Dorothea Orem’s Dorothea Orem’s Theory of Self Theory of Self

CareCare

Dorothea OremDorothea OremBorn in Baltimore, Maryland.Born in Baltimore, Maryland.

One of America’s foremost nursing One of America’s foremost nursing theorists.theorists.

Father was a construction workerFather was a construction worker

Mother was a homemaker.Mother was a homemaker.

Youngest of two daughters.Youngest of two daughters.

EducationEducationStudied at Providence Hospital school of Studied at Providence Hospital school of Nursing in Washington D.C. in 1930’sNursing in Washington D.C. in 1930’sGot her B.S.N.E. in 1939 and her M.S.N.E Got her B.S.N.E. in 1939 and her M.S.N.E in 1946 both from the Catholic University in 1946 both from the Catholic University of America Got her M.S.N.E. at Catholic of America Got her M.S.N.E. at Catholic University of America in 1946University of America in 19461958-1960 upgraded practical nursing 1958-1960 upgraded practical nursing training at Department of Health, training at Department of Health, Education and WelfareEducation and WelfareWas editor to several texts including Was editor to several texts including Concepts Formalization in Nursing: Concepts Formalization in Nursing: Process and Production, revised in 1980, Process and Production, revised in 1980, 1985, 1991, 1995, 20011985, 1991, 1995, 2001

Nursing ExperienceNursing ExperienceEarly nursing experience included Early nursing experience included operating room nursing, private duty operating room nursing, private duty nursing (in home and hospital), pediatric nursing (in home and hospital), pediatric and adult medical and surgical units, and adult medical and surgical units, evening supervisor in the emergency evening supervisor in the emergency room, and biological science technician.room, and biological science technician.

1940-1949 Orem held directorship of both 1940-1949 Orem held directorship of both nursing school and the department of nursing school and the department of nursing at Providence Hospital in Detroit.nursing at Providence Hospital in Detroit.

Development of TheoryDevelopment of Theory

1949-1957 Orem worked for the Division of 1949-1957 Orem worked for the Division of Hospital and Institutional Services of the Hospital and Institutional Services of the Indiana State Board of Health. Her goal was Indiana State Board of Health. Her goal was to upgrade the quality of nursing in general to upgrade the quality of nursing in general hospitals throughout the state. During this hospitals throughout the state. During this time she developed her definition of nursing time she developed her definition of nursing practice.practice.

1958-1960 U.S Department of Health, 1958-1960 U.S Department of Health, Education and Welfare where she help publish Education and Welfare where she help publish “Guidelines for Developing Curricula for the “Guidelines for Developing Curricula for the Education of Practical Nurses” in 1959.Education of Practical Nurses” in 1959.

Development of TheoryDevelopment of Theory

1959 Orem subsequently served as acting 1959 Orem subsequently served as acting dean of the school of Nursing and as an dean of the school of Nursing and as an assistant professor of nursing education assistant professor of nursing education at CUA. She continued to develop her at CUA. She continued to develop her concept of nursing and self care during concept of nursing and self care during this time.this time.Orem’s Nursing: Concept of Practice was Orem’s Nursing: Concept of Practice was first published in 1971 and subsequently first published in 1971 and subsequently in 1980,1985, 1991, 1995, and 2001.in 1980,1985, 1991, 1995, and 2001.Continues to develop her theory after her Continues to develop her theory after her retirement in 1984retirement in 1984

AchievementAchievement1976 and 1980 Honorary degree of Doctor 1976 and 1980 Honorary degree of Doctor of Science.of Science.1980 CUA Alumni Association Award for 1980 CUA Alumni Association Award for Nursing Theory.Nursing Theory.1988 Doctor of Humane Letters from 1988 Doctor of Humane Letters from Illinois Wesleyan UniversityIllinois Wesleyan University1988 Linda Richards Award1988 Linda Richards Award1991 National League for Nursing1991 National League for Nursing1992 Honorary Fellow of the American 1992 Honorary Fellow of the American Academy of Nursing.Academy of Nursing.1998 Doctor of Nursing 1998 Doctor of Nursing Honoris CausaeHonoris Causae from the University of Missouri.from the University of Missouri.

