1. Nursing Theorist: Dorothea Orem Self-Care Deficit Theory
Presented by MSN Students:
Cheryl L Holz RN, BSN
Anna Marshall RN, BSN

2. Dorothea Orem 1914- June 22,2007 Born in Baltimore, Maryland Died at home in Skidaway Island
Education:
Diploma (early 1930's) Providence Hospital School of Nursing, Washington, DC
BSN Ed. (1939) and MSN Ed. (1945) from the Catholic University of America, Washington, DC.
[Introduce the nursing theorist and pertinent personal information (2)]
Father-construction worker who liked fishing.
Mother-homemaker who liked reading.
Younger of two daughters
Dorothea Elizabeth Orem, born in 1914 (Baltimore, MD), died June 22 of She received a diploma in nursing in the early 1930s and went on the earn BSN (1939), MSN (1945) and honorary doctorates of science (1976, 1980) and Humane Letters (1988). (next slide)

3. Credentials & Background
Honorary Doctorates:
Doctor of Science from Georgetown University (1976) and Incarnate Word College in San Antonio, Texas (1980)
Doctor of Humane Letters from Illinois Wesleyan University, Bloomington, Illinois (1988)
Doctor Honoris Causae, University of Missouri-Columbia (1998).
She received a diploma in nursing in the early 1930s and earned a BSN (1939), MSN (1945, honorary doctorates of science (1976, 1980) and Humane Letters (1988).

4. Credentials & Background
Special Awards:
Catholic University of America Alumni Achievement Award for Nursing Theory (1980)
Linda Richards Award, National League for Nursing (1991)
Honorary Fellow of the American Academy of Nursing (1992).

5. Early Nursing Experiences
Clinical OR
Private Duty Nursing (home & hospital)
Staff nursing (pediatric & adult medical and surgical units)
Evening supervisor-ER
Education:
Biological science teacher
Assistant Director of School of Nursing
Consulting:
Indiana St. Board of Health ( )
Office of Education, US Department of Health, Education, and Welfare ( )
Her early nursing experiences included clinical roles: practice roles as a staff nurse in medical-surgical and pediatric settings, OR, assistant director of nursing in a general hospital; nursing education as a teacher of biological sciences in a nursing program and as an assistant director of a school of nursing. She served as a nurse consultant with the Indiana State Board of Health from , and later with the Office of Education for the U.S. Department of Health, Education, and Welfare.

6. Theoretical Sources & Influences
Eugenia K. Spaulding-great friend & teacher only
Cites no particular nursing leader as a direct influence on her work.
Does cite many other nurses’ works in terms of their contributions to nursing:
Abdullah, Henderson, Johnson, King, Levine, Nightingale, Orlando, Peplau, Riehl, Rogers, Roy, Travelbee, and Weidenbach, et al
Cites numerous other authors from other disciplines:
Chester Barnard, Rene’ Dubos, Robert Katz, Ernest Nagel, Hans Selye, Ludwig von Bertalanffy, et al
Between 1949 and 1959, she began to develop ideas regarding the uniqueness of nursing in an effort to clarify the subject matter of nursing in general. She questioned the domain and boundaries of nursing as a field of practice and a field of knowledge. Her theory of nursing evolved over the course of four decades as ideas were developed and refined in an attempt to help formalize a framework by which to organize nursing knowledge. The experiences of her personal nursing career, her studies in the areas of formal logic and metaphysics, and her abilities to reflect as well as her collaborations with students, practitioners, researchers, educators, administrators and scholars challenged her and aided in the development of a general theory of nursing.

7. Theoretical Sources & Influences-cont’d
Human organization, action theory
An area of philosophy concerned with theories about the processes causing intentional/willful human bodily movements of more or less complex kind
retrieved 10/10/08

8. Theoretical Sources & Influences-cont’d
The works of:
Aristotle
Thomas Aquinas
Barnard (1962)
Kotarbinski (1965)
Macmurray (1957)
Parson, Bales, and Shils (1953)
B.J.F Lonergan’s Insight(1958) [on reflective thinking],
Assays by Wallace (1979, 1983) [for recent clarifications].
Orem, D.E (1987). Orem’s general theory of nursing. (p.73)
Aristotle & Thomas Aquinas- action theory, others-context of action, deliberate action theory

