Dorothea OremDorothea Orem

SelfSelf--Care Deficit theory Care Deficit theory

nn Overview about OremOverview about Orems theory:s theory:--nn Orem's CVOrem's CVnn Origins Origins PurposePurposenn Philosophy and world view Philosophy and world view nn Metaparadigm Metaparadigm Concepts Concepts nn Assumptions and Propositions Assumptions and Propositions nn Theories included in the Theories included in the SelfSelf--Care Deficit theory Care Deficit theory nn OremOrems Theory and Nursing processs Theory and Nursing process

Time oriented Time oriented

Peplau:Peplau:

Published at 1952.

Published at 1952.Orem:Orem:

Published at 1959.

Published at 1959.Roy:Roy:

Published at 1960.

Published at 1960.RogerRogers:s:

Published at 1970.

Published at 1970.King:King:

Published at 1971

Published at 1971Newman:Newman:

Published at 1989

Published at 1989

Dorothea OremDorothea OremC.V.C.V.

nn

1939

1939 BSN completedBSN completednn

1945

1945 -- MS in nursing educationMS in nursing educationnn

1958

1958 -- consultant to the Office of Education consultant to the Office of Education where she began working on her SELFwhere she began working on her SELF--CARE CARE THEORYTHEORY

nn

1959

1959 -- first published her theory in first published her theory in Guides Guides for Developing Curricula for the Education for Developing Curricula for the Education of Practical Nursesof Practical Nurses (a government (a government publication)publication)

Dorothea OremDorothea OremC.V.C.V.

nn

1976

1976 -- honorary Doctorate of Science from honorary Doctorate of Science from Georgetown UniversityGeorgetown University

nn

1980

1980: Award for nursing theory from : Award for nursing theory from catholic university of America.catholic university of America.

nn

1999

1999 -- last edition of her theory was last edition of her theory was publishedpublished

PublicationsPublications

nn

1959: Guidelines For Developing Curricula

1959: Guidelines For Developing Curricula For The Education Of Practical NurseFor The Education Of Practical Nurse

nn

1962: The Hope Of Nursing

1962: The Hope Of Nursingnn

1971: Nursing: Concept And Practices 6

1971: Nursing: Concept And Practices 6thth

edition in (1999).

edition in (1999).nn

1972: Concept Formalization In Nursing:

1972: Concept Formalization In Nursing: Process And Product.Process And Product.

nn

1979: Levels of nursing education and

1979: Levels of nursing education and practicepractice

OriginOriginnn While Orem was working in the Department of While Orem was working in the Department of

Health Education and Welfare (HEW)Health Education and Welfare (HEW) as a as a curriculum consultant she worked to upgrade curriculum consultant she worked to upgrade practical nursing training.practical nursing training.

nn That stimulated the need to address the That stimulated the need to address the questionquestion

What is the subject matter of

nursing?(Curriculum)

Origin Origin contcontd.d.

nn OremOrems book of s book of guidelines for developing guidelines for developing curricula for the education of practical nursingcurricula for the education of practical nursing

was the seed for her work (Orem,1959 in

was the seed for her work (Orem,1959 in

Fawcett 1995) and (

Fawcett 1995) and (MeleisMeleis

, 1998).

, 1998).

nn To conceptualize a curriculum for a diploma To conceptualize a curriculum for a diploma program by isolating and specifying nursing program by isolating and specifying nursing action.action.

Origin Origin contcontd.d.

nn Ideas that helped to shape the selfIdeas that helped to shape the self--care care framework were formulated as Orem framework were formulated as Orem experienced a period of intensive exposure to experienced a period of intensive exposure to

nurses and their endeavors from 1949 to 1957

nurses and their endeavors from 1949 to 1957

(Fawcett, 1995).

(Fawcett, 1995).

Philosophical viewPhilosophical view

nn Orem has identified her philosophical view Orem has identified her philosophical view based on the action theory, from the based on the action theory, from the perspective of the person as a deliberate actor perspective of the person as a deliberate actor or agent.or agent.

Philosophical view Philosophical view contcontd.d.

nn Orem model is based upon the philosophy that Orem model is based upon the philosophy that all all patients wish to care for themselves and patients wish to care for themselves and its purpose was to define the following:its purpose was to define the following:

nn Nursing concern is on the manNursing concern is on the mans needs for selfs needs for self--care care action and the provision and management of it on a action and the provision and management of it on a continues basis in order to sustain life and health, recover continues basis in order to sustain life and health, recover from disease or injury and cope with their effect.from disease or injury and cope with their effect.

nn Nursing goal is overcoming human limitations ( Nursing goal is overcoming human limitations ( BerbelgiaBerbelgia, ,

2002).

2002).

World ViewWorld View

nn World view referred to the physiologic World view referred to the physiologic assumptions about the nature of person assumptions about the nature of person environment relationship.environment relationship.

nn Orem: adopted the organicism rather than Orem: adopted the organicism rather than mechaniscismmechaniscism as world view, she proclaimed as world view, she proclaimed that man include internal physical, that man include internal physical, psychological and social nature with the change psychological and social nature with the change rather than stability.rather than stability.

World View World View contcontd.d.

nn She stated that man and environment interact She stated that man and environment interact as a selfas a self--care system.care system.

nn A change in either the system of man and the A change in either the system of man and the system of the environment will affect the selfsystem of the environment will affect the self--care system.care system.

nn Orem states: Man functioning is linked to his Orem states: Man functioning is linked to his environment and together man and environment and together man and environment form an integrated whole system.environment form an integrated whole system.

nn Keywords that support this view: Keywords that support this view: change, change, whole, interaction, man and environmentwhole, interaction, man and environment..

