Orem

DOROTHEA OREM’SSELF-CARE DEFICIT NURSING THEORY

By: Tracy Clarke & Jeanine Grossman

Purpose Orem’s purpose for developing the Self-

Care Framework was two-fold: To find the meaning of nursing and to develop a body of nursing knowledge based on research.

According to McLaughlin-Renpenning and Taylor (2002, p. 301), Orem states that “my work in theory development has focused on the beginning development of scientific knowledge in the field of nursing.”

Orem’s theory Orem produced conceptual models and

theories in an attempt to answer the following question (Hartweg, 1991, p. 4): What condition exists in an individual or a

group when judgments are made that nursing is required, that a nurse or nurses should now be related to this person or group as health care providers?

Theory description The theory rests upon:

The reality of the human condition of social dependency that casts members of a social group into the roles of the one in need of help and the helper

The reality that adults do deliberately care for themselves and their dependents (Orem, 2003, p 103)

Orem’s Theory of Self Care Each person has a need for self care in

order to maintain optimal health and wellness

Each person possess the ability and responsibility to care for themselves and dependants.

Theory is separated into three conceptual theories: self care, self care deficit, and nursing system.

Theory Description Orem’s Self-care deficit theory of nursing

(SCDTN) is a general theory composed of the following three interrelated theories: (Hartweg, 1991, p. 14) Self-care: Describes why and how people

care for themselves. Self-care deficit: Describes & explains why

people can be helped through nursing. Theory of nursing systems: Describes &

explains relationships that must be maintained for nursing to be produced.

Major Concepts SCDTN is composed of six basic concepts:

self care, self-care agency, therapeutic self-care demand, self-care deficit, nursing agency, and nursing system (Berbiglia & Banfield, 2006, p. 260-272)

The concepts of self-care, self-care agency, therapeutic self-care demand, and self care deficit are related to the patient, while nursing agency & nursing system are related to the nurses and their actions.

Definitions of major concepts:Theory of Self Care Self-care is the practice of activities that

individuals initiate & perform on their own behalf in maintaining life, health, and well being (Hartweg, 1991, p. 24).

Self care is learned behavior, it is goal directed with a purpose in mind.

Three components: universal self care needs, developmental self care needs, and health deviation.

Definitions of major concepts:Theory of Self Care Agency The power of individuals to engage in

self-care and the capability for self-care (Hartweg, 1991, p. 17).

Acquired ability that is affected by conditions & factors in the environment.

Ability to engage in self-care that develops from childhood reaches maturity in adulthood, and declines with old age

Definitions of major concepts:Therapeutic Self -Care Demand This includes activities which are

essential to health and vitality (Hartweg, 1991, p. 20-21).

These are universal requirements that all humans share throughout our life-cycle.

Includes: air, water, food, elimination, activity and rest, solitute and social interactions, prevention of harm and promotion of normalcy,

Definitions of major concepts:Self-care Deficit Theory Every mature individual has the ability to meet

self-care needs, a deficit may exist with a current inadequacy (Hartweg, 1991, p. 23).

Individuals may benefit from nursing interventions when situations inhibit their ability to perform self-care or their abilities are limited and not sufficient to maintain health (Hartweg, 1991, p. 23).

Nursing action focuses on the deficit and implementing appropriate interventions to meet the patient’s needs (Hartweg, 1991, p. 23).

Definitions of major concepts:Theory of Nursing Agency Comprises developed capabilities of

persons educated as nurses that empower them to represent themselves as nurses (Hartweg, 1991, p. 24).

To help others know their therapeutic self demands.

To help others regulate the development of their self-care agency.

Definitions of major concepts:Theory of Nursing System All actions and interactions of nurses and

patients in practice settings (Hartweg, 1991, p. 27).

Three types of compensatory nursing systems: Wholly: Pt unable to perform/control actions.

Ex: Pt in a coma. Pt has advanced Alzheimer's disease Partial: Nurse & patient share the responsibility.

Ex: Pt performs most of self care tasks, but needs assistance

Supportive/educative: Pt performs all self care actions related to ambulation & movement. The nurse provides education & is supportive. Ex: Nurse provides info & supports the new mom re:

breastfeeding, but the mom performs the action.

Major relational statements Nursing science is concerned with the

exploration of relationships between entities.