9. Origins 1949-1959 Began to develop ideas regarding
the uniqueness of nursing
In effort to formalize a framework by which to organize nursing knowledge, she asked the following questions…
: While Orem was working as a nurse consultant with Indiana State Board of Health (traveling around observing and talking to nurses), she recognized the ability of nurses to do nursing, but inability to talk about nursing. These questions were derived from the need to understand the subject matter of nursing in general

10. Origins “What is nursing?”
“How was it different from other disciplines?
“How was it similar?”
“What is the domain and what are the boundaries of nursing as a field of practice and a field of knowledge?”
“What condition exists when judgments are made that people need nursing?”
(Answer: The inabilities of people to care for themselves at times when they need assistance because of their state of personal health)

11. Ideas evolved from: Unique experiences of her personal nursing career
Observations in practice
Study of formal logic and metaphysics
Use of resources from many fields
Abilities in methods of reflect and questioning
Collaborations with students, practitioners,
researchers, educators, administrators and scholars
Metaphysics:

12. Formalization 1960-1980 through extensive reading and self-reflection
collaborations with students, practitioners, researchers, educators, administrators and scholars
Formalization of ideas occurred during the years,

13. Publications 1971-Nursing: Concepts of Practice
Editor for Nursing Development Conference Group (NDCG)-prepared & later revised Concept Formalization in Nursing: Process and Product
1980, 1985, 1991, 1995, and subsequent editions of Nursing Concepts of Practice
1984: Orem retired
Many…including

14. Practice First documented use:
1973-John Hopkins Hospital
In nurse-managed clinics
Various clinical populations & age groups
Neonates to the elderly
Health promotion practices & care of the sick
(The nursing management of pertussis was described from the SCDNT perspective).
Beth Israel Medical Center, Newark, New Jersey-first acute care hospital in NE United States-nursing care philosophy based on Orem’s self-care deficit model.
Used in work with adolescent alcohol abusers, employees with RA, women recovering from radical mastectomies, families and children with CF, patients with congestive heart failure, diabetes, and many more.
(Marriner & Tomey, 3rd Ed. 1994, pg 187)

15. Practice-cont’d Ethnically & culturally diverse populations
Orem’s SCDNT: translated into Italian, French, Spanish, Dutch, and Japanese
Currently, translations of some or all of her most recent work in Germany, Thailand, and Norway, et al.
Used throughout the world
Great Britain, Taiwan, Thailand, Japan, Korea, Canada, Australia, New Zealand, South Africa, Israel, Germany, Spain, Italy, France, Belgium, the Netherlands, Bolivia, Colombia, Uruguay, and Mexico
emphasis on self-care is not completely congruent with some people’s expectations of nursing practice; (Expectations with regional and cultural groups can vary)

16. Central Philosophy The philosophy of Orem’s SCDNT is based upon:
“patients wish to care for themselves”
“moderate realism”

17. Conceptual Theoretical Model R=relationship; <=deficit relationship, current or projected (Tomey & Alligood, 5th Ed., 2002, pg 192)
Deficit
Self-Care
Self-Care Demands
Nursing Agency
Self-Care Agency R R R
Conditioning
Factors
Conditioning
Factors
<
[Illustrate the theoretical model created by the nursing theorist (2)]
Orem explicated self-care as a human need.
Orem defines nursing as a human service and indicates that nursing’s special concern is a person’s need for the provision and management of self-care actions on a continuous basis in order to sustain life and health or to recover from disease or injury. R R
Conditioning
Factors

18. Internal/External Stimuli
Conditioning factors?
Page 194: Helping Methods:
1-acting for or doing for another
2-guiding and directing
3-providing physical or psychological support
4-providing & maintaining an environment that supports personal development
5-teaching
Marriner-Tomey, A., & Alligood, A. (2002). Nursing Theorists and Their Work. St Louis: Mosby.

19. SCDNT: A General Theory Composed of Three Related Theories
THEORY OF SELF-CARE:
How and why people care for themselves.
THEORY OF SELF-CARE DEFICIT:
Describes and explains why people can be helped through nursing.
THEORY OF NURSING SYSTEMS:
Describes and explains relationships that must be brought about and maintained for nursing to be produced.
[Define the concepts and principles of the theory (2)]
Orem had a spontaneous insight in 1958 about the concept of nursing.
Publishing since the 1950s about nursing practice and education.
Identifies her self-care deficit theory of nursing as a general theory composed of (the above 3 theories).

