Dorothea Orem

1. Dorothea Orem Why do people need nursing? • Jennifer Ames • Charles Dietrich • Holly Leveille

2. What if every individual adult has the capacity for self-care; however, when a health problem arises it is possible that this capacity is insufficient to confront the situation, making it then necessary to receive help from other persons who compensate for this deficit Dorothea Orem’s motivation for developing her self care theory

3. The theory begins to take shape • In 1957 while working for the US Department of Health, Education and Welfare as curriculum consultant, Dorothea attempted to plan a nursing curriculum for licensed practical nurses. She was searching for a pragmatic framework to organize nursing knowledge. Her focus was on the questions “What is nursing?” and “When do people need nursing care?” and from this she theorized that people need nursing when they are unable to care for themselves.

4. Shape into a book • In 1971, she presented the Self- Care Deficit Theory of Nursing (S-CDTN) in the book Nursing Concepts of Practice • She incorporates the medical model rather than rejects it, centers on the individual, is problem oriented, and is easily adaptable in varied clinical situations.

5. Orem’s Theory of Nursing

6. Theory in depth • Theory of self care- Health deviation self-care is required in conditions of illness, injury, or disease • Theory of self care deficit- nursing is required when an adult is incapable or limited in the provision of continuous, effective self-care. • Theory of nursing system- is how the patient's self-care needs will be met by the nurse, the patient, or by both

7. “It is the existence of a self-care deficit that indicates the need for nursing.” (Banfield, 2001)

8. Orem defines nursing • Nursing is a service to people, not a derivative of medicine. • Nursing has responsibilities • Roles of nurse and the patient • Rational of nurse/patient relationship • Type of actions needed to meet the patients demands • Her theory helps make nursing a legitimate science

9. Global Concepts • The human being • Environment • Health • Nursing

10. Human being • A person is composed of physical, psychological, interpersonal, and social aspects. • They have the potential for learning and develop a way to meet self care needs • Symbolize what they experience

11. Environment • Is anything outside of or external to the person. • Can positively or negatively effect a persons ability to function

12. Nursing • Promotes the health of self and that of service of helping others. • It is actions by the nurse to overcome or prevent self care limitations. • A nurse may have to provide service that is wholly compensatory or partly compensatory and also educate the client.

13. Nursing cont: • wholly compensatory nursing system- the nurse supports and protects the client, compensates for the client’s inability to care for self, and attempts to provide care for the client. • partly compensatory nursing system- both the nurse and client perform care measures. • supportive-educative nursing system- the nurse’s actions are to help clients develop their own self-care abilities through knowledge, support, and encouragement

14. Health • Is the internal and external conditions that permit self-care needs to be met • The person as a whole • It is a team effort by the nurse and patient for the promotion of self care

15. Interpretation & Inferences • Goal of self care is to promote health and well being. • A human being is the focus of nursing only when self care demand surpasses self care capabilities. • Actions are deliberate, systematic, and purposeful. • “Deliberate action refers to actions performed by individual human beings who have intentions and are conscious of their intentions to bring about, through their actions, conditions or states of affairs that do not at present exist” (Orem, 2001, pp 62-63).

16. Interpretation & Inferences • A person needs to engage in behaviors that will regulate self & the environment (Banfield, 2011). • The environment can positively or negatively affect the health and well being of individuals (Orem, 2001). • A nurse within the healthcare environment will help patients develop their capabilities to meet self care requisites. • Patient and nurse variables are not determinants of health rather can influence under various circumstances at various points in time.

17. Implications & Consequences • The Institute of Medicine (IOM) called for a redesign of the country’s healthcare system. • Shift from acute care to management of chronic health problems. • Six goals of healthcare identified: • Safe, effective, patient centered, efficient, timely, & equitable.

18. Implications & Consequences • These change will continue to influence a patient’s self care demand and agency. • Patients manage their health conditions, not healthcare providers. • Nurses influence will increase to assist patients in developing their abilities to meet their self care demand.

19. Long Term Impact on Nursing • Nurse-patient relationship was refocused to include a more intertwined connection. • Nurses were given a sense of direction for the development and management of the nursing practice. • Provided framework for nurses to focus on the individual’s self-care ability and ensuing plan of care, not the disease process. • Dorothea Orem delineated the why, what, and how of nursing especially in the notion of design in the nursing process (Clarke et al, 2009).

20. Evaluation of the nursing model “Orem’s work is widely used in nursing education and practice” (Chitty & Black, 2011, pg 311). The self-care theory framework was formulated as Orem experienced a period of intensive exposure to nurses and their activities from 1949 to 1957(Fawcett, 1995). Orem’s self-care model addresses the four global concepts of human being, environment, health, and nursing but also adds in the nursing process of problem identification and planning (why is the person under care, what is the plan of care, and implementation of care).

21. Evaluation of the nursing model Orem’s self-care theory can be used in all settings because the theory starts with maintenance of sufficient intake of air, water, and food. The theory also focuses on elimination and balancing activity with rest. Because these the necessities of the basic life functions, this theory can be used in any department. The concepts are easily understood in which the nursing process is used to determine the self-care deficit. The self-care theory would be used in dealing with illness, injury, or disease such as cancer, a heart attack, a stroke, or even adjusting to a different job because of a condition.

