• Theorist : Dorothea Orem (1914-2007)
• Born 1914 in Baltimore, US
• Earned her diploma at Providence Hospital – Washington, DC
• 1939 – BSN Ed., Catholic University of America
• 1945 – MSN Ed., Catholic University of America
• She worked as a staff nurse, private duty nurse, nurse educator and administrator and nurse consultant.
• Received honorary Doctor of Science degree in 1976.
• Theory was first published in Nursing: Concepts of Practice in 1971, second in 1980, in 1995, and 2001.

MAJOR ASSUMPTIONS

• People should be self-reliant and responsible for their own care and others in their family needing care
• People are distinct individuals
• Nursing is a form of action – interaction between two or more persons
• Successfully meeting universal and development self-care requisites is an important component of primary care prevention and ill health
• A person’s knowledge of potential health problems is necessary for promoting self-care behaviors
• Self care and dependent care are behaviors learned within a socio-cultural context

DEFINITIONS OF DOMAIN CONCEPTS

Nursing – is art, a helping service, and a technology

• 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
• Encompasses the patient’s perspective of health condition ,the physician’s perspective , and the nursing perspective
• Goal of nursing – to render the patient or members of his family capable of meeting the patient’s self care needs
• To maintain a state of health
• To regain normal or near normal state of health in the event of disease or injury
• To stabilize ,control ,or minimize the effects of chronic poor health or disability

Health – health and healthy are terms used to describe living things …

• It is when they are structurally and functionally whole or sound … wholeness or integrity. .includes that which makes a person human,…operating in conjunction with physiological and psychophysiological mechanisms and a material structure and in relation to and interacting with other human beings

Environment

• environment components are enthronement factors, enthronement elements, conditions, and developed environment

Human being – has the capacity to reflect, symbolize and use symbols

• Conceptualized as a total being with universal, developmental needs and capable of continuous self care
• A unity that can function biologically, symbolically and socially

Nursing client

• A human being who has "health related /health derived limitations that render him incapable of continuous self care or dependent care or limitations that result in ineffective / incomplete care.
• A human being is the focus of nursing only when a self –care requisites exceeds self care capabilities

Nursing problem

• deficits in universal, developmental, and health derived or health related conditions

Nursing process

• a system to determine (1)why a person is under care (2)a plan for care ,(3)the implementation of care

Nursing therapeutics

• deliberate,  systematic and purposeful action,

OREM’S GENERAL THEORY OF NURSING

Orem’s general theory of nursing in three related parts:-

• Theory of self care
• Theory of self care deficit
• Theory of nursing system

A. Theory of Self Care

This theory Includes:

• Self care – practice of activities that individual initiates and perform on their own behalf in maintaining life ,health and well being
• Self care agency – is a human ability which is "the ability for engaging in self care" -conditioned by age developmental state, life experience sociocultural orientation health and available resources
• Therapeutic self care demand – "totality of self care actions to be performed for some duration in order to meet self care requisites by using valid methods and related sets of operations and actions"
• Self care requisites - action directed towards provision of self care. 3 categories of self care requisites are-
• Universal self care requisites
• Developmental self care requisites
• Health deviation self care requisites

1. Universal self care requisites

• Associated with life processes and the maintenance of the integrity of human structure and functioning
• Common to all , ADL
• Identifies these requisites as:
• Maintenance of sufficient intake of air ,water, food
• Provision of care assoc with elimination process
• Balance between activity and rest, between solitude and social interaction
• Prevention of hazards to human life well being and
• Promotion of human functioning

2. Developmental self care requisites

• Associated with developmental processes/ derived from a condition…. Or associated with an event
• E.g. adjusting to a new job
• adjusting to body changes

3. Health deviation self care

• Required in conditions of illness, injury, or disease .these include:--
• Seeking and securing appropriate medical assistance
• Being aware of and attending to the effects and results of pathologic conditions
• Effectively carrying out medically prescribed measures
• Modifying self concepts in accepting oneself as being in a particular state of health and in specific forms of health care
• Learning to live with effects of pathologic conditions

