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Dorthea Orem

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Laura McKnight

on 4 February 2015

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Transcript of Dorthea Orem

Dorthea Orem
Role of Orem's Theory in Nursing Practice Today
• The Self Care Deficit Theory was developed to answer the question “why do people need nursing?”

• The ultimate goal of Orem’s theory is self care.

• The term “deficit” was chosen not to refer to an individual’s limitations but to the relationship between the capabilities of the individual and the need for action.

• This theory is being used in the forefront of many healthcare facilities

• Utilized in most interactions with our patients

• With the increasing market competition, and more families being primary caregivers, a new focus is being placed with the family

Self Care Deficit Theory
Main Concepts
“The individual practices self-care, a set of learned behaviors, to sustain life, maintain or restore functioning, and bring about a condition of well-being. The nurse assists the client with self-care when he or she experiences a deficit in the ability to perform.” (Creasia & Friberg, 2011)
Dorthea Orem
“The environment is linked to the individual, forming a integrated system” (Creasia & Friberg 2011)

• Person and environment are a functional unit in which exchange are reciprocal and influence is mutual
• Interaction between person and environment
• Relationship between person and environment

“Health, which has physical, psychological, interpersonal, and social aspects, is a state in which human beings are structurally whole or sound” (Creasia & Friberg 2011)

• It is the responsibility of a society and individual
• It is when a person is functionally and structurally whole or sound
• The aspects of health are inseparable in the individual
• Supports the premises of holistic health in that both nurse and patient promote the individual responsibility of self-care
Major Concepts to Orem's Theory
• Environment
• Health
• Nursing
• Person

• 1971 Nursing: Concepts of Practice

• 1980, 1985, 1991, 1995, and 2001- subsequent editions of Nursing: Concepts of Practice

Role of Theory and Implications to Nursing Practice
“The goal of nursing is to move a patient toward responsible self-care or meet existing health care needs of those who have health care deficits.” (Creasia & Friberg, 2011, p.103)

-Orem’s self-care deficit focuses on helping the individual person with their daily activities, allowing the patient reach his/her desired level of self-care.

• occurs when an individual is incapable of
maintaining self-care as a result of structural
or functional limitations

• 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 Nursing Process
• 3 Nursing Systems: Wholly Compensatory, Partly Compensatory, Supportive-Educative System

• Working through this process takes a partnership

• These actions level the playing field, promote teamwork, allowing the development of interpersonal relationships

• These acts create trust

Orem's Theory At Work
• Trust is a huge part of bridging the gaps

• Until trust is established, patients are skeptical and often afraid, and that prevents acceptance of education

• Once education is accepted, only then can it be applied to care for themselves and place them on their journey to recovery

Identifying the Need for a Bridge
Bridging the Gap Through Nursing Systems
• The deficit can be small such as educating why a medicine is so important to their health (Supportive-Educative)

• The deficit could be utilizing assitive devices and teaching its use while ambulating the patient progressively (Partly Compensatory)

• The deficit could be comprehensive, where patient needs assist breathing, eating, turning, bathing, and/or toileting. (Wholly Compensatory)

Support and Encouragement
• The theory is only successful if the patient is coping with their illness or injury.
• It is not uncommon for patients to feel defeated or depressed.

• We have to be there for them to work them through the process
• It means being there to support them until the goal is reached

Relationship of Main Concepts to Nursing Practice
There are 3 self-care requisites:
-Universal: those things every person needs to promote survival: water, food, air, etc.
-Developmental: focuses on the life-cycle stage each patient is in.
-Health Deviation: “Genetic and constitutional defects and deviations that affect integrated human functioning and impair the individual’s ability to perform self-care” (Creasia , p.103).

Self-care Requisites
Initial Assessment
Design Nursing System
Implementing Nursing System
Orem's self-care deficit theory views the nursing role as "assisting the individual with self-care practices" (Creasia & Friberg, p. 111)

Patient's recover more quickly if they are independent in their activities (to the best of their ability).
Why is nursing needed for this specific patient?

-Health status
-Requirements for self care & baseline functioning
-Health goals
Utilizing Orem's nursing system , create an individualized plan that is wholly compensatory, partly compensatory or supportive-educative.

This step helps the nurse to determine specific compensation needs (i.e. assistive devices, physical therapy, home health visits, etc).

The nurse assists the patient with achieving goals that were previously set by implementing the necessary resources needed to attain optimal health and independence of the patient.
Creasia, J. L., & Friberg, E. E. (2011). Conceptual foundations: The bridge to professional nursing practice (5 ed.). St. Louis, MO: Elsevier Mosby

De Chesnay, M., & Anderson, B. A. (2012). Caring for the vulnerable (3 ed.). Burlington, MA: Jones & Bartlett Learning.

Manzini, F., & Simonetti, J. (2009). Nursing consultation applied to hypertensive clients: application of Orem's self-care theory. Revista Latino-Americana De Enfermagem (RLAE), 17(1), 113-119.

O'Shaughnessy, M. (2014). Application of Dorothea Orem's theory of self-care to the elderly patient on peritoneal dialysis.Nephrology Nursing Journal, 41(5), 495-498. Retrieved from http://search.proquest.com/docview/1617932423?accountid=15070

Nursing Theory. (2013). Dorothea E. Orem’s Contribution to Nursing Theory: Self-care Deficit Nursing Theory. Retrieved from

Seed, M. S., & Torkelson, D. J. (2012). Beginning the Recovery Journey in Acute Psychiatric Care: Using Concepts from Orem's Self-Care Deficit Nursing Theory. Issues In Mental Health Nursing, 33(6), 394-398. DOI:10.3109/01612840.2012.663064

The University of Tennessee Chattanooga School of Nursing. (2012). Philosophy. Retrieved from http://www.utc.edu/nursing/about/philosophy.php

Discuss main concepts of Orem's theory
Discuss relationship of Orem's theory to nursing practice
Discuss role of Orem's theory & implications as it relates to nursing practice
"Nursing involves assisting the individual with self-care practices to sustain life and health, recover from disease or injury, and cope with their effects.” (Creasia & Friberg, 2011, p.103)

-Prioritizing the nursing care given should focus on actions that are important to human existence and functioning; and also maintain focus on each person as a separate identity.

Nursing Systems

1: Supportive-educative care: nurse provides assistance with decision making, while the patient preforms all their care by themselves.
2: Partly Compensatory: the Patient needs assistance with some parts of their care, but is able to complete the majority of their care alone.
3. Wholly compensatory: nurse preforms all levels of self-care for the patient; these patients are completely dependent on others for survival.

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