orem theory

1.  Orem theory

2. Presentation outline
 Objective
 Introduction
 Background
 Meta-paradigm
 Assumption of theory
 Major concept of theory
 Application of theory
 Strength and weakness
 Acknowledgment
 References

3. Objectives
At the end of this session we are expected to;
1.Know the purpose of Dorothea Orem theory
2.List assumption of Dorothea Orem theory
3.Identify major concept of Dorothea Orem theory
4.Discuss meta paradigm of Dorothea Orem theory
5.Describe the application of Dorothea Orem theory
6.List strength and weakness of Dorothea Orem theory

4. INTRODUCTION
 Dorothea Elizabeth Orem (July 15,
1914 – June 22, 2007) was one of
America’s foremost nursing
theorists who developed the Self-
Care Deficit Nursing Theory, also
known as the Orem Model of
Nursing.

5. BACKGROUND
Biography of Dorothea Orem
 Dorothea Orem was born on July 15, 1914, in Baltimore,
Maryland.
 In the early 1930s, she earned her nursing diploma from the
Providence Hospital School of Nursing in Washington, D.C.
 She completed her Bachelor of Science in Nursing in 1939 and
her Master’s of Science in Nursing in 1945, both from the
Catholic University of America in Washington, D.C.

6. Cont…
 Dorothea Orem helped publish the “Guidelines for Developing
Curricula for the Education of Practical Nurses” in 1959.
 In 1971 Orem published Nursing: Concepts of Practice, the work in
which she outlines her nursing theory, the Self-care Deficit Theory
of Nursing. This work’s success and the theory it presents established
Orem as a leading theorist of nursing practice and education.
 Dorothea Orem was also given many awards during her career: the
Catholic University of America Alumni Achievement Award for
Nursing Theory in 1980,

7. Cont…
 Orem was a member of the group of nurse theorists who
presented patterns of unitary man (humans), the initial frame
work for nursing diagnosis, to the North America Nursing
Diagnosis Association in 1982.
 Orem died on june 22, 2007 in savannah, Georgia, where she
had spent the last 25 years of her life as a consultant and author
, she was 92 years.

8. What Influenced Orem To Develop The Theory
 First she wanted to answer the question why people
needed nursing
 Then when she entered nursing in 1930’s nursing was
an ill defined profession her goal was to improve the
quality of nursing and provide a frame work for nursing
practice

9. Meta- Paradigm
 The four major paradigm of orem’s theory
 Nursing
Nursing is an art through which the practitioner of nursing gives
specialized assistance to persons with disabilities, making more than
ordinary assistance necessary to meet self-care needs. The nurse also
intelligently participates in the medical care the individual receives
from the physician.
 Humans
Humans are defined as “men, women, and children cared for either
singly or as social units” and are the “material object” of nurses and
others who provide direct care.

10. Cont…
 Environment
The environment has physical, chemical, and biological
features. It includes the family, culture, and community.
 Health
Health is “being structurally and functionally whole or
sound.” Also, health is a state that encompasses both the
health of individuals and groups, and human health is the
ability to reflect on oneself, symbolize experience, and
communicate with others.

11. Theory
 The Self-Care or Self-Care Deficit Theory of Nursing is
composed of three interrelated theories:
(1) the theory of self-care,
(2) the self-care deficit theory, and
(3) the theory of nursing systems, which is further classified into
wholly compensatory, partially compensatory and supportive-
educative.

12. Cont…
 Theory of Self-Care
 This theory focuses on the performance or practice of activities
that individuals initiate and perform on their own behalf to
maintain life, health, and well-being.
 Self-Care Requisites
 Self-care Requisites or requirements can be defined as actions
directed toward the provision of self-care. It is presented in
three categories:

13. Cont…
These are
Universal Self-Care Requisites
Normalcy
Developmental self-care requisites

14. Cont…
Theory of Self-Care Deficit
 This theory delineates when nursing is needed. Nursing is required when an
adult (or in the case of a dependent, the parent or guardian) is incapable of or
limited in providing continuous effective self-care.
Orem identified 5 methods of helping:
 Acting for and doing for others
 Guiding others
 Supporting another
 Providing an environment promoting personal development about meet future
demands
 Teaching another

15. Cont…
Theory of Nursing System
 This theory is the product of a series of relations
between the persons: legitimate nurse and legitimate
client. This system is activated when the client’s
therapeutic self-care demand exceeds the available
self-care agency, leading to nursing.