22. Case Study • 54 year old male is admitted to the floor with the diagnosis of acute myocardial infarction. He lives in a rural community and lives with his wife and two young children. He is a truck driver by trade who drives long hours cross country daily. He admits to drinking lots of caffeine and living mostly on fast food with little consumption of vegetables or fruit in his diet. The patient’s past medical history is only significant for hypertension while his surgical history is positive for total knee arthroplasty and cholecystectomy. His father has a history of cardiovascular disease and dies at the age of 62, while his mother has a history of breast cancer. The patient experienced onset of symptoms at home while shoveling snow after a large storm. Pt states he experienced chest tightness and shortness of breath. He stated he took a break and symptoms stopped. He continued then to finish shoveling and upon return to his home he became increasingly short of breath, diaphoretic, and felt a gripping and twisting in his chest. Upon arrival to the hospital the patient showed ST segment changes and troponin levels were elevated. Pt was immediately taken to the cath lab with successful surgical interventions. The patient is now staying overnight for recovery. The patient tells the nurse he is depressed and worries how he is going to manage his condition while on the road for his job.

23. Questions • According to Orem’s theory nursing intervenes: • When the demands for self care are greater than the individual is able to achieve on their own. • To reduce the stressors interacting with an individual. • To promote adaptation in the patient through modification. • In utilizing the self care theory in this situation, the nurse will provide interventions to improve the well-being of the patient by having the opportunity to teach the patient to help control the impact that cardiovascular disease can have on his life. (T/F) • According to Orem’s theory the patient will actively participate in their own care by demonstrating conscious actions to regulate his health and well-being. (T/F)

24. Questions • In utilizing Orem’s theory of the nursing system, match the nursing system with the action provided by the nurse. ___Supportive-educative _____wholly compensatory ____partly compensatory • Monitor the patient’s ability for independent care and providing assistance until patient is fully able to resume activities of daily living. • Reducing the patient’s pain post operatively through parenteral medications. • The nurse’s assessment identified key areas of his health condition and the adequacy of his current activity/rest patterns. The patient identifies what activity and rest mean to them and current exercise plan. Together they come up with an activity schedule and establish priorities. • The nurse working with the patient regarding meal planning and dietary restrictions while on the road is an example of a nursing intervention utilizing the theory to help patient achieve their self care requisites. (T/F) • The nurse, understand that environmental factors can positively or negatively affect the health of an individual, will focus on the patient’s ability to change environmental factors such as diet, exercise, and activity rather than focusing on the cardiovascular disease process when utilizing Orem’s theory. (T/F)

25. References Alligood, M. R., & Tomey, A. M. (2010). Nursing theorists and their work(7th ed., pp. 266-268). Maryland Heights, MO: Mosby Elsevier. Application of Orem's Self-Care Deficit theory. (2011, October 17).InNursing Theories a companion to nursing theories and models . Retrieved February 16, 2013, from http://currentnursing.com/nursing_theory/application_self_care_deficit_theory.html Banfield, B. E. (2011). Environment:: A perspective of the self-care deficit nursing theory. Nursing Science Quarterly. 24(96). doi: 10.1177/0894318411399457 Biography of Dorothea Orem. (2013). In Nursing Theories. Retrieved February 16, 2013, from http://nursingtheories.info/biography-of-dorothea-orem/ Chitty, K.K., & Black, B.P. (2011). Professional nursing: Concepts and challenges. (6th ed.) Maryland Heights, MO: Saunders Clarke, P.N., Allison, S.E., Berbiglia, V.A., & Taylor, S.G. (2009). The impact of Dorothea E. Orem’s life and work: An interview with Orem scholars. Nursing Science Quarterly. 22(41). doi: 10.1177/0894318408329160 Davidson, S. (2012). Challenging RN-BSN students to apply Orem's theory to practice. Self-Care, Dependent-Care & Nursing, 19(1), 15-19. Dorothea Orem's Self-Care Theory. (2012, February 4). In Nursing Theories. Retrieved February 16, 2013, from http://currentnursing.com/nursing_theory/self_care_deficit_theory.htm Dorothea E Orem. (2013). In nursing theory. Retrieved February 17, 2013, from http://nursing-theory.org/theories-and-models/orem-self-care-deficit-theory.php El-Kader, N. (n.d). Self-Care Deficit Theory. Retrieved February, 24, 2013, from http://ocw.up.edu.ps/repositories/pdf-archive/New%20orem%20theory.pdf Fawcett, J. (1995). Analysis and evaluation of conceptual models of nursing(3rd ed.). Philadelphia, PA: F.A. Davis. Institute of Medicine. (2001). Crossing the quality chasm a new health system for the 21st century. Washington, DC: National Academy Press. Orem, D.E. (2001). Nursing concepts of practice (6th ed.) St. Louis, MO: Mosby.