1. 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

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
Time oriented Peplau: Published at Orem: Published at Roy: Published at Roger’s: Published at King: Published at 1971 Newman: Published at 1989

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

5. Dorothea Orem C.V.
honorary Doctorate of Science from Georgetown University
1980: Award for nursing theory from catholic university of America.
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. 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)

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 Strategy cont’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 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.

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 Metaparadigm Health

26. 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.

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
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
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 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.

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
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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

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

52. 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

53. 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

54. 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

55. 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

57. 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

58. Thank You