Transcript Document

Self-Care Deficit theory
Dorothea Orem
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Overview about Orem’s theory:-
Orem's CV
Origins – Purpose
Philosophy and world view
Metaparadigm – Concepts
Assumptions and Propositions
Theories included in the Self-Care Deficit theory
Orem’s Theory and Nursing process
Time oriented
Peplau:
Orem:
Roy:
Roger’s:
King:
Newman:
Published at 1952.
Published at 1959.
Published at 1960.
Published at 1970.
Published at 1971
Published at 1989
Dorothea Orem
C.V.
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1939 – BSN completed
1945 - MS in nursing education
1958 - consultant to the Office of Education
where she began working on her SELF-CARE
THEORY
1959 - first published her theory in “Guides
for Developing Curricula for the Education
of Practical Nurses” (a government
publication)
Dorothea Orem
C.V.
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1976 - honorary Doctorate of Science from
Georgetown University
1980: Award for nursing theory from
catholic university of America.
1999 - last edition of her theory was
published
Publications
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1959: Guidelines For Developing Curricula For
The Education Of Practical Nurse
1962: The Hope Of Nursing
1971: Nursing: Concept And Practices 6th
edition in (1999).
1972: Concept Formalization In Nursing:
Process And Product.
1979: Levels of nursing education and
practice
Origin
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While Orem was working in the Department of
Health Education and Welfare (HEW) as a
curriculum consultant she worked to upgrade
practical nursing training.
That stimulated the need to address the
question
What is the
subject matter of
nursing?
(Curriculum)
Origin
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cont’d.
Orem’s book of “ guidelines for developing
curricula for the education of practical nursing”
was the seed for her work (Orem,1959 in
Fawcett 1995) and (Meleis, 1998).
To conceptualize a curriculum for a diploma
program by isolating and specifying nursing
action.
Origin
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cont’d.
Ideas that helped to shape the self-care
framework were formulated as Orem
experienced a period of intensive exposure to
nurses and their endeavors from 1949 to 1957
(Fawcett, 1995).
Philosophical view
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Orem has identified her philosophical view
based on the action theory, from the
perspective of the person as a deliberate actor
or agent.
Philosophical view cont’d.
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Orem model is based upon the philosophy that
all “ patients wish to care for themselves and
its purpose was to define the following:
Nursing concern is on the man’s needs for self-care action
and the provision and management of it on a continues
basis in order to sustain life and health, recover from
disease or injury and cope with their effect.
 Nursing goal is overcoming human limitations ( Berbelgia,
2002).
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World View
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World view referred to the physiologic
assumptions about the nature of person
environment relationship.
Orem: adopted the organicism rather than
mechaniscism as world view, she proclaimed
that man include internal physical,
psychological and social nature with the change
rather than stability.
World View cont’d.
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She stated that man and environment interact
as a self-care system.
A change in either the system of man and the
system of the environment will affect the selfcare system.
Orem states: Man functioning is linked to his
environment and together man and
environment form an integrated whole system.
Keywords that support this view: change,
whole, interaction, man and environment.
Conceptual Models
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Nursing models are categorized according to
the discipline or anthropology from which
they were derived.
It is clear in Orem’s theory that she used
developmental model (Montgomery,2004).
Also, Meleis (1998) viewed that Orem’s theory
could be categorized as an interaction model.
Theory Development Strategy
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The theory development strategy used by Orem
was induction from practice.
Induction from practice is clearly evident in
Orem’s detailed accounts of how concepts in
the theory were determined and defined based
on “ experience in concrete nursing practice
situations or results of analysis of nursing care
materials “ (Orem,1991)
Theory Development Strategy cont’d.
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Orem did however read widely and identified some of
major influences on her thinking, suggests that there
was an element of deduction in her work
(Montgomery,2004).
Sources of influences include ideas about deliberate
human actions and motivation.
Theory Development Strategy cont’d.
Factors influencing development:
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Practical nursing curriculum development
Women’s movement
Nursing theory conferences
Basic Elements in the Model
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The structure and components of the self-care
framework have undergone various interpretations
overtime.
Orem (1991) explained “all of the conceptual elements
of the self-care framework were formalized and
validated as static concepts by 1970.