Image of NursingImage of Nursing

Orem began her theory development in Orem began her theory development in the 1960’s, and her first publication was the 1960’s, and her first publication was in 1971. During that time the mass media in 1971. During that time the mass media played a small role in portraying nursing played a small role in portraying nursing as a respected profession but as a respected profession but unfortunately played a much larger role in unfortunately played a much larger role in the destruction of that image.the destruction of that image.

Image of NursingImage of NursingIn the early 1960’s Nurses were depicted In the early 1960’s Nurses were depicted as subordinate to Physicians in films and as subordinate to Physicians in films and on television. For example, in TV shows on television. For example, in TV shows such as Dr. Kildare and Ben Casey, nurses such as Dr. Kildare and Ben Casey, nurses were shown delivering messages to the were shown delivering messages to the doctors, carrying trays and doing minimal doctors, carrying trays and doing minimal skill level tasks. Throughout the show, skill level tasks. Throughout the show, the doctors were condescending towards the doctors were condescending towards the nurses, and constantly portrayed as the nurses, and constantly portrayed as superior.superior.In 1962 a revolutionary TV show came In 1962 a revolutionary TV show came about, and for the first time nurses were about, and for the first time nurses were depicted in a positive realistic light. depicted in a positive realistic light.

““The Nurses”1962-1964The Nurses”1962-1964

This TV show was the first of medical This TV show was the first of medical drama’s to focus on the nurse instead of drama’s to focus on the nurse instead of the physician, and showed the nurses in the physician, and showed the nurses in their true profession. They were depicted their true profession. They were depicted as:as: -objective-objective-articulate-articulate-disciplined-disciplined-concerned with professional development -concerned with professional development of herself and colleaguesof herself and colleagues-demonstrated the existence of nursing -demonstrated the existence of nursing standards and organizationstandards and organization

““The Nurses”1962-1964The Nurses”1962-1964

For the first time in TV history, when For the first time in TV history, when problems arose, instead of waiting for the problems arose, instead of waiting for the physician to arrive and give orders, the physician to arrive and give orders, the nurses identified the problem themselves nurses identified the problem themselves and found solutions.and found solutions.

In the short time that it was on the air it In the short time that it was on the air it did a great deal for the propagation of a did a great deal for the propagation of a positive nursing image.positive nursing image.

Image of NursingImage of Nursing

In the mid 1960’s the positive image of In the mid 1960’s the positive image of nursing took a plunge.nursing took a plunge.

In the media, the obsession with nurse’s In the media, the obsession with nurse’s sex lives dominated over all other thematic sex lives dominated over all other thematic elements.elements.

Films, books and television shows depicted Films, books and television shows depicted the nurse as a tall, thin, well endowed the nurse as a tall, thin, well endowed blonde whom every man craved. Nurses blonde whom every man craved. Nurses would often fall in love with their patients, would often fall in love with their patients, and the physicians would woe them. and the physicians would woe them.

Image of NursingImage of NursingThis ushered in an era of sexually suggestive This ushered in an era of sexually suggestive material which included nurses as material which included nurses as promiscuous women, having sex with promiscuous women, having sex with patients, physicians and other male patients, physicians and other male characters without any attachment, such as characters without any attachment, such as in “Carry on Nurse”.in “Carry on Nurse”.Soon the context had completely left the Soon the context had completely left the screen and all that was left was outright screen and all that was left was outright pornography. Including such titles as “Night pornography. Including such titles as “Night Call Nurses”, “I, A Woman” and “Deep Call Nurses”, “I, A Woman” and “Deep Throat”.Throat”.Fortunately, although this portrayal hindered Fortunately, although this portrayal hindered the progress nurses were making, this was the progress nurses were making, this was not the image the majority of society assumed not the image the majority of society assumed when thinking about what nurses do.when thinking about what nurses do.