Orem’s triad of relations constitute SCDNT: (1) Self-care agency as related to self-care

demands (2) Self-care agency as related to self-care (3) Self-care as related to self-care

demands

RelationshipsSCDNT:General theory of nursing, it represents a

complete picture of nursing (Berbiglia & Banfield, 2006, p. 273):

Theory of self-care is the foundation of all theories. Expresses the purpose, method, and outcome of taking care of self.

Theory of self-care deficit develops the reason why a person may benefit from nursing.

Theory of nursing systems is the unifying theory and includes all essentials elements.

AssumptionsFive premises underlying the general theory of

nursing(Berbiglia & Banfield, 2006, p. 272):

(1) Human beings require continuous deliberate inputs to themselves and their environments to remain alive and function 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.

Assumptions(3) Mature human beings experience privations in the form of limitations or action in care of self and others involving and making of 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 structures relationships cluster tasks and allocate responsibilities for providing care to group members who experience privation for making required deliberate input to self and others

Basic Structure with Model

Theory Synthesis According to Chinn and Kramer (2008),

Orem’s emphasized that self-care maintains wholeness. Dorothea Orem's theory of Self-Care Deficit involves the client, known as the patient as the main focus in providing care. It is the role of the nurse to provide care based on the patients inability and incapacity to perform self-care related to health problems.

Origins of theory Evolved over a period of four decades from

individual work and collaboration with several groups (students, practitioners, researchers, educators etc).

Searched for the meaning of nursing using her own unique experiences and observations (Hartwell, 1991, p. 3-4).

Orem originally searched for the answer to the question, “What is nursing and what condition exist when judgments are made that people need nursing?” The answer she found stated, “The inabilities of people

to care for themselves at times when they need assistance because of their state of personal health.”

Origins of the model (1949-1959) 1949-1957: 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 (Hartwell, 1991, p. 4).

1958-1960: U.S. Department of Health, Education and Welfare where she help publish "Guidelines for Developing Curricula for the Education of Practical Nurses" in 1959 (Hartwell, 1991, p. 4).

Origins of the model (1949-1959) 1959: Served as acting dean & assistant

professor of nursing at CUA. She continued to develop her concept of nursing and self care during this time (Hartweg, 1991, p. 4).

1965: Members of the Nursing Models Committee at CUA helped to further define & formalize the concept of nursing.

Orem’s Nursing: Concept of Practice was first published in 1971 and subsequently in 1980, 1985, 1991, 1995, and 2001.

Orem continued to develop her theory after retirement in 1984.

Clarity Theoretical terms are defined precisely. Theoretical language is consistent with 21st

century language. Terminology of the theory is congruent

throughout. Ex: The term self-care has multiple meanings;

Orem defined the term & elaborated the structure of the concept to be unique to this theory while also congruent with other interpretations (Berbiglia & Banfield, 2006, p. 276).

Simplicity Theory is expressed in limited terms. Complexity of Orem’s theory is viewed as a

balance between highly complex and parsimonious.

• Terms are defined & used consistently within the theory (Berbiglia & Banfield, 2006, p. 276).

Ex: The self-care deficit theory of nursing is a synthesis of knowledge comprising eight concepts:

The relationship between & among these concepts can be presented in a simple diagram.

The structure of the theory can be identified within these concepts.

The depth & complexity of the concepts is necessary to describe & understand the human practice discipline.

Generalizability/UsefulnessOrem stated:

“The self-care deficit theory of nursing is not an explanation of the individuality of a particular concrete nursing practice situation, but rather the expression of a singular combination of conceptualized properties or features common to all instances of nursing. As a general theory, it serves nurses engaged in nursing practice, in development and validation of nursing knowledge, and in teaching and learning nursing (Berbiglia & Banfield, 2006, p. 276).”

Testability Instrument development plays an important

role in building nursing knowledge (Berbiglia & Banfield, 2006, p. 277)

Research instruments to measure Orem’s concepts are currently being used, developed, & tested. Ex: American Society of Anesthesiologist examines

relationship btwn basic conditioning factors & self-care agency.

Ex: Moore’s self care questionnaire used to measure the self care practice of children and adolescents.

Ex: Campbell’s danger assessment tool measures women at risk for battering

Ex: The nursing care plan is an example of how self care theory can be applied to the nursing process

Testability Concepts of SCDNT are complex & based on

real (empirically based) nursing situations (Berbiglia & Banfield, 2006, p. 277) .