Since then, some refinements of expression and
further development of substantive structure and
continued validation have occurred and changes have
been made (Fawcett,1995).
Three theories in the model
Self-care Deficit Theory
Theory of Self-care
Theory of Nursing System
Structurally, each theory is presented as a set of
assumptions, and a set of propositions.
Main Concepts in the Model
Self-care
Self-care agency
Self-care demand
Self-care deficit
Nursing Agency
Nursing System
Model Metaparadigm- Nursing
Orem viewed nursing as :A community service, an art and
a technology.
Community ( is a group of individuals and families who share
not only a common geographic area but common Interest.
As a health service: in the community : It is an interpersonal
process that requires the social encounter of a nurse with
a patient (transaction process) based on the values of
that community.
Art: As an art, it is the ability to assist others in the design,
provision and management of systems of self-care to improve
or to maintain human functioning at some level of effectiveness
Model Metaparadigm- Nursing
Technology: techniques of practice
1- Communicating with persons in states of health and disease.
2- Maintaining interpersonal, intragroup, and intergroups
relationships for cooperative efforts.
3-Giving human assistance adapted to specific human needs &
limitations.
4- Maintaining and controlling the positions and movements of
persons in physical environment for therapeutic purposes.
5- Promoting process of human growth and development including
self or ego development.
6-Sustaining and maintaining life process.
7- Appraising, changing and controlling psycho-physical modes of
human functioning in health and disease.
8- Maintaining therapeutic relations based on psychosocial modes of
human functioning in health & disease.
Model Metaparadigm
Nursing
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It is the ability to assist
others
in design,
provision
and
management of self-care
to improve or maintain
human function at some
level of effectiveness.
Methods of Nursing Help
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Acting or doing for
Guiding & directing another
Teaching another
Providing psychological and physical
support.
Providing a supportive environment to
promote the patient’s ability to meet
current or future demands.
Model Metaparadigm
Health
As a state of
being
Sound
Strength
Vigor
whole
Absence of
disease
Nothing is
Missing
Or
Diminished
Model Metaparadigm
Health
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Not only a bodily state but
also to how one functions in
everyday living and
progressive development
that is movement toward
higher and higher level of
integration and functioning.
Model MetaparadigmENVIRONMENT
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Person and environment are a
functional unit in which exchange are
reciprocal and influence is mutual.
Persons are viewed as existing in their
environments and never isolated from
them.
4 environmental features (physical,
chemical, biologic and social) have an
impact on the health and well- benign
the person and the family.
Model Metaparadigm - PERSON
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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)
Model Metaparadigm - PERSON
Human beings are distinguished from other
living beings by their capacity to:
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Reflect upon themselves and their
environment
Use symbolic creations (ideas, words)
in thinking, communicating, and
guiding efforts to make things that are
beneficial for themselves and/or for
others
Man and environment form an
integrated system . A change in either
component may affect the self-care
system.
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
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Self-care
The practice of activities that mature
person initiates and performs independently
within time frame, to promote and maintain
personal well-being, healthful functioning
and continuing development throughout
life.
Orem’s Self-care Agency
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Definition: the individual’s ability to perform
self-care activities (capabilities of the person)
It is a complex acquired abilities to meet one’s
continuous requirement for care.
Consists of TWO agents:
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Self-care Agent - person who provides the selfcare and has the power to do so
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)
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Definition: the expressions of action to be
performed by or for individuals for controlling
human and environmental factors that affect
human functioning and development
Three types of self-care requisites constitute the
therapeutic self- care demand:
 Universal - requisites/needs that are common
to all individuals.
1- Air, water and food
2- elimination and excrements
Orem’s Self-care Requisites
cont’d.
3- activity/rest
4- solitude (aloneness) /social interaction
5-prevention of hazards to life and well-being
(physical , social & psychological hazards).
6-promotion of function and development
within social group based on group norms.
Orem’s Self-care Requisites
(also called Self-care Needs)
Developmental – Actions that need to be
performed in relation to human developmental
processes , conditions and events and relation to
events that adversely affect development.