Conceptual ModelsConceptual Models

nn Nursing models are categorized according to Nursing models are categorized according to the discipline or anthropology from which the discipline or anthropology from which they were derived.they were derived.

nn It is clear in OremIt is clear in Orems theory that she used s theory that she used

developmental model (Montgomery,2004).

developmental model (Montgomery,2004). Also, Also, MeleisMeleis

(1998) viewed that Orem

(1998) viewed that Orems theory s theory could be categorized as an interaction model.could be categorized as an interaction model.

Theory Development StrategyTheory Development Strategy

nn The theory development strategy used by The theory development strategy used by Orem was induction from practice.Orem was induction from practice.

nn Induction from practice is clearly evident in Induction from practice is clearly evident in OremOrems detailed accounts of how concepts in s detailed accounts of how concepts in the theory were determined and defined based the theory were determined and defined based on on experience in concrete nursing practice experience in concrete nursing practice situations or results of analysis of nursing care situations or results of analysis of nursing care materials materials

(Orem,1991)

(Orem,1991)

Theory Development Strategy Theory Development Strategy contcontd.d.

nn Orem did however read widely and identified some of Orem did however read widely and identified some of major influences on her thinking, suggests that there major influences on her thinking, suggests that there was an element of deduction in her work was an element of deduction in her work

(Montgomery,2004).

(Montgomery,2004).

nn Sources of influences include ideas about deliberate Sources of influences include ideas about deliberate human actions and motivation.human actions and motivation.

Factors influencing development:Factors influencing development:

nn Practical nursing curriculum developmentPractical nursing curriculum developmentnn WomenWomens movements movementnn Nursing theory conferencesNursing theory conferences

Theory Development StrategyTheory Development Strategy contcontd.d.

Basic Elements in the ModelBasic Elements in the Model

nn The structure and components of the selfThe structure and components of the self--care care framework have undergone various interpretations framework have undergone various interpretations overtime.overtime.

nn

Orem (1991) explained

Orem (1991) explained all of the conceptual elements all of the conceptual elements of the selfof the self--care framework were formalized and care framework were formalized and

validated as static concepts by 1970.

validated as static concepts by 1970.

nn Since then, some refinements of expression and Since then, some refinements of expression and further development of substantive structure and further development of substantive structure and continued validation have occurred and changes have continued validation have occurred and changes have

been made (Fawcett,1995).

been made (Fawcett,1995).

Three theories in the model

Self-care Deficit Theory

Theory of Self-care

Theory of Nursing System

Structurally, each theory is presented as a set of assumptions, and a set of propositions.

Main Concepts in the Model

Self-care

Self-care agency

Self-care demand

Self-care deficit

Nursing Agency

Nursing System

Orem viewed nursing as :A community service, an art anda technology.Community ( is a group of individuals and families who share not only a common geographic area but common Interest.

As a health service: in the community : It is an interpersonal process that requires the social encounter of a nurse with a patient (transaction process) based on the values of that community.

Art: As an art, it is the ability to assist others in the design, provision and management of systems of self-care to improve or to maintain human functioning at some level of effectiveness

Model Metaparadigm- Nursing

Model MetaparadigmMetaparadigm-- NursingNursingTechnology: techniques of practice

1- Communicating with persons in states of health and disease.

2- Maintaining interpersonal, intragroup, and intergroupsrelationships for cooperative efforts.

3-Giving human assistance adapted to specific human needs & limitations.

4- Maintaining and controlling the positions and movements of persons in physical environment for therapeutic purposes.

5- Promoting process of human growth and development including self or ego development.

6-Sustaining and maintaining life process.

7- Appraising, changing and controlling psycho-physical modes of human functioning in health and disease.

8- Maintaining therapeutic relations based on psychosocial modes of human functioning in health & disease.

Model MetaparadigmModel MetaparadigmNursingNursing

nn It is the ability to assist It is the ability to assist othersothers in design, in design, provision and provision and management of selfmanagement of self--care to improve or care to improve or maintain human maintain human function at some level of function at some level of effectiveness.effectiveness.

Nursing

Methods of Nursing HelpMethods of Nursing Helpnn Acting or doing for Acting or doing for nn Guiding & directing another Guiding & directing another nn Teaching another Teaching another nn Providing psychological and physical Providing psychological and physical

support.support.nn Providing a supportive environment to Providing a supportive environment to

promote the patientpromote the patients ability to meet s ability to meet current or future demands.current or future demands.

Model MetaparadigmModel MetaparadigmHealthHealth

As a state of being

Sound whole

Strength Vigor Absence of diseaseNothing is

MissingOr

Diminished

Model MetaparadigmModel MetaparadigmHealthHealth

nn Not only a bodily state but Not only a bodily state but also to how one functions in also to how one functions in everyday living andeveryday living and

nn progressive development progressive development that is movement toward that is movement toward higher and higher level of higher and higher level of integration and functioning.integration and functioning.

Health

ModelModel MetaparadigmMetaparadigm--ENVIRONMENTENVIRONMENT

nn Person and environment are a Person and environment are a functional unit in which exchange are functional unit in which exchange are reciprocal and influence is mutual.reciprocal and influence is mutual.

nn Persons are viewed as existing in their Persons are viewed as existing in their environments and never isolated from environments and never isolated from them.them.

nn

4 environmental features (physical,

4 environmental features (physical, chemical, biologic and socialchemical, biologic and social) ) have an have an impact on the health and wellimpact on the health and well-- benign benign the person and the family.the person and the family.

Model Metaparadigm Model Metaparadigm -- PERSONPERSON

nn The recipient of nursing