20. Three Types of Nursing Systems
Wholly Compensatory
Doing for the patient
Partially Compensatory
Helping the patient do for him/herself
Supportive-Educative
Helping the patient learn to do for him/herself

21. Concepts & Principles SELF-CARE:
Activities individuals do on a daily basis within time frames, on their own behalf
In the interest of maintaining life & healthful functioning
To continue personal development & well being

22. Concepts & Principles-cont’d
SELF-CARE REQUISITES (SCRs):
Groups of needs or requirements
Classified as:
UNIVERSAL SELF-CARE REQUISITES
those needs all individuals have (six SCR common to men, women, and children)
DEVELOPMENTAL SELF-CARE REQUISITES
those needs that relate to the development of the individual
HEALTH DEVIATION REQUISITIES
those needs that arise as a result of an individual’s condition
Universal SCR-air, water, food, elimination, balance b/t activity & rest, balance b/t solitude & social interaction, hazard prevention (to human life, functioning, & well-being), promotion of normalcy (that which is essentially human & is in accordance with genetic & constitutional characteristics & talents of each individual).
The nurse is encouraged to assign a support modality to each of the SCRs.

23. Concepts & Principles-cont’d
THERAPEUTIC SELF-CARE DEMAND:
Controlling or managing factors identified in the requisites; the values of which are regulatory of human functioning (air, water, and food)
Fulfilling the activity element of the requisite (maintenance, promotion, prevention, and provision)
1-Describes factors in the pt or environment that must be held steady within a range of values or brought within & held within such a range for the sake of the patient’s life, health, or well being &
2-has a known degree of instrumental effectiveness derived from choice of technologies and specific technologies for using changing, or in some way controlling, pt or environmental factors.

24. Concepts & Principles-cont’d
SELF-CARE AGENCY:
“Complex acquired ability to meet one’s continuing requirements for care that regulates life processes, maintains or promotes integrity of human structure and functioning and human development, and promotes well-being.”
(Marriner-Tomey, 1994, pg. 184)
The complex acquired ability of mature and maturing persons to know & meet their continuing requirements for deliberate, purposive action to regulate their own human functioning and development.

25. Concepts & Principles-cont’d
AGENT:
“The person taking action”
SELF-CARE AGENT:
“The provider of self-care”
DEPENDENT-CARE AGENT:
“The provider of infant care, child care, or dependent adult care”
Agent: the person who engages in a course of action or has the power to engage in a course of action.
Self-care agent: the person providing care to the pt.
Dependent-care agent: Maturing adolescents or adults who accept & fulfill the responsibility of to know and meet the therapeutic self-care demand of relevant others who are socially dependent on them or to regulate the development or exercise of these person’s self-care agency.

26. Concepts & Principles-cont’d
SELF-CARE DEFICIT:
When a patient is very unable to meet their own self-care requisites (refer to slide 21)
NURSING AGENCY:
Educated nurses
Ability to act, know, & help patients
SELF-CARE DEFICIT: All limitations of persons for engagement in practical endeavors within the domain & boundaries of nursing are associated with subjectivity of mature and maturing individuals to health-related or health-derived action limitationscompletely or partially dependent.
NURSING AGENCY: Knowledge empowered nurses who help patients to meet their therapeutic self-care demands.

27. Concepts & Principles-cont’d
NURSING DESIGN:
Professional function (done before and after nursing diagnosis and prescription)-
Basis of reflective practical judgments
Purpose-
Provide guides for achieving needed and foreseen results in production of nursing toward the achievement of nursing goals
The units taken together constitute the pattern to guide the production of nursing.