16. Cont…
Wholly Compensatory Nursing System
 This is represented by a situation in which the individual is
unable “to engage in those self-care actions requiring self-
directed and controlled ambulation and manipulative movement
or the medical prescription to refrain from such activity…
Persons with these limitations are socially dependent on others
for their continued existence and well-being.”
 Example: care of a newborn, care of client recovering from
surgery in a post-anesthesia care unit

17. Cont…
Partial Compensatory Nursing System
 This is represented by a situation in which “both nurse
and perform care measures or other actions involving
manipulative tasks or ambulation… [Either] the patient
or the nurse may have a major role in the performance of
care measures.”
 Example: Nurse can assist the postoperative client in
ambulating, Nurse can bring a meal tray for a client who
can feed himself

18. Cont…
Supportive-Educative System
 This is also known as a supportive-developmental system. The
person “can perform or can and should learn to perform
required measures of externally or internally oriented
therapeutic self-care but cannot do so without assistance.”
 Example: Nurse guides a mother on how to breastfeed her
baby, Counseling a psychiatric client on more adaptive coping
strategies.

19. Dorothea Orem’s Theory And The Nursing Process
 The Nursing Process presents a method in determining self-
care deficits and defining the roles of persons or nurses to meet
the self-care demands.
Assessment
 Diagnosis and prescription; determine why nursing is needed.
Analyze and interpret by making a judgment regarding care.
 Design of a nursing system and plan for delivery of care.
 Production and management of nursing systems.

20. Cont…
Step 1 – Collect Data in Six Areas
 The person’s health status
 The physician’s perspective of the person’s health status
 The person’s perspective of his or health
 The health goals within the context of life history, lifestyle, and health
status.
 The person’s requirements for self-care
 The person’s capacity to perform self-care

21. Cont…
Step 2
Nursing Diagnosis & Care Plans
 The nurse designs a system that is wholly or partly compensatory
or supportive-educative.
 The two actions are:
(1) Bringing out a good organization of the components of patients’
therapeutic self-care demands.
(2) Selection of a combination of helping methods will be effective
and efficient in compensating for/overcoming the patient’s self-care
deficits.

22. Cont…
Step 3
Implementation & Evaluation
 A nurse assists the patient or family in self-care matters to
identify and describe health and health-related results.
Collecting evidence in evaluating results achieved against results
specified in the nursing system design.
 The etiology component of nursing diagnosis directs actions.

23. Critique: Analysis And Evaluation
 The frame work used to evaluate the orem theory is chin
and Kramer evaluation theory.
 Chinn and Kramer (2015) propose evaluation of theories
to be evaluated using theory description and critical
reflection.
 There are six elements in theory description: purpose,
content, definitions, relationships, structure and
assumptions.
 Where as Critical reflection examines how well a theory
meets its purpose, and analyzes clarity, consistency,
complexity, generality, accessibility and importance.

24. Theory description
 Purpose
 Orem’s self-care deficit theory suggests patients are better
able to recover when they maintain some independence over
their own self-care
 So it’s purpose is to show individuals (patients) how to take
good care of them selves with the help of nurses as their
guide and educator to reach optimum level of self care
 Content
 Major content of her theory is as she stated is “the act of
assisting others in the provision and management of self-
care to maintain or improve human functioning at home
level of effectiveness.” it also focuses on each individual and
“the practice of activities that individuals initiate and
perform on their own behalf in maintaining life, health, and
well-being.

25. Cont…
 Definition
 “The condition that validates the existence of a
requirement for nursing in an adult is the absence of the
ability to maintain continuously that amount and quality
of self-care which is therapeutic in sustaining life and
health, in recovering from disease or injury, or in coping
with their effects. With children, the condition is the
parent’s inability (or guardian) to maintain continuity for
the child the amount and quality of care that is
therapeutic.” (Orem, 1991)
 Generally this theory mainly defined the role of nurse in
sustaining adequate self care effectively when they are
needed

26. Cont…
 Relation and Structure
Orem’s theory relates legitimate client (patient) with the
legitimate nurses in the appropriate agency for the
provision of needed interventions


27. Critical reflection
Clarity and complexity
 Orem’s theory is clear and easily understood by every
individual who came across with it with out facing any
complexity once familiar with the terms and
applications.
Accessibility
 Orem’s theory is easily accessible for every individual.
Importance
 this theory is important to improve quality of care
given for the individual, state area of need and how
nurse perform activities and when to perform it.

