Dorothea Orem Nursing Theory

Dorothea Orem Early 1930’s - AD from Providence School of Nursing, Washington, D.C. 1939 – BSN completed 1945 - MS in nursing education 1958 - consultant to the Office of Education where she began working on her SELF-CARE THEORY

Dorothea Orem 1959 - first published her theory in “Guides for Developing Curricula for the Education of Practical Nurses” (a government publication) 1976 - honorary Doctorate of Science from Georgetown University 1999 - last edition of her theory was published

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 is a service to people, not a derivative of medicine. Nursing promotes the goal of patient self-care.

Orem’s Nursing Process Consists of 3 steps: Step 1: determine why a patient needs care Step 2: design a nursing system & plan the delivery of care Step 3: management of nursing systems - planning, initiating, & controlling nursing actions

Orem’s General Theory of Nursing Consists of three related theories collectively referred to as “Orem’s General Theory of Nursing”: Self-care Theory: 3 types of self-care requisites (needs) or categories Self-care Deficit Theory: 5 Methods of Assistance 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 Agency Definition: the individual’s ability to perform self-care activities Consists of TWO agents: Self-care Agent - person who provides the self-care 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 actions or measures used to provide self-care Consists of THREE categories: Universal - requisites/needs that are common to all individuals Developmental - needs resulting from maturation or develop due to a condition or event Health Deviation - needs resulting from illness, injury & disease or its treatment

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

Five Methods of Nursing Help Acting or doing for Guiding Teaching Supporting Providing an environment to promote the patient’s ability to meet current or future demands

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 meet 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’s 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)

Orem’s Theory & Nursing’s Metaparadigm - PERSON Human beings are distinguished from other living beings by their capacity to: Reflect upon themselves and their environment Symbolize what they experience Use symbolic creations (ideas, words) in thinking, communicating, and guiding efforts to make things that are beneficial for themselves and/or for others

Orem’s Theory & Nursing’s Metaparadigm - ENVIRONMENT Environmental Conditions - external physical & psychosocial surroundings Developmental Environment - promotion of personal development through motivation to establish appropriate goals & to adjust behavior to meet those goals Can positively or negatively impact a person’s ability to provide self-care

Orem’s Theory & Nursing’s Metaparadigm - NURSING A service geared towards helping the self and others Is required when self-care demands exceed a patient’s self-care ability (agency) Promotes the patient as a self-care agent Has several components

Components of NURSING NURSING ART: the theoretical base of nursing and other disciplines such as sciences, art, humanities NURSING PRUDENCE: the quality that enables the nurse to seek advice in new or difficult situations, to make correct judgements, to decide to act in a particular manner, and/or to act NURSING SERVICE: a helping service NURSING AGENCY: the ability of the RN

Orem’s Theory & Nursing’s Metaparadigm - NURSING ROLE THEORY: the role of the nurse & patient are complementary as they work together to achieve self-care SPECIAL TECHNOLOGIES: Social & Interpersonal technologies - communicating, coordinating, establishing & maintaining therapeutic relations, rendering assistance Regulatory technologies - maintaining and promoting life processes, growth/development, and psycho-physiologic modes of functioning

Orem’s Theory & Nursing’s Metaparadigm - HEALTH Supports health promotion and health maintenance Supports the premises of holistic health in that both RN and patient promote the individual’s responsibility for self care

Orem’s Key Contribution To Nursing The continued evolution of original ideas to further delineate nursing practice, functions, self-care needs, and nursing systems based on research.