Dorothea Orem - Union County College Faculty Web Site
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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”:
1.
Self-care Theory: 3 types of self-care requisites
(needs) or categories
2.
3.
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 wellbeing 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 selfcare
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 selfcare 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 selfcare
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.