Images of Images of NursingNursing

Media Portrayal Media Portrayal

Image of NursingImage of Nursing

Realistic PortrayalRealistic Portrayal

Metaparadigm ConceptMetaparadigm ConceptPerson: An individual with physical and Person: An individual with physical and emotional requirements for development of emotional requirements for development of self and maintenance of their well-being.self and maintenance of their well-being.Environment: Client’s surroundings which Environment: Client’s surroundings which may affect their ability to perform their self-may affect their ability to perform their self-care activities.care activities.Health: “Structural and functional Health: “Structural and functional soundness and wholeness of the individual” soundness and wholeness of the individual” (Orem 1991).(Orem 1991).Nursing: The acts of a specially trained and Nursing: The acts of a specially trained and able individual to help a person or multiple able individual to help a person or multiple people deal with their actual or potential people deal with their actual or potential self-care deficits.self-care deficits.

Orem’s Theory of Self Orem’s Theory of Self CareCare

Each person has a need for self care in Each person has a need for self care in order to maintain optimal health and order to maintain optimal health and wellness.wellness.

Each person possesses the ability and Each person possesses the ability and responsibility to care for themselves and responsibility to care for themselves and dependants.dependants.

Theory is seperated into three conceptual Theory is seperated into three conceptual theories which include: self care, self care theories which include: self care, self care deficit and nursing system.deficit and nursing system.

Theory of Self CareTheory of Self Care

Self care is the ability to perform Self care is the ability to perform activities and meet personal needs with activities and meet personal needs with the goal of maintaining health and the goal of maintaining health and wellness of mind, body and spirit.wellness of mind, body and spirit.Self care is a learned behaviour Self care is a learned behaviour influenced by the metaparadigm of influenced by the metaparadigm of person, environment, health and nursing.person, environment, health and nursing.Three components: universal self care Three components: universal self care needs, developmental self care needs, and needs, developmental self care needs, and health deviation.health deviation.

Universal Self CareUniversal Self Care

This includes activities which are This includes activities which are essential to health and vitality. essential to health and vitality.

Eight elements identified these include: Eight elements identified these include: air, water, food, elimination, activity and air, water, food, elimination, activity and rest, solitude and social interactions, rest, solitude and social interactions, prevention of harm, and promotion of prevention of harm, and promotion of normality.normality.

Developmental Self Care Developmental Self Care NeedNeed

These include the interventions and These include the interventions and teachings designed to return a person to teachings designed to return a person to or sustain a level of optimal health and or sustain a level of optimal health and well being.well being.

Examples can include such things as toilet Examples can include such things as toilet training a child or learning healthy eating.training a child or learning healthy eating.

Health Deviation Self Health Deviation Self CareCare

This encompasses the variations in self This encompasses the variations in self care which may occur as a result of care which may occur as a result of disability, illness, or injury.disability, illness, or injury.

In other words the person with a variation In other words the person with a variation is meeting self care and maintaining is meeting self care and maintaining health and wellness in a more health and wellness in a more individualize meaning.individualize meaning.

Theory of Self Care Theory of Self Care DeficitDeficitEvery mature person has the ability to meet Every mature person has the ability to meet

self care needs, but when a person self care needs, but when a person experiences the inability to do so due to experiences the inability to do so due to limitations, thus exists a self care deficit.limitations, thus exists a self care deficit.A person benefits from nursing intervention A person benefits from nursing intervention when a health situation inhibits their ability when a health situation inhibits their ability to perform self care or creates a situation to perform self care or creates a situation where their abilities are not sufficient to where their abilities are not sufficient to maintain own health and wellness.maintain own health and wellness.Nursing action focuses on identification of Nursing action focuses on identification of limitation/deficit and implementing limitation/deficit and implementing appropriate interventions to meet the needs appropriate interventions to meet the needs of person.of person.

Theory of Nursing Theory of Nursing SystemsSystems

The ability of the nurse to aid the person in The ability of the nurse to aid the person in meeting current and potential self care meeting current and potential self care demands.demands.Focused on personFocused on personThree support modalities identified in Three support modalities identified in theory including: total compensatory, theory including: total compensatory, partial compensatory, and partial compensatory, and educative/supportive compensatory.educative/supportive compensatory.The client’s ability for self care involvement The client’s ability for self care involvement will determine under which support will determine under which support modality they would be considered.modality they would be considered.

