Dorothea Orem

1. Dorothea Orem Jessica Collings Kevin Doan Julie Walker

2. Purpose and Issues • Why do we need nurses? • How did Orem define nursing practice? • How does her definition differ from other nursing theorists? • What does this look like in daily practice? • How does a nurse balance caring for the patient with encouraging him or her to gain independence? • In what settings is this model of nursing applicable?

3. Introduction In 1959, Dorothea Orem defined nursing as: “giving of direct assistance to a person, as required, because of the person’s specific inabilities in self- care resulting from a situation of personal health” (Chitty 129). Such definition requires that each patient take an active role in the improvement of his or her health status.

4. Introduction (cont’d) • Orem’s nursing theory is also known as the Self-Care Deficit Theory • This idea comes from Orem’s observation that mature individuals have a desire to do things for and take care of themselves (Orem and Taylor 2011). • The Self-Care Deficit Theory proposes that the nurse will do for the patient that which he would normally do for himself but cannot due to a deviation from his baseline of health.

5. Orem’s Motivation • Worked for the U.S. Department of Health Education and Welfare as a consultant. It was there she began working on improving practical nurse training. • Much of her motivation came while leading the Nursing Model Committee of the School of Nursing Faculty of the Catholic University of America. • This committee was developing a model for the foundation and characteristics of nursing research.

6. Philosophic values • Belief that “ordinary people in contemporary society want to be in control of their lives” (Pearson, 104). • Believed nursing is needed in the presence of an actual or potential self-care deficit (Orem, 2001). • “Nursing is a community service, an art, and a technology” (Orem, 2001).

7. Information and Concepts • Developed three interrelated theories that form one main theory known as the Theory of Self-Care Deficit: • Self-Care • Nursing Systems • Self-Care Deficit

8. Theory of Self-Care • Self-care is the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health and well-being. (Orem, 1991)

9. Theory of Nursing Systems • Provides organization to the grand theory of Self-Care Deficit. • Establishes forms of nursing, and nurse patient relationship. • Identifies three support modalities • Wholly compensatory • Partially compensatory • Supportive-educative

10. Theory of Self-Care Deficit This theory identified when nursing support should be given, and the ways in which such support should be given. Orem identified 6 ways of providing support: • Doing • Guiding • Physical Support • Psychological Support • Environment Support • Teaching

11. Human Being • Saw individuals as an integrated whole. • Responsible for own self (self-care). • Nursing provides specific needs when patient is in need providing self-care.

12. Environment • Humans are an integrated whole including environment. • Environmental conditions can have strong effects on people.

13. Health & Nursing • Healthy people are able to provide their own self-care needs. • Nursing performs interventions for individuals who are not able to perform their self-care needs. Interventions decrease as individual is able to provide for more of his own needs.

14. Interpretation & Inference • Orems’s self-care model is contemporary with the concepts of health promotion, and health maintenance (Current nursing, 2012). • Nursing is practical and has a nature of doing and making (Dorothea Orem Promo, 2011).

15. Implications & Consequences • Goal of nursing - to render the patient and/or family capable of meeting the patient’s self-care needs. • To maintain or regain health • Self-care refers to the practice of activities that the individual performs on his or her own to maintain life, health and well- being.

16. Evaluation of the Nursing Model • Origin – Why do people need nursing? • Dorthea Orem answered this question through exploration. Her answer is, “People require nursing when they are unable to provide for themselves or dependent others...” (Dorothea Orem Promo, 2011). • Comprehensive model; describes the four global concepts as follows: • Health: self-care is learning to live with one’s new state of health as defined by his/her illness or disease. • Nursing: self –care deficits encompass the whole individual • Human being: self-care is a human need • Environment: one’s surroundings that affect health, development and self-care capacity. • Orem’s view is broad as it can be used in long term care and the acute care setting, from the injured to the dying.

17. Web Links • Impact of Orem’s work • http://nsq.sagepub.com/content/22/1/41.short • Xtranormal cartoon about Self-Care Deficit • http://www.youtube.com/watch?v=GaYm2IS0PQg • Dorothea Orem Promo • http://www.youtube.com/watch?v=O_ie_504B7U

18. Case Study • A home care nurse is visiting a nursing student who lives alone, and is restricted to her office chair due to atrophy of the muscles in her legs. During the assessment the nurse finds the student has anxiety, and now depression due to her disability.

19. Case Study From one of the five methods of helping others plan a Nursing intervention – • Acting for and doing for others. • Guiding others. • Supporting another. • Providing an environment promoting personal development in relation to meet future demands. • Teaching another.

20. References • Nursing Theories. Dorothea Orem's Self-Care Theory. February 4, 2012. Retrieved from http://currentnursing.com/nursing_theory/self_care_deficit_theory.html • Orem, D. (1991). Nursing: Concepts of practice (4th Ed.) St. Louis: Mosby • Orem, D. (2001) Nursing: concepts of practice, (6th Ed.) St. Louis, Mosby. • Pearson A, Vaughn B, Fitzgerald M: Nursing models for practice. Edinburgh, United Kingdom, 2005, Butterworth Heinemann. • Orem, D. and Taylor, S. (2011). Reflections on nursing practice science: The nature, the structure, and the foundation of nursing sciences. Nursing Science Quarterly, 24, 39. doi 10.1177/089431840389061