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

Nursing Theorist: Dorothea Orem

Self-Care Deficit Theory

Presented by MSN Students:Cheryl L Holz RN, BSN

Anna Marshall RN, BSN

Dorothea Orem 1914- June 22,2007

Born in Baltimore, MarylandDied 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.

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).

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).

Early Nursing Experiences Clinical

ORPrivate 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 (1949-1957)Office of Education, US Department of Health, Education,

and Welfare (1957-1959)

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

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

http://en.wikipedia.org/wiki/Philosophy_of_action, retrieved 10/10/08

Theoretical Sources & Influences-cont’dThe works of:

AristotleThomas 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)

Origins

1949-1959Began 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…

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?”

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

Formalization

1960-1980 through extensive reading and self-reflection

collaborations with students, practitioners, researchers, educators, administrators and scholars

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 2001- subsequent editions of Nursing Concepts of Practice

1984: Orem retired

PracticeFirst documented use:

1973-John Hopkins HospitalIn nurse-managed clinics

Various clinical populations & age groupsNeonates to the elderlyHealth promotion practices & care of the sick(The nursing management of pertussis was

described from the SCDNT perspective).

Practice-cont’d

Ethnically & culturally diverse populationsOrem’s SCDNT: translated into Italian, French,

Spanish, Dutch, and JapaneseCurrently, translations of some or all of her most

recent work in Germany, Thailand, and Norway, et al.

Used throughout the worldGreat Britain, Taiwan, Thailand, Japan, Korea, Canada,

Australia, New Zealand, South Africa, Israel, Germany, Spain, Italy, France, Belgium, the Netherlands, Bolivia, Colombia, Uruguay, and Mexico

Central Philosophy

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

Conceptual Theoretical ModelR=relationship; <=deficit relationship, current or projected

(Tomey & Alligood, 5th Ed., 2002, pg 192)

Deficit<

RR

RR

RConditioningFactors

ConditioningFactors

ConditioningFactors

Internal/External Stimuli

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.

Three Types of Nursing Systems

Wholly CompensatoryDoing for the patient

Partially CompensatoryHelping the patient do for him/herself

Supportive-EducativeHelping the patient learn to do for him/herself

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

Concepts & Principles-cont’d

SELF-CARE REQUISITES (SCRs):Groups of needs or requirementsClassified 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 individualHEALTH DEVIATION REQUISITIES

those needs that arise as a result of an individual’s condition


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)


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)


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”


SELF-CARE DEFICIT:When a patient is very unable to meet their own

self-care requisites (refer to slide 21)

NURSING AGENCY:Educated nursesAbility to act, know, & help patients


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


NURSING SYSTEMS:Constructed through actions of nurses and nurses-

patients.Deliberate practical actions of nursesPerformed 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

Conceptual Theoretical ModelR=relationship; <=deficit relationship, current or projected

(Tomey & Alligood, 5th Ed., 2002, pg 192)

Deficit<

RR

RR

RConditioningFactors

ConditioningFactors

ConditioningFactors

Fawcett’s Criteria & Pertinent Questions for Evaluation of

Nursing Theories

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 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

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


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)

“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)


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


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.


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 institution2. The purpose of nursing services3. Characteristics of personnel4. Settings for nursing services5. Management strategies and administrative policies

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)

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.

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

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).

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.

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


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


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


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).

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.

Contrast of TheoriesConceptual Model Person Environment Health Nursing

Orem’sSelf-Care Framework

Self-care agentTherapeutic self-care demand made up of:1-universal SCRs2-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 peopleGoal: 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-beingAction: 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, learningInterpersonal 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 rolesActions: A process of action, reaction, interaction, and transaction directed toward establishment of goals and goal attainment.

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.

Eastern Kansas VAHome 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.”

ReferencesChinn, 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. 139-202). 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: http://en.wikipedia.org/wiki/Philosophy_of_action

Documents

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