Support ModalitiesSupport ModalitiesTotal compensatory supportTotal compensatory support encompasses encompasses total nurse care- client unable to do for total nurse care- client unable to do for themselves.themselves.Partial compensatory supportPartial compensatory support involves both involves both the nurse and the client sharing in the self the nurse and the client sharing in the self care requirements.care requirements.Educative/supportive compensatoryEducative/supportive compensatory support support elicits the help of the nurse solely as a elicits the help of the nurse solely as a consultant, teacher or resource person. consultant, teacher or resource person. Client is responsible for their own self care.Client is responsible for their own self care.A person can fluctuate between support A person can fluctuate between support modalities at any given time throughout modalities at any given time throughout life.life.

Nurse’s RoleNurse’s Role

The nurse’s role in helping the client to The nurse’s role in helping the client to achieve or maintain a level of optimal achieve or maintain a level of optimal health and wellness is to act as an health and wellness is to act as an advocate, redirector, support person and advocate, redirector, support person and teacher, and to provide an environment teacher, and to provide an environment conducive to therapeutic development.conducive to therapeutic development.

Application of Theory To Application of Theory To Nursing ProcessNursing Process

Orem’s theory of self-care is applied to Orem’s theory of self-care is applied to many undergraduate nursing curricula.many undergraduate nursing curricula.

The nursing care plan is one example of The nursing care plan is one example of how her theory of self-care can be applied how her theory of self-care can be applied to nursing processto nursing process

Nursing Care PlanNursing Care Plan

The nursing care plan includes; The nursing care plan includes; assessment data pertaining to Gordon’s assessment data pertaining to Gordon’s Functional Assessment, a NANDA nursing Functional Assessment, a NANDA nursing diagnosis, the identification of client diagnosis, the identification of client expected outcomes, the nursing expected outcomes, the nursing interventions and evaluation. interventions and evaluation.

Nursing Theory in Nursing Theory in PracticePractice

The self-care aspect of Orem’s theory The self-care aspect of Orem’s theory applies to the assessment and evaluation applies to the assessment and evaluation of the nursing process. Orem emphasizes of the nursing process. Orem emphasizes the importance of how one’s own self-care the importance of how one’s own self-care is important for maintaining life, health is important for maintaining life, health development and wellbeing. development and wellbeing. The only restriction to this method is that The only restriction to this method is that the nurse can only make assessments the nurse can only make assessments where there is direct contact between the where there is direct contact between the nurse and the client and or the family. nurse and the client and or the family.

Nursing Theory in Nursing Theory in PracticePractice

The area of self-care deficit applies to the The area of self-care deficit applies to the diagnosis area of the nursing care diagnosis area of the nursing care process.process.

Although self-care deficit is an abstract Although self-care deficit is an abstract concept, it does provide a guideline for concept, it does provide a guideline for the selection of methods for helping and the selection of methods for helping and understanding the patient roles in self-understanding the patient roles in self-care. care.

Nursing Theory In Nursing Theory In PracticePractice

The third area of her theory, nursing The third area of her theory, nursing systems, applies to the interventions of the systems, applies to the interventions of the nursing care. nursing care.

In order to help explain this concept, Orem In order to help explain this concept, Orem also created three areas of how care can be also created three areas of how care can be administrated to a client depending on the administrated to a client depending on the physical and mental capabilities of the physical and mental capabilities of the client. client.

