. Does not address cultural needs

Analysis and Insights Three theories combined into one. Cumbersome Completely dependent on nursing to assess the patient and family’s ability to complete self-care requisites and deficits Culturally diverse

References Marrier Tomey, A. & Alligood, M. (2006). Nursing theorists and their work. (6th ed.) St. Louis, MO : Mosby Elsevier. Bruce, E., Gagnon, C., Gendron, Puteris, L., & Tamblyn, A.(2009, November 7). Dorothea Orem’s Theory of Self Care. Retrieved from http://www.nipissingu.ca/faculty/arohap/aphome/NURS3006/Resour ces/DorotheaOremTheory.ppt Dorothea Orem, Nursing Theory ( 2009, November 7). Retrieved from http://faculty.ucc.edu/nursing-gervase/Orem%5B1%5D.pps

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