28. Cont…
Assumptions
 Dorothea Orem’s Self-Care Theory assumptions are:
(1) To stay alive and remain functional, humans engage in
constant communication and connect among themselves and
their environment.
(2) The power to act deliberately is exercised to identify needs
and to make needed judgments.

29. (3) Mature human beings experience privations in the
form of action in care of self and others involving making
life-sustaining and function-regulating actions.
(4) Human agency is exercised in discovering,
developing, and transmitting to others ways and means to
identify needs for, and make inputs into, self and others.
(5) Groups of human beings with structured
relationships cluster tasks and allocate responsibilities for
providing care to group members.

30. Strength And Limitations
Strengths
 A major strength of Dorothea Orem’s theory is that it is applicable for nursing by
the beginning practitioner and the advanced clinicians.
 It provides a comprehensive basis for nursing practice. Which helps professionals
in the areas of nursing practice, nursing education, and administration.
 The terms self-care, nursing systems, and self-care deficit are easily understood by
the beginning student nurse and can be explored in greater depth as they gain
more knowledge and experience.
 She specifically defines when nursing is needed: Nursing is needed when the
individual cannot maintain continuously that amount and quality of self-care
necessary to sustain life and health, recover from disease or injury, or cope with
their effects.
 The self-care approach is contemporary with the concepts of health promotion
and health maintenance.
 Three identifiable nursing systems were clearly delineated and are easily
understood.

31. Limitations
 Orem’s theory, in general, is viewed as a single whole thing, while
Orem defines a system as a single whole thing.
 Orem’s theory is simple yet complex. The use of self-care in
multitudes of terms, such as self-care agency, self-care demand,
self-care deficit, self-care requisites, and universal self-care, can be
very confusing to the reader.
 Orem’s definition of health was confined to three static conditions,
which she refers to as a “concrete nursing system,” which connotes
rigidity.
 Throughout her work, there is a limited acknowledgment of the
individual’s emotional needs.
 Health is often viewed as dynamic and ever-changing.

32. Conclusion
 Orem’s theory is relatively simple but generalizable to apply to a wide
variety of patients. It explains the terms self-care, nursing systems, and
self-care deficit essential to students who plan to start their nursing
careers.
 Moreover, this theory signifies that all patients want to care for
themselves. They can recover more quickly and holistically by performing
their own self-care as much as they’re able.
 This theory is particularly used in rehabilitation and primary care or other
settings where patients are encouraged to be independent.
 Though this theory greatly influences every patient’s independence, the
definition of self-care cannot be directly applied to those who need
complete care or assistance with self-care activities such as infants and the

33. References
 “Obituary: Dorothea Elizabeth Orem,” Savannah Morning News, June 24, 2007,
retrieved June 17, 2014
 Taylor, Carol R.; Lillis, Carol; LeMone, Priscilla; Lynn, Pamela (2011). Fundamentals of
Nursing. Philadelphia: Wolters Kluwer Health. p. 74. ISBN 978-0-7817-9383-4.
 Orem, D. (1991). Nursing: Concepts of practice. (4th ed.). In George, J. (Ed.). Nursing
theories: the base for professional nursing practice. Norwalk, Connecticut: Appleton &
Lange.
 Orem, D. (1995). Nursing: Concepts of practice. (5th ed.). In McEwen, M. and Wills, E.
(Ed.). Theoretical basis for nursing. USA: Lippincott Williams & Wilkins.
 Orem, D. (2001). Nursing: Concepts of practice. (6th ed.). In McEwen, M. and Wills, E.
(Ed.). Theoretical basis for nursing. USA: Lippincott Williams & Wilkins.
 Taylor, S.G. (2006). Dorothea E. Orem: Self-care deficit theory of nursing.
 Meleis Ibrahim Afaf (1997), Theoretical Nursing: Development & Progress 3rd ed.
Philadelphia, Lippincott.

34. Thank you!