Health Deviation – exists for persons who are ill or
injured have specific forms of pathologic conditions
(including defects and disabilities & who are under
medical diagnosis and treatment..
 Needs resulting from illness, injury & disease or
its treatment
Self-Care Deficit
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The relationship between self-care agency (ability to
perform self-care) and the therapeutic self-care
demand in which self care agency is not sufficient to
meet one’s therapeutic self-care demands.
Dependent- care deficit exists when the person’s
ability to perform dependent-care (i.e., dependentcare agency) is not sufficient to meet the socially
dependent person’s therapeutic self care demand).
Deficit can be complete or partially and as such
indicate whether wholly or compensatory system.
Therapeutic Self-care Demands
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The sum of self-care measures/ actions,
required to meet the specific self-care
requisites of a person at a point in time.
Assumptions & Propositions
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Assumptions (explicit)
deliberate
For the sake
Of others
purposeful
Nursing
Performed
By
nurses
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Helping
service
Nursing is a deliberate , purposeful helping
service performed by nurses for the sake of
others over a period of time.
Assumptions (explicit)
Capable &
willing
Dependent
member
Person
Perform
Self-care
For self
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Persons are capable and willing to perform selfcare for self or for dependent members of the
family.
Assumptions (explicit)
Health
Self care
necessity
Well being
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Human
development
Self care is part of life that is necessary for
health human development & well-being.
Assumptions (explicit)
Education
Individual
Culture
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Education and culture influence individuals.
Assumptions (explicit)
Human
interaction
Self-care is
learned through
communication
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Self-care is learned through human interaction and
communication.
Assumptions (explicit)
deliberate
Needs for
care
Self-care
Systematic
actions
Performed
To meet
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Self-care includes deliberate and systematic actions
performed to meet needs for care.
Assumptions (implicit)
Self-reliant
Dependent others in
the family
People
Should be
Responsible for
Own care
needs
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People should be self- reliant and responsible for
their own care needs as well as others in the family
who are not able to care for themselves.
Assumptions (implicit)
Entities
people
Environment
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Distinct from
others
People are individuals with entities that are distinct
from others and from their environments.
Propositions
Person and nursing client:
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Human beings have capabilities to provide their own self-care
or care for dependents to meet universal, developmental and
heath deviation self-care requisites.
Self care abilities are influenced by age, developmental state
experiences and sociocultural background.
Self-care deficits are to balance between self-care demands
and self-care capabilities and an indication of a state of social
dependency..
Propositions Cont’
Nursing Therapeutic
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Therapeutic self-care includes actions of nurses,
patients, and others that regulate self care capabilities
and meet self-care needs.
Nurses assess the abilities of patients to meet their
self-care needs.
Nurses engage in selecting valid and reliable processes
, or technologies or action for meeting self-care
demands.
Components of therapeutic self-care are wholly
compensatory, partly compensatory and supportive
educative.
Orem’s General Theory of
Nursing
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Consists
of
three
related
theories
collectively referred to as “Orem’s General
Theory of Nursing”:
Self-care Theory
Self-care Deficit Theory
Nursing Systems Theory
Orem’s Self-care Theory
Based on the concepts of:
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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 well-being throughout life.
Orem’s Self-care Deficit
Theory
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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
Orem’s Nursing Systems
Theory Describes...
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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
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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:
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Wholly compensatory
Partly compensatory
Supportive-educative
Three Nursing Systems
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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
self-care requisites but needs a nurse to help
for others.
Supportive-educative: a pt can meet selfcare requisites but needs help in decisionmaking, behavior control, or knowledge
acquisition
Orem's theory, Nursing process
&Critical thinking operations
Critical Thinking Operations
It includes four cognitive operati
Nursing process
Assessment
Diagnosis
Planning
Implementation
Evaluation
Intellectual Phase
Step I: the initial and
determination of needs
Step II: the designing
of system (Planning).
Practical phase:
Step III: Initiation,
conduction
& controlling
of assisting actions.
Diagnostic Operation
Identify self-care practice,
its limitation
Perspective
Operations
Select the appropriate therapeut
method and explaining it to clie
Regulatory operations
Design plan and implement it
Control operations
Evaluation of the effectiveness
of regulatory operations