Dorothea Orem’s Self Care Deficit Nursing Theory Presented By: Michol Popp, Patrick Murphy, Janice Schmuckal and Toni Stout

In 1914, Dorothea Orem was 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 early1930’s  Earned her B.S.N. in 1939 and her M.S.N. in 1946 both from the Catholic University of America  In 1957 she moved to Washington D.C. to take a position at the Office of Education, U.S. Department of Health, Education, and Welfare as a curriculum consultant  she worked on a project to upgrade practical nurse training, as a result, Guides for Developing Curricula for the Education of Practical Nurses was developed

Nursing Experience  Early nursing experience included operating room nursing, private duty nursing (in home and hospital), pediatric, medical and surgical units, evening supervisor in the emergency room, and biological science technician  Orem held directorship of both the nursing school and the Department of Nursing at Providence Hospital in Detroit

Development of Theory  After leaving Detroit after 8 years, 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

Development of Theory  1959 Orem subsequently served as acting dean of the School of Nursing and as an assistant professor of nursing education at CUA. She continued to develop her concept of nursing and self care at this time  Members of the Nursing Models Committee at CUA and the Improvement in Nursing Group, which later became the Nursing Development Conference Group (NDCG), all contributed to the development of the theory  In 1970 she left CUA and began her own consulting firm, and published her first book, Nursing: Concepts of Practice in 1971  Subsequent editions were published in 1980, 1985, 1991, 1995, and 2001  Orem continued to develop her theory after her retirement in 1984

Achievements  1976 Georgetown University conferred Orem the 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 Honoris Causae from the University of Missouri

Nursing’s Metaparadigm  Human Beings  Environment  Health  Nursing

SCDNT in regards to human beings One of the foundations of the SCDNT is, “the view of human beings as dynamic, unitary beings who exist in their environments, who are in the process of becoming, and who possess free-will as well as other essential human qualities” “Five broad views of human beings that are necessary for developing understanding of the conceptual constructs of self-care deficit nursing theory and for understanding the interpersonal and societal aspects of the nursing systems”: (1) person (2) agent (3) user of symbols (4) organism (5) object

SCDNT in regards to environment Considerations:  What is the patient’s environment like? Do they live at home, assisted living, ECF?  Does the patient’s environment support the patients needs: room for walker/wheelchair use, ramps, appropriate assistive devices in the bathroom, etc.  Do they have a support system? If needed, who takes care of them if unable to do for themselves?  Does their environment prohibit them in performing self-care tasks?

SCDNT in regards to health  The concept of health in Orem’s Self-care framework refers to all the conditions that are interacting with the patient. The nurse not only treats the disease but takes into consideration the patient as a whole. His or her mental, physical, biological and spiritual needs have to be met.

SCDNT in regards to nursing  This theory represents Orem’s work regarding the substance of nursing as a field of knowledge and as a field of practice  Nursing = Practical Science  In practical sciences, knowledge is developed for the sake of the work to be done; in the case of nursing, knowledge is developed for the sake of nursing practice.

Orem’s Theory of Self Care  The primary source for Orem’s ideas about nursing was her experiences in nursing  Each person has a need for self care in order to maintain optimal health and wellness  Each person possesses the ability and responsibility to care for themselves and dependents  Theory is separated into three conceptual theories which include: self care, self care deficit and nursing system

Orem’s General Theory of Nursing  Consists of three theories referred to as  "Orem's General Theory of Nursing”:  Self-Care Theory: describes why and how people care for themselves  Self-Care Deficit Theory: describes and explains why people can be helped through nursing  Nursing System Theory: describes and explains relationships that must be brought about and maintained for nursing to be produced

Orem states that “if a person’s capabilities are inadequate to meet the therapeutic demand, a self- care deficit exists”

Orem’s Definition of Nursing  Nursing is the provision of self-care which is therapeutic in sustaining life and health, in recovering from disease or injury, or coping with their effects  Nursing promotes the goal of patient self- care  Nursing is a service to people, not a derivative of medicine

Orem’s Nursing Process Consists of three steps:  Step 1 : Determine why the patient needs care  Step 2 : Design a nursing system and plan the delivery of care  Step 3 : Management of nursing systems- planning, initiating, and controlling nursing actions

Self-Care Self-care is behavior directed by individuals to themselves or their environments to regulate factors that affect their own development and functioning in the interests of life, health, or well-being. Self-care deficit is the relationship of inadequacy between self-care agency and the therapeutic self-care demand. Self- Care Agency A self-care agency is the complex capability of maturing and mature individuals 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

Five Methods of Nursing Help  Acting or doing for  Guiding and directing  Teaching  Providing physical or psychological support  Providing and maintaining an environment that supports personal development

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

While watching the following video, think of self-care nursing diagnoses related to this situation. Remember to return to the rest of the presentation following the video clip! It may not continue automatically, click each slide to move onto the next…

Major assumptions of Orem’s general theory of nursing are as follows: (1)Human beings require continuous deliberate inputs to themselves and their environments to remain alive and functions in accord with natural human endowments. (2) Human agency, the power to act deliberately, is exercised in the form of care of self and others in identifying needs for and in making needed inputs. (3) Mature human beings experience privations in the form of limitations or action in care of self and others involving and making life sustaining and functioning regulating inputs. (4) Human agency is exercised in discovering, developing, and transmitting to others ways and means to identify needs for and make inputs to self and others. (5) Groups of human beings with structure relationships cluster tasks and allocate responsibilities for proving care to group members who experience privation for making required deliberation input to self and others.

Strengths of the SCDNT  A foundation to nursing practice  Explains the need for nursing care  Not only addresses the needs for the individual but addresses the needs of the family/support system as well

Limitations of the SCDNT  Unless familiar with the language being used throughout Orem’s SCDNT, it may be difficult to understand  A great deal of work is needed in regard to the structuring of existent knowledge around the practice sciences and the foundational sciences that Orem identified

References:  Kearney-Nunnery, R. (2008). Advancing your career: Concepts of professional nursing (4 th ed.). Philadelphia, PA: F. A. Davis Company.  Marriner-Tomey, A., & Alligood, M. R. (2010). Nursing theorists and their work (7 th ed.). St. Louis, MO: Elsevier.  Orem, D. E. (2001). Nursing: Concepts of Practice (6 th ed.). St. Louis: Mosby-Year Book.  All images were retrieved from Google

Orem Discussion 1. In evaluating your own practice, what ways have you empowered your patient in achieving self-care? Are there times when you or your co-workers enabled a self-care deficit? Explain. 2. After watching the video, describe what nursing system applies to the scenario; Wholly Compensatory, Partly Compensatory, or Supportive-educative? What barriers do you see limiting the patient in reaching the Supportive-educative system? 3. Have you used Dorothea Orem's Nursing Theory in your nursing career? Give one example of how you may have used the Self Care Deficit Nursing Theory in your practice.