28. Concepts & Principles-cont’d
NURSING SYSTEMS:
Constructed through actions of nurses and nurses-patients.
Deliberate practical actions of nurses
Performed at times in coordination with actions of their patients to know & meet components of their patient’s therapeutic self-care demands.
To protect and regulate the exercise or development of patient’s self-care agency

29. Conceptual Theoretical Model R=relationship; <=deficit relationship, current or projected (Tomey & Alligood, 5th Ed., 2002, pg 192)
Deficit
Self-Care
Self-Care Demands
Nursing Agency
Self-Care Agency R R R
Conditioning
Factors
Conditioning
Factors
<
[Illustrate the theoretical model created by the nursing theorist (2)]
Orem explicated self-care as a human need.
Orem defines nursing as a human service and indicates that nursing’s special concern is a person’s need for the provision and management of self-care actions on a continuous basis in order to sustain life and health or to recover from disease or injury. R R
Conditioning
Factors

30. Fawcett’s Criteria & Pertinent Questions for Evaluation of Nursing Theories

31. Explication of Origins
Are the philosophical claims on which the nursing model is based explicit?
Yes, Orem’s Self-Care Framework is based on philosophical, theoretical, and scientific knowledge about human behavior
Philosophical claims stated in the form of: assumptions, presuppositions, and premises
Orem: “Philosophy will help you think about things, but will not tell you your subject matter”
Explication of Origins
Are the philosophical claims on which the nursing model is based explicit?
Yes, Orem’s Self-Care Framework is based on philosophical, theoretical, and scientific knowledge about human behavior
Philosophical claims stated in the form of: assumptions, presuppositions, and premises (about human beings, self-care, self-care requisites, deliberate action, nursing, the Theory of Self-Care, the Theory of Self-Care Deficit, the Theory of Nursing System, & the General Theory of Nursing Administration)
Examples of things Orem values:
individuals’ abilities to care for selves and dependent others; the person’s perspective of his/her health status; physician’s perspective of health status
***Orem: “Philosophy will help you think about things, but will not tell you your subject matter”

32. Explication of Origins
Are the scholars who influenced the model author’s thinking acknowledged and are bibliographic citation given?
YES; scholars from a variety of disciplines cited Bibliographical citations provided.
Aristotle, Thomas Aquinas, T. Parsons et al (1953), J. Macmurray (1957), B.J.F Lonergan (1958), M.B. Arnold (1960), M. Black (1962), T. Kotarbinski (1965), R. Harre (1970), Paul Weiss (1980), William A. Wallace (1983, 1996)
The Nursing Development Conference Group
Orem Study Group
Are the scholars who influenced the model author’s thinking acknowledged and are bibliographic citation given?
Yes, Orem has always cited the works of other scholars from a variety of disciplines as influencing her thinking. Bibliographical citations are provided. The study of formal logic and metaphysics, resources from many fields, specific areas of philosophy:
Human organization, Action theory (works of Aristotle, Thomas Aquinas, modern logicians, philosophers, psychologists, physiologists, sociologists, industrialists)
Talcott Parsons, Bales, Shils (1953)-the context of action; John Macmurray (1957)-self as agent; B.J.F Lonergan’s Insight (1958)-contributing to her ability to reflect, question/search for meaning; Black, Kotarbinski & Harre (1960s)-science of deliberate human action
Paul Weiss (1980), William A. Wallace (1983, 1996)-help with more recent clarifications
Others:
The Nursing Development Conference Group- lists 13 individuals (including Orem) involved in the group over the years
Orem Study Group- lists 11 individuals (including Orem)
Orem mentions many others as influencing her theory, including collaborations with students, practitioners, researchers, educators, administrators and scholars.

33. Comprehensiveness of Content
Does the nursing model provide adequate descriptions of all four concepts of nursing’s metaparadigm?
Yes, the descriptions of all four of nursing’s metaparadigm concepts are adequate.
Nursing-Person Emphasis
Comprehensiveness of Content
Does the nursing model provide adequate descriptions of all four concepts of nursing’s metaparadigm? (Nursing, environment, person, health)
Yes, the descriptions of all four of nursing’s metaparadigm concepts are adequate.
(Some inconsistencies in language have occurred over the course of the 6 editions with most revisions resulting in clarification; a few descriptions have become more difficult to understand)

34. Comprehensiveness of Content
Do the relational propositions of the nursing model completely link the four metaparadigm concepts?
Yes, linkages are specified between concepts throughout the editions
However, only ONE statement links all 4 concepts- in the 2nd edition of Orem’s book (1980)
Statement: “Nursing is made or produced by nurses. It is a service, a mode of helping human beings…Nursing’s form or structure is derived from actions deliberately selected and performed by nurses to help individuals or groups under their care to maintain or change conditions in themselves or their environments. This may be done by individuals or groups through their own actions under the guidance of a nurse or through the actions of nurses when persons have health-derived or health-related limitations that cannot be immediately overcome (Orem, 1980, p.5)