B. Theory of self care deficit

• Specifies when nursing is needed
• Nursing is required when an adult (or in the case of a dependent, the parent) is incapable or limited in the provision of continuous effective self care. Orem identifies 5 methods of helping:
• Acting for and doing for others
• Guiding others
• Supporting another
• Providing an environment promoting personal development in relation to meet future demands
• Teaching another

C. Theory of Nursing Systems

• Describes how the patient’s self care needs will be met by the nurse , the patient, or both
• Identifies 3 classifications of nursing system to meet the self care requisites of the patient:-
• Wholly compensatory system
• Partly compensatory system
• Supportive – educative system
• Design and elements of nursing system define
• Scope of nursing responsibility in health care situations
• General and specific roles of nurses and patients
• Reasons for nurses’ relationship with patients and
• Orem recognized that specialized technologies are usually developed by members of the health profession
• A technology is systematized information about a process or a method for affecting some desired result through deliberate practical endeavor, with or without use of materials or instruments.

Categories of technologies

1. Social or interpersonal

• Communication adjusted to age, health status
• Maintaining interpersonal, intra group or inter group relations for coordination of efforts
• Maintaining therapeutic relationship in light of psychosocial modes of functioning in health and disease
• Giving human assistance adapted to human needs ,action abilities and limitations

2. Regulatory technologies

• Maintaining and promoting life processes
• Regulating psycho physiological modes of functioning in health and disease
• Promoting human growth and development
• Regulating position and movement in space

OREM’S THEORY AND NURSING PROCESS

• Nursing process presents a method to determine the self care deficits and then to define the roles of person or nurse to meet the self care demands.
• The steps within the approach are considered to be the technical component of the nursing process.
• Orem emphasizes that the technological component "must be coordinated with interpersonal and social processes within nursing situations.

Application of Orem’s theory to nursing process

OREM’S WORK AND THE CHARACTERISTICS OF A THEORY

• Orem's theory
• interrelate concepts in such a way as to create a different way of looking at a particular phenomenon
• is logical in nature.
• is relatively simple yet generalizable
• is basis for hypothesis that can be tested
• contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them
• can be used by the practitioners to guide and improve their practice
• must be consistent with other validated theories ,laws and principles

Strengths

• Provides a comprehensive base to nursing practice
• It has utility for professional nursing in the areas of nursing practice nursing curricula ,nursing education administration ,and nursing research
• Specifies when nursing is needed
• Her self-care approach is contemporary with the concepts of health promotion and health maintenance

Limitations

• In general system theory a system is viewed as a single whole thing while Orem defines a system as a single whole, thing.
• Health is often viewed as dynamic and ever changing.
• The theory is illness oriented.

RESEARCH ON OREM'S THEORY

1. Self-care requirements for activity and rest: an Orem nursing focus
2. Nursing diagnoses in patients after heart catheterization--contribution of Orem
3. Self-care--the contribution of nursing sciences to health care
4. Self-care: a foundational science
5. Orem's self-care deficit nursing theory: its philosophic foundation and the state of the science
6. Dorothea E. Orem: thoughts on her theory
7. Orem's theory in practice. Hospice nursing care
8. Solving the Orem mystery: an educational strategy
9. Orem's family evaluation

REFERENCES

• Orem, D.E. (1991). Nursing: Concepts of practice (4th ed.). St. Louis, MO: Mosby-Year Book Inc.
• Taylor, S.G. (2006). Dorthea E. Orem: Self-care deficit theory of nursing. In A.M.
• Tomey, A. & Alligood, M. (2002). Significance of theory for nursing as a discipline and profession. Nursing Theorists and their work. Mosby, St. Louis, Missouri, United States of America.
• Whelan, E. G. (1984). Analysis and application of Dorothea Orem’s Self-care Practuce Model. Retrieved October 31, 2006.
• George B. Julia , Nursing Theories- The base for professional Nursing Practice, 3rd ed. Norwalk, Appleton & Lange.
• Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins.
• Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia,  Lippincott.
• Taylor Carol,Lillis Carol (2001)The Art & Science  Of Nursing Care 4th ed. Philadelphia,  Lippincott.

Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concept.