Both quantitative & qualitative research methods are appropriate for the development of knowledge related to SCDNT. Quant: Test the relationship btwn Orem’s 3

central concepts (self care, self care agency & basic conditioning factors) in adolescent CF pts.

Qualt: Hemodialysis pts at risk for self-care deficits.

Testability Current emphasis in SCDNT is on building

a body of knowledge based on nursing practice, rather than engaging in theory testing (Berbiglia & Banfield, 2006, p. 277).

Additional descriptive studies of various pop. to provide a solid base for the development of instruments to measure the concepts of SCDNT (Berbiglia & Banfield, 2006, p. 277).

Practice ImplicationsThe application of Orem’s model to

nursing practice takes many forms (Hartweg, 1991, p. 35-38): Philosophical guide to nursing practice. Develop & guide nursing practice. Self-care model used as a framework for

clinical practice & guide to nursing research.

Conceptual guide to develop nursing curricula in ASN & BSN programs.

Nursing Metaparadigm Person: Integrated whole. Has the capacity

for self knowledge and for engagement in deliberate action.

Health: State of wholeness. Physical, psychological, interpersonal, and social aspects of health are inseparable.

Environment: External surroundings that consists of physical& psychosocial elements.

Nursing: Helping service. Focuses on an individuals’ abilities and requirements for self-care (Hanucharurnkuls, 1989, p. 367).

Synthesis The Self-Care Deficit Nursing Theory

differentiates the focus of nursing from other disciplines.

It gives directions to nursing-specific outcomes related to knowing and meeting the therapeutic self-care demands of individuals.

Guides nursing administration, and is useful in the design of curriculums for nursing education programs.

Orem’s theory continues to be expanded through the use of theory-based computer systems, assessment forms, and the overall structuring of the delivery of care. This will further attest to the usefulness of this theory.

Synthesis Orem’s 5 essential factors for

development of nursing science: (Berbiglia & Banfield, 2006, p. 278)1) A model of practice science2) A valid, reliable, general theory of nursing3) Models of the operations of nursing

practice4) Conceptual structure of the theory5) Integrated conceptual elements of the

theory

Conclusion The critical question-What is the condition

that indicates that a person needs nursing care?-was the starting point for SCDNT.

Theory provides a foundation for organizing existing nursing knowledge and for the development of new knowledge (Berbiglia & Banfield, 2006, p. 277).

Continued efforts to expand nursing knowledge will continue to guide nurses in their provision of care.

Annotated ReferencesBerbiglia, V.A. & Banfield, B. (2006). Self-care deficit theory of

nursing. In M.R. Alligood & A.M. Tomey ( Eds.), Nursing theorists and their work (pp. 265-285). St. Louis, MO: Mosby, a division of Elsevier.

This book features 37 chapters grouped into six units that covers a bibliography for the works of each theorist. Chapter 14 includes the evolution of nursing theories, models and philosophies related to Dorothea Orem. Primary and secondary sources are identified with appropriate websites related to Orem and her works.

Chinn, P.L. & Kramer, M.K. (2008). Integrated knowledge development in nursing. (7th ed.). St. Louis, MO: Mosby, a division of Elsevier.

This book written by Chinn and Kramer, provided the definitions and framework used in this theoretical analysis. This book explained the steps needed to critique the theory, and was the basis for the process used. 

Annotated ReferenceHanucharurnkuls, S. (1989). Comparative analysis of Orem’s and King’s

theories. Journal of Advanced Nursing, 14(5), 365-372. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=1989094611&site=ehost-live

This article found on CINAHL is a comparative analysis of Orem’s and King’s theories. This article compared the nursing metaparadigm concepts of Orem’s and King’s theories.

Hartweg, D.L. (1991). Dorothea Orem: Self-care deficit theory: Notes on nursing theories. Newbury Park, CA: Sage Publishing.

The purpose of this volume is to present a descriptive overview of Dorothea Orem’s Self-Care Deficit Theory of Nursing. This book is primarily intended for use by beginning students of Orem’s theory.

Annotated Reference

McLaughlin-Renpenning, K., & Taylor, S. G. (2003). Self-care theory in nursing: Selected papers of Dorothea Orem. New York: Springer.

This book is a collection of 38 works of Dorothea Orem consisting of her findings related to the nursing sciences, education and practice with regards to the structure and content. The historical and cultural context is described in chronological order with regards to the development of Orem’s self care deficit theory.