35. “Nursing is made or produced by nurses
“Nursing is made or produced by nurses. It is a service, a mode of helping human beings…Nursing’s form or structure is derived from actions deliberately selected and performed by nurses to help individuals or groups under their care to maintain or change conditions in themselves or their environments. This may be done by individuals or groups through their own actions under the guidance of a nurse or through the actions of nurses when persons have health-derived or health-related limitations that cannot be immediately overcome”
(Orem, 1980, p.5)
Nursing, Health, Environment, Health
From the 2nd edition of Orem’s book, Nursing: Concepts of Practice

36. Comprehensiveness of Content
Is the researcher given sufficient direction about what questions to ask and what methodology to use?
Purpose: to develop knowledge for the practical sciences of nursing…
Methods associated with: Empiricist research paradigm, Interpretive research paradigm –
most consistent with Orem’s Framework
See Fawcett Table 8-2, Table 8-3 for examples
Breadth of content of model is sufficient to guide research in various applications/settings; (although specific guidelines not explicitly stated)
Purpose:
develop knowledge for the practical sciences of nursing (theoretically practical- & practically-practical science); enhance understanding of patient-nurse variables
Recommended Methods:
Empiricist research methods: descriptive, descriptive-correlational, case-study, quasi-experimental
Interpretive research methods: ethnographic, grounded theory, phenomenological
(Critical Theory Research Paradigm methods- limited usefullness)
Quant & Qualitative examples
Data collection (from individuals or multiperson units) in any setting in which nursing occurs (home, hospital, clinic, long-term care facilities)using S-CF-based research instrument. See Table 8-2 (pg. 261)in Fawcett for a list of S-CF-based research instruments

37. Comprehensiveness of Content
Does the educator have sufficient guidelines to construct a curriculum?
The framework has been used as a conceptual guide to nursing curriculums in a number of programs:
associate degree,
diploma,
baccalaureate,
masters and doctorate levels.
Guidelines, although not explicitly stated, have been, and are currently being developed based on the content of framework and publications about its use.
Official Homepage: SCDNT-International Orem Society for Nursing Science & Scholarship.
Colleges: At least 45 SON-use SCDNT (data from IOS)
1978-University of Missouri & Sinclair School of Nursing; all levels of the curriculum & in cont. educ.
Oakland University, College of Benedict, & Anderson College-samples of their courses-on internet search word ‘SCDNT”.
Thornton Comm. College-South Holland, Illinois
Georgetown University,-Washington, DC
University of Southern Mississippi at Hattiesburg
Southern Missouri State at Springfield
(Marriner & Tomey, 3rd Ed. 1994, pg 188)

38. Comprehensiveness of Content
Does the administrator have sufficient guidelines to organize and deliver nursing services?
Yes, the Self-Care Framework provides ideas to guide:
1. The focus of nursing in the health-care institution
2. The purpose of nursing services
3. Characteristics of personnel
4. Settings for nursing services
5. Management strategies and administrative policies
1-(ex. To provide nursing care to individuals with health-derived/associated self-care deficits)
2-(ex. To help people enhance their abilities to provide continuing, therapeutic self-care & dependent-care)
3-(ex. Includes nurses, nursing practitioners, & nursing administrators);high-level technical training or professional level education
4-(ex. Many…”nurses may go to where patients are…Or patients may come to clinics or other types of facilities where nurses are available…(Orem, 1989, p.56))
5-(ex. “the proper ordering of persons and material resources so that a functioning whole is continuously created…” (Orem, 1989, p. 61))

