Sunday, July 11, 2010

Orem's Self Care Deficit Theory

Legends: R- relationship
< - deficit relationship, current/projected








-Each person has a need for self care in order to maintain optimal health/wellness -Each person possesses ability and responsibility to care for themselves and dependents -The theory is separated into three conceptual theories which include: a. self care/self care system- "human regulatory function" based on the patients capabilities to perform own care. Refers to the action of patients/client directed to self or environmental to regulate factors /conditions in the interest of the individual's life , health and well being. b. self care deficit c. nursing system -The purpose of developing the selfcare framework was two-fold: a. she was trying to find meaning of nursing and to develop a body of nursing knowledge based on research. Self care and Self care System - self care refers to actions of individuals to self or environment to regulate factors or conditions in the interest of the individual's life, health and well being. Dependent-care system -term applied to a coordinated system of action performed over time to meet self-care requirements of a dependent person.
Self care is the ability to perform activities and meet personal needs with the goal of maintaining health ans wellness of the mind, body and spirit. Self care is a learned behaviour of a person, environment, health and nursing.
Three components : Universal self care needs-includes activitied which are esential to health Developmental self care needs Health deviations Eight Elements Identified: air, water, food, elimination, activity/rest, solitude, promotion of normality, prevention harm

Theories of Self Care Deficit (Dependent Care Deficit)
1. Persons who take action to provide their own self-care or care for the dependents have specialized capabilities
for action
2. Th ability of the individual to care for self and dependents are conditioned by age, developmental state, life
experience, sociocultural orientation, health and available resources.
3. The relationship of the individual's ability for self care to the qualitative and quantitative selfcare demand can be
determined when the value of each is known
4. NURSING- is a legitimate service
a. care abilities are less than those required for meeting a known self-care demand
b. self care or dependent-care abilities exceed or are equal to those required meeting the current self care
demand

Theory of Self care (dependent care)
1. Self care a human regulatory function deliberately executed with degree of completeness and effectiveness
2. Self care involves the use of material resources and energy to supply materials for internal functions, maintain essential and safe relationships with the environmental factors and forces.
3. Self care is performe over time

Theory of Nursing System
1. Nurses relate to and interact with persons who occupy the status of nurses' patient.
2. Legitimate patients have existent and projected continuous selfcare requisites.
3. Legitimate patients have existent and projected deficits for meeting their own self care requisites.
4. Nurses determine the value of patient's continuous selfcare requisites.
5. NUrses determine the current and changing values of patient's abilities to meet their selfcare requisites using
specific processes or technologies.
6. NUrsed must be aware of patients potential to engaging in therapeutic purposes, and develop abilities to
engage in care
7. Nurses and patient act together to allocate the roles of each other in regulation of pxt self care capabilities.



Four Concepts -Nursing's Metaparadigm

1. Human Being (Humanity) - an integrated whole composed of an internal physical, psychological and social nature
with varying degrees of self care ability (chin/kramer, 2004).
-a substantial or real unity whose parts are formed and attain perfection through the differentiation of the
whole during the process of development. Has the capability to reflect, symbolize, and use symbols.
-when referring to humans, Orem uses the term individual, patient, multiperson, self care agent, dependent
care agent.
2. Health - health and healthy are terms to describe living things according to Orem, they are structurally and funcitonally whole or sound, includes that which make a person human, she define health as "a state of physical, mental and social sell-being, and not merely the absence of disease or infirmity (p 184, foster/bennett 2001).Orem sees health as a state of well being, which refer to a person's condition of existence, characterized by contentment, pleasure, happiness, movement towars self ideals. The present sociopolitical climate influenced Orem to exand her definition of health to include the concept of preventive health care. She uses the terms health, health state, and well being.
3. Nursing - according to Orem its an art through which the practitioner of nursing gives specialized assisstance to persons with disabilities that needed greater than ordinary assistance to meed the daily needs for self care. It consists of actions deliberately selected and performed by nurses to help patients under their care to maintain or change conditions in themselves or their environment. Terms used: nursing, nursing agency.
4. Environment- the sorrounding of the patients may affect their ability to perform their selfcare activity. Includes two dimensions a. physical, chemical, biologic features and socioeconomic features.
a. Physical,chemical and biologic features: atmosphere, pollutants, weather, pets, infectious organisms
b. Socioeconomic features: family, community, gender, gender roles, cultural roles, cultural prescription
of authority.
Terms used- environment, environment features

Biography

-born in Baltimore, Maryland
-one of America's foremost nursing theorist
-she is the youngest of two daughters born to a construction worker and a housewife
-a graduate of Providence Hospital School of Nursing at Washington DC in 1930's
-Got her BSNE in 1939, MSNE in 1946 at Catholic University of America
-in 1958-1960- upgraded practical nursing training at Department of Health, Education and Welfare
-she was editor to several textbks including Concepts of formalization in nursing.

Early Nursing Experience:
-operating room, private duty nurse (home /hospital), pediatric and adult medical and surgical units,
evening supervisor in the emergency room
-1940-49 - Orem held directorship of both nursing school and the department of nursing at Providence
Hospital in Detroit.





Development of Theory

-1949-1957- Orem worked in Indiana University
- Her goal: is to upgrade the quality of nursing in general hospitals throughout the state, she noted
that nurses had difficulty articulating needs to hospital administrators in the face of demands
made upon them regarding such issues as lenght of stay, scheduling admissions and
discharges.
-1958-1960- she worked with US Department of Health, Education and Welfare where she helped publish
"Guidelines of Developing Curricula for the Education of Practical Nurses" (1959)
-1959 - she served as acting Dean of School of Nursing, she became assistant professor at the Catholic University
of America, where she continued to develop her concept of nursing and selfcare.
-1960- Role of a nurse -identified as subordinate of the physicians , and negative image to the public through
media. (eg movies, tv)
-1962- The role of nurses became positive and realistic.
-1971- "Nursing: Concept of Practice" - a time for change within the nursing profession, being a time for
planning, researching, expanding nursing roles. Nurisng was beginning to recognized as a
legitimate science.