Wholly compensatory, partly compensatory Wholly compensatory, partly compensatory and supportive-educative role and supportive-educative role

Case StudyCase StudyThe wholly compensatory system The wholly compensatory system accomplishes the client’s therapeutic self-accomplishes the client’s therapeutic self-care, compensates for the client’s inability to care, compensates for the client’s inability to participate in their self-care, provides participate in their self-care, provides support and protects the client. support and protects the client. Bedridden oncology patient arrives via Bedridden oncology patient arrives via ambulance for chemotherapy. Family insists ambulance for chemotherapy. Family insists upon keeping patient at home; however, upon keeping patient at home; however, leaves patient alone with nurse in chemo leaves patient alone with nurse in chemo clinic for treatment. Patient requires O2 at clinic for treatment. Patient requires O2 at 2L/min, continuous tube feeding at 90cc 2L/min, continuous tube feeding at 90cc hour, foley catheter, bedpan. Nurse in clinic hour, foley catheter, bedpan. Nurse in clinic administers chemo premeds and chemo; administers chemo premeds and chemo; changes dressing around g-tube due to changes dressing around g-tube due to leaking; administers O2 at 2L; empties Foley leaking; administers O2 at 2L; empties Foley at end of treatment; places patient on bed at end of treatment; places patient on bed pan one time. pan one time.

Case StudyCase StudyThe partly compensatory system has a give The partly compensatory system has a give and take system in between the nurse and and take system in between the nurse and the client. The nurse performs, the client. The nurse performs, compensates for limitations, regulates and compensates for limitations, regulates and assists the client as needed. The client assists the client as needed. The client participates in some self-care procedures, participates in some self-care procedures, regulates and accepts care and assistance regulates and accepts care and assistance from the nurse. from the nurse. Preterm labour patient regularly visits clinic Preterm labour patient regularly visits clinic for BP monitoring, etc. Patient on bed rest for BP monitoring, etc. Patient on bed rest (at home), except for weekly visit to module. (at home), except for weekly visit to module. Nurse assists patient out of wheel chair into Nurse assists patient out of wheel chair into bathroom, assists with urine sample bathroom, assists with urine sample collection, and onto exam table. Nurse collection, and onto exam table. Nurse administers injection of terbutaline and administers injection of terbutaline and educates patient regarding oral terbutaline.educates patient regarding oral terbutaline.

Case StudyCase StudyThe supportive-educative role indicates that the The supportive-educative role indicates that the client is participating in most of their self-care, and client is participating in most of their self-care, and the nurse’s role is simply to monitor and regulate the nurse’s role is simply to monitor and regulate the client’s self-care.the client’s self-care.Newly diagnosed diabetic patient received diabetic Newly diagnosed diabetic patient received diabetic care teaching while in hospital. Now, patient visits care teaching while in hospital. Now, patient visits module and reports highly variable BS/chemstrip module and reports highly variable BS/chemstrip readings. Nurse suspects patient may be performing readings. Nurse suspects patient may be performing procedure incorrectly. Nurse assesses that patient procedure incorrectly. Nurse assesses that patient has been cutting some of his chemstrips in half to has been cutting some of his chemstrips in half to save money. Nurse instructs patient that cutting save money. Nurse instructs patient that cutting strips exposes chemicals and inaccurate readings strips exposes chemicals and inaccurate readings may result. Additionally, nurse assesses that may result. Additionally, nurse assesses that patient's wife (who does family cooking) did not patient's wife (who does family cooking) did not receive any nutritional education while patient was receive any nutritional education while patient was hospitalized. Nurse begins nutritional counseling hospitalized. Nurse begins nutritional counseling and provides wife with referral to nutritional and provides wife with referral to nutritional services department. services department.

Personal Philosophy of Personal Philosophy of NursingNursing

Nursing is the art of caring, nurturing and Nursing is the art of caring, nurturing and healing. Nursing goes beyond simply healing. Nursing goes beyond simply caring for illness, disease or ailment it is caring for illness, disease or ailment it is caring for the person. Part of the person caring for the person. Part of the person is caring enough to aid them return to a is caring enough to aid them return to a state of optimal health and wellness in state of optimal health and wellness in mind, body and spirit. These are believe mind, body and spirit. These are believe to be the basic aspects essential to a to be the basic aspects essential to a fundament nursing philosophy. fundament nursing philosophy.