39. Comprehensiveness of Content
Is the practitioner given sufficient direction to be able to make pertinent observations, decide that an actual or potential need for nursing exists, and prescribe and execute a course of action that achieves the goal specified in a variety of practice situations?
Purpose: to help people with health-related self-care deficits
Concepts encompass people across the lifespan and in a variety of diverse settings
Nursing Process: Professional-Technological Operations of Nursing Practice (see Fawcett Table 8-1)
Orem defines ‘domain & boundaries of nursing practice’
Legitimate participants (those that require nursing) for maintaining therapeutic level of self-care, recovery, coping, etc. Plans of care for: Individual clients, families, communities
Nursing Process: (see Fawcett, p. 243) comprised of Case Management Operations, Diagnostic Operations, Prescriptive Operations, Regulatory Operations, & Control Operations. The Self-Care model also ‘linked the patient assessments with nursing diagnosis, expected patient outcomes, discharge planning, quality assurance variables, clinical research, and external agency reports’ (Metzger, 1995, p.152)
‘Theory-based computer software for bedside care was developed within Orem’s general theory of nursing by Nursing Systems International’ (Metzer, 1995, p. 152)

40. Logical Congruence Does the model reflect more than one world view?
No, only that of ‘reciprocal interaction’ is noted
Does the model reflect characteristics of more than one category of nursing knowledge?
Characteristics are congruent with classification as a developmental model.
Although several different categories have been suggested (i.e. systems model, interaction model), characteristics of the framework do not support these…

41. Logical Congruence
Do the components of the model reflect logical translation or reformulation of diverse perspectives?
Yes, the content of Orem’s Framework is logically congruent with her philosophical claims
Orem’s thinking was influenced by a variety of perspectives and resources from a range of disciplines
Ideas from specific areas of philosophy, metaphysics, psychology, physiology, sociology, etc. (human organization, deliberate action theory, formal logic) were logically translated to fit into her framework. Really helps to understand basics of the human organization, deliberate action theory, metaphysics to grasp Orem’s concepts

42. Generation of Theory
What theories have been generated from the nursing model?
Orem’s Self-Care Deficit Theory of Nursing
Middle-Range Theory of relating factors & concepts of self-care agency & dependent-care agency of school-aged children & their mothers. (Gaffney & Moore, 1996).
Middle-Range Theory of Testicular Self-Examination (Fessenden, 2003).
General theory of nursing=conceptual framework that contains 3 parts: Theory of Self-Care, Theory of Self-Care Deficit, Theory of Nursing System

43. Credibility of the Nursing Model: social utility, social congruence, social significance
Are education and special skill training required before applying the nursing model in nursing practice?
Yes, it is a rather unique framework in: focus, content, style and vocabulary.
Need to learn specific “style of thinking and communicating nursing” (Orem, 2001, p.137)
Familiarity with language of the theories of deliberate human action enhances understanding of Orem’s work.
Are education and special skill training required before applying the nursing model in nursing practice?
(Ex. Agent: the person who engages in a course of action or has the power to engage in a course of action)

44. Credibility of the Nursing Model: social utility, social congruence, social significance
Is it feasible to implement practice protocols derived from the nursing model and related theories?
Despite the need for special training and education, the implementation of Self-Care Framework-based practice protocols is feasible.
Patients of all ages, across diverse practice settings
Considering the recommendations and suggestions given by Nunn and Mariner-Tomey (1989), Fernandez et al. (1996), Hooten (1992), and Paternostro (1992) [as cited in the Fawcett evaluation]: full implementation of SC Framework in nursing practice settings would take 6-8 years (evaluation ongoing)

45. Credibility of the Nursing Model: social utility, social congruence, social significance
To what extent is the nursing model actually used to guide nursing research, education, administration, and practice?
Actual application of Orem’s model takes many forms in all of the above arenas.
World-wide use: clinics, hospitals, home-health, health promotion practices & screenings
Actual documented use in all of the mentioned areas.

46. Credibility of the Nursing Model: social utility, social congruence, social significance
Does the nursing model lead to nursing activities that meet the expectations of the public and health professionals of various cultures and in diverse geographic regions?
Yes, it does; however, the emphasis on self-care may not be completely congruent with some people’s expectations of nursing practice
Has been well-documented…Many examples of international application and development of the model; First International Self-Care Deficit Nursing Theory (S-CDNT) Conference- held in KC in 1989 (Participants from: Sweden, Netherlands, Canada, Thailand, Australia, Japan, and US)=Global Impact
Think of an example

