Dorothea OremWho she is and how the

theory was formulated

Dorothea Orem●One of the leading nursing theorists

●Born in Baltimore, Maryland in 1914

●Greatly involved in practice, service, and education in

nursing

●Received many honorary degrees and professional

awards

●During her professional career, her roles as a nurse

included: staff, private duty, administrator, professor,

director, and consultant

●Worked in pediatrics, emergency rooms, operating

rooms, adult medical and surgical units

Timeline

●1930s – received her diploma in nursing at Providence Hospital

in Washington, DC

●1939 – received BSN from Catholic University of America (CUA)

●1945 – received MSN from Catholic University of America (CUA)

●1976 - received honorary degree in Doctor of Science

●1986 – retired and lived in Savannah, Georgia

●2007 – passed at 92 years of age

Development of Orem’s Theory●Orem has developed her self-care deficit theory early in her

career and refined it throughout her career and retirement

●From 1949-1957, Orem worked for the Division of Hospital and

Institutional Services of the Indiana State Board of Health.

During this time, she saw a need to upgrade the nursing quality

in this state’s general hospitals. This has led her to develop her

definition of nursing practice. Her first ideas were formulated in

1956.

●In 1959, Orem then worked for CUA school of Nursing, serving

as acting dean and assistant professor of nursing education.

During this time, she continued to develop her concept of

nursing and self care.

oShe first published her nursing concept of self-care during this year.

Development of Orem’s Theory

●In 1971, Orem first published her formal

articulation of ideas in Nursing: Concepts of

Practice

●Orem continued to refine her theory in subsequent

works, which were later published in 1980, 1985,

1991, 1995, and 2001.

●In 1985, Orem introduced the three theories

associated with her self-care framework

●In 1980, she published her 1st edition. In 2001,

she published her 6th edition.

References●Masters, K. (2011). Nursing Theories: A Framework for Professional Practice.

Sudbury, MA: Jones and Bartlett Learning, LLC.

●Nursing Theories. (2011). Dorothea Orem’s Self-Care Theory. Retrieved from:

http://currentnursing.com/nursing_theory/self_care_deficit_theory.html

●Sitzman, K. L. & Eichelberger, L.W. (2011). Understanding the Work of Nurse

Theorists: A creative beginning (2nd ed.). Sudbury, MA: Jones and Bartlett

Publishers, LLC.

Theory of Self Care

Why and how people care for

themselves; how nursing is

required to assist in performing

self-care due to patient limitations

Key Terms

Self care

Self care agency

Therapeutic self care demand

Self care requisites

Key Terms - continuedSelf careActivities that an

individual practices,

performs, or initiates on

his or her own behalf in

order to maintain life,

health and well- being

Self care agencyPerson’s ability to engage in self-care,

which is conditioned by factors:

Age

Gender

Developmental stage

Life experience

Sociocultural factors

Health

Pattern of living

Healthcare/family system

Available resources

Three categories of self-care

requisites

1.Universal

2.Developmental

3.Health deviation

1. Universal Self-care requisitesAssociated with life processes and in maintaining the integrity of human

structure and functioning

Common to everyone, includes ADLs

These requisites are:air

water

food

elimination

activity and rest

solitude and social interaction

prevention of hazards

promotion of human functioning

Key Terms - continuedTherapeutic self care

demandAll self-care actions needed at

various times in a person’s life to

meet all of an individual’s self-care

requisites

Self care requisitesGroup of actions or needs for

self care

2. Developmental self care requisitesRelated to different stages in human life cycle

i.e. college, marriage, retirement

Maturational, which are associated with developmental processes

and derived from a condition

Situational, which are associated with an event

E.g. adjusting to a new job or adjusting to body changes

Needs are:

Maintaining good health and promoting human

development/maturation

Preventing or treating illness and disease that affects human

development/maturation

3. Health deviation requisites

Needs and conditions arising from illness, injury, or disease

These include:

“Seeking and securing appropriate medical assistance

Being aware of and attending to the effects and results of pathologic

conditions

Effectively carrying out medically prescribed treatments

Being aware of and attending to side effects of treatment

Modifying self concepts in accepting oneself in a particular state of

health

Learning to live with effects of illness and medical treatment” (Orem,

1985, p. 99-100)

References

Masters, K. (2011). Nursing Theories: A framework for professional

practice. Sudbury, MA: Jones and Bartlett learning, LLC.

Nursing Theories. (2011). Dorothea Orem’s Self-Care Theory.

Retrieved from: http://currentnursing.com/nursing_theory/

self_care_deficit_theory.html

Orem, D. (1985). Nursing: Concepts of practice (3rd ed.). St. Louis,

MO: Mosby.

Sitzman, K. L. & Eichelberger, L.W. (2011). Understanding the Work

of Nurse Theorists: A creative beginning (2nd ed.). Sudbury, MA:

Jones and Bartlett Publishers, LLC.

Theory of Self Care

Deficit & Theory of

Nursing Systems

Theory of Self Care Deficit

●Self care deficit occurs when patient or

parents of dependents are unable to

meet self care requisites.

●Therefore, nursing help is needed

●Nursing care is used to help people

enhance self-care abilities needed for

survival, well-being, and quality of life

●Orem identifies 5 methods nurses use to help

patients meet their self-care deficits : (used alone

or in conjunction with another)

o“Acting for and doing for another

oGuiding and directing

oProviding physical or psychological support

oProviding and maintaining an environment that

supports personal development

oTeaching”

(Orem, 2001, as cited in Masters, 2011, p. 183)

Theory of Nursing Systems

Theory of Nursing System●Describes how the patient’s self care needs will be met

by the nurse , the patient, or both

●Nurse-designed based on assessment of individual’s

self-care needs and ability to perform self care needs

odefines nurse’s role in patient care

●3 systems nurses use to meet patient’s self- care

requisites or needs

oWholly compensatory

oPartially compensatory

oSupportive-educative

The three systems of nursing1.Wholly compensatory

oPatient is unable to perform any self-care activities;

nurse accomplishes most or all of care

2.Partially compensatory

oSelf-care activities are performed by both nurse and

patient to meet self-care requirements; nurse assists with

care

3.Supportive-educative

oPatient performs own self-care, but nurse is required for

support, education, knowledge, decision-making to

promote the patient as a self-care agent

References●Masters, K. (2011). Nursing Theories: A Framework for Professional Practice. Sudbury,

MA: Jones and Bartlett Learning, LLC.

●Nursing Theories. (2011). Dorothea Orem’s Self-Care Theory. Retrieved from:

http://currentnursing.com/nursing_theory/self_care_deficit_theory.html

●Sitzman, K. L. & Eichelberger, L.W. (2011). Understanding the Work of Nurse

Theorists: A creative beginning (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers,

LLC.

Major Concepts of Nursing

FOUR key concepts

●Interrelated

●Person (Patient or parent of

dependent)

●Environment

●Health

●Nursing

Person●The patient whom the nurse cares for

●Capable of self care

●Possesses developmental, universal, and

health deviation needs

●A functioning whole or unity that is viewed

socially, biologically, and symbolically

Environment●Provides the context within which the person exists

●Subcomponent of the person

●Along with the person, makes an integrated system, given that the

environment affects a patient’s health needs

●Can be modified by the nurse to meet patient’s needs

●Components consist of environmental elements, conditions, factors,

and developmental environment

Health

●“ a state characterized by soundness or wholeness of developed

human structures and of bodily and mental functioning” (Orem, 1995,

p. 101)

●Dependent on environment, therefore, health definition varies

●Includes ability to achieve a level of innate potential while living within

social, biological and physical environments

Nursing●Encompasses actions by nurses used to assist patients

o to accomplish therapeutic self-care,

omove towards responsible self-care,

oor maintain care with supervision and consultation

●Helps patients maintain a state of health

●Assists the patient with disease or injury to regain normal or near

normal state of health

●Stabilizes, controls, or minimizes the effects of chronic poor

health or disability

●Goal is to provide patient or family members the necessities

needed to meet the patient’s self care needs

Terms related to Nursing●Nursing client

oPerson who has "health related /health derived limitations that render him

incapable of continuous self care or dependent care or limitations that result

in ineffective / incomplete care.” (Nursing Theories, 2011)

●Nursing problem

odeficits in health-related conditions, including universal and developmental

dimensions

●Nursing process

osystem used to determine why a person requires care, plan of care, and

implementation of care

●Nursing therapeutics

oActions that are systematic and purposeful

References●Masters, K. (2011). Nursing Theories: A Framework for Professional Practice. Sudbury,

MA: Jones and Bartlett Learning, LLC.

●Nursing Theories. (2011). Dorothea Orem’s Self-Care Theory. Retrieved from:

http://currentnursing.com/nursing_theory/self_care_deficit_theory.html

●Orem, D. (1995). Nursing: Concepts of practice (5th ed.). St. Louis, MO: Mosby.

●Sitzman, K. L. & Eichelberger, L.W. (2011). Understanding the Work of Nurse

Theorists: A creative beginning (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers,

LLC.