Personal Nursing Personal Nursing PhilosophyPhilosophy

Nursing is being able to intervene when Nursing is being able to intervene when the person is unable to care for the person is unable to care for themselves and teach them methods to themselves and teach them methods to help them move beyond their inability. help them move beyond their inability. This can include offering information, This can include offering information, teaching and tools necessary for their well teaching and tools necessary for their well being.being.

Orem’s PhilosophyOrem’s Philosophy

It is believed that Orem’s theory portrays It is believed that Orem’s theory portrays the idea that nursing is the ability to care the idea that nursing is the ability to care for another, especially when they are for another, especially when they are unable to care for themselves. This unable to care for themselves. This corresponds to our philosophy of caring corresponds to our philosophy of caring for person with the goal of achieving for person with the goal of achieving optimal level of health and wellness.optimal level of health and wellness.

GameGame

While watching the video clip, think of a While watching the video clip, think of a self-care nursing diagnosis related to this self-care nursing diagnosis related to this situation.situation.

Come up with self-care deficit as a classCome up with self-care deficit as a class

Divide the class into two groupsDivide the class into two groups

Each group is asked to come up with as Each group is asked to come up with as many nursing interventions as they can many nursing interventions as they can related to this person and the self-care related to this person and the self-care deficit.deficit.

GameGame

Flip a coin to find out which team gets Flip a coin to find out which team gets to answer first. Then it will go back to answer first. Then it will go back and forth.and forth.

For every intervention that is For every intervention that is appropriate, the team will receive a appropriate, the team will receive a game piece.game piece.

The object of the game is to connect The object of the game is to connect four.four.

Prizes at the end!! Good luckPrizes at the end!! Good luck

ReferencesReferencesHartweg, D.L. (1995). Dorthea Orem: Self-care Hartweg, D.L. (1995). Dorthea Orem: Self-care deficit theory. In C.M. deficit theory. In C.M.

Kalisch, P. A. & Kalisch, B.J. (1987). The Kalisch, P. A. & Kalisch, B.J. (1987). The Changing Image of the Nurse. Menlo Park, Changing Image of the Nurse. Menlo Park, CA: Addison-Wesley Publishing Company.CA: Addison-Wesley Publishing Company.

Mayo, A. (1997). Mayo, A. (1997). Professional nursing web site. Professional nursing web site. Retrieved October 31, 2006 from Retrieved October 31, 2006 from http://members.aol.com/annmrn/nursing_portfoliohttp://members.aol.com/annmrn/nursing_portfolio_I_index.html_I_index.html

McQuiston & A.A. Webb (Eds.), McQuiston & A.A. Webb (Eds.), Foundations of Foundations of nursing theory: Contributions of 12 key theoristsnursing theory: Contributions of 12 key theorists (pp. 139-202). USA: Sage Publications Inc.(pp. 139-202). USA: Sage Publications Inc.

ReferencesReferencesOrem, D.E. (1991). Nursing: Concepts of practice Orem, D.E. (1991). Nursing: Concepts of practice (4(4thth ed.). St. Louis, MO: Mosby-Year Book Inc. ed.). St. Louis, MO: Mosby-Year Book Inc.Taylor, S.G. (2006). Dorthea E. Orem: Self-care Taylor, S.G. (2006). Dorthea E. Orem: Self-care deficit theory of nursing. In A.M. deficit theory of nursing. In A.M. Tomey, A. & Alligood, M. (2002). Significance of Tomey, A. & Alligood, M. (2002). Significance of theory for nursing as a discipline and profession. theory for nursing as a discipline and profession. Nursing Theorists and their work. Nursing Theorists and their work. Mosby, St. Mosby, St. Louis, Missouri, United States of America. Louis, Missouri, United States of America. Whelan, E. G. (1984). Whelan, E. G. (1984). Analysis and application Analysis and application of dorothea orem’s self-care practuce model. of dorothea orem’s self-care practuce model. Retrieved October 31, 2006 from Retrieved October 31, 2006 from http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=Pubmed&list_uids=6094754cmd=Retrieve&db=Pubmed&list_uids=6094754&dopt=Abstract&dopt=Abstract