47. Credibility of the Nursing Model: social utility, social congruence, social significance
Does the application of the nursing model, when linked with relevant theories and appropriate empirical indicators, make important and positive differences in the health conditions of the public?
Yes, much empirical evidence supports Orem’s claim that nurses contribute to “maintaining health, preventing disease, and disability and restoring or maintaining life processes” by overcoming “health-associated human limitations for engagement in self-care or dependent-care” (Orem, 2001, p. 81).
Empirical evidence r/t social significance is equivocal (some +/some- results)-beneficial?
When linked with relevant theories, the Orem model has potential to make a positive difference: Improved self-care abilities, less inappropriate use of health services (cost containment),

48. Contributions to the Discipline of Nursing
What is the overall contribution of the nursing model to the discipline of nursing?
Orem’s framework presents an optimistic view of patients’ contributions to their health care and an explicit focus on what matters to nurses.
Orem has identified the domain and boundaries of nursing as a science and an art as well as nursing’s unique contribution to health-care.
Art=

49. Contrast of Theories Conceptual Model Person Environment Health
Nursing
Orem’s
Self-Care Framework
Self-care agent
Therapeutic self-care demand made up of:
1-universal SCRs
2-developmental SCRs
3-Health deviation SCRs
The person’s external environment
Soundness or wholeness of developed human structures & of bodily & mental functioning
Definition: a helping service, creative effort to help people
Goal: help people to meet their own therapeutic self-care demand
Actions: wholly/partly, compensatory, supportive-educative nursing systems.
Assist by acting for or doing, guiding, physical &/or psychological support, providing a developmental environment, teaching.
Roger’s Science of Unitary Human Beings
A unitary human being, a patterned, open, pandimensional energy field
A patterned, open, pandimensional energy field
An expression of the life process
Definition: A learned profession that is both a science and an art.
Goal: Help people achieve maximum well-being
Action: Deliberative mutual patterning that involves environmental patterning to promote helicy, integrality, and resonancy.
King’s
Interacting Systems Framework
Personal system: Focus on perception, self, growth & development, body image, time, space, learning
Interpersonal system:
Focus on interaction, communication, transaction, role, stress, coping.
Social system:
Focus on organization, authority, power, status, decision-making, and control.
Internal/external
Dynamic life experiences of a human being.
Ability to function in social roles
Definition: Perceiving, thinking, relating, judging, and acting vis-à-vis the behavior of individuals who come to a nursing situation.
Goal: Help individuals maintain their health so they can function in their roles
Actions: A process of action, reaction, interaction, and transaction directed toward establishment of goals and goal attainment.
[Contrast the theory with other nursing theories from the same paradigm (2)]
Grand theorists include aspects of human beings, their environment, and health in the nursing conceptual modes.
Orem, Levine, Rogers, Johnson, Roy, Neuman, and King, all developed conceptual models that helped direct theory development.
Explain why we picked Rogers and King’s theory.

50. Peer Discussion
“We need to order home health for Mr. Orem before he is discharged.” The Orem Model of Nursing or Self Care Deficit Nursing Theory states nurses have to administer care when the patients cannot provide care to themselves.
Engage peers in a discussion of the theorists’ work (2)
Help Mr. Orem help himself

51. Eastern Kansas VA Home Based Primary Care (HBPC) Mission Statement
“…to provide compassionate care to veterans at home and in the community, promoting optimal independence of the veteran and support to the caregiver.”

52. References
Chinn, P., & Kramer, M. (1991). Theory and Nursing (3rd Ed.). St. Louis: Mosby. Fawcett, J. (2005). Contemporary Nursing Knowledge: Analysis and Evaluation of Nursing Models and Theories (2nd Ed.). Philadelphia, PA: F.A. Davis Company. Hartweg, D. L. (1995). Dorothea Orem: Self-Care Deficit Theory. In C.M. McQuiston & A.A. Webb (Eds.), Foundations of Nursing Theory: Contributions of 12 Key Theorists (pp ). Thousand Oaks, CA: Sage Publications, Inc. Marriner-Tomey, A. (1994). Nursing Theorists and Their Work (3rd Ed.). St Louis: Mosby. Marriner-Tomey, A., & Alligood, A. (2002). Nursing Theorists and Their Work (5th Ed.). St Louis: Mosby. Orem, D. E. (2001). Nursing: Concepts of Practice (6th ed.). St. Louis, MO: Mosby, Inc. Wikipedia: Philosophy of action. (Oct. 7, 2008). Retrieved October 10, 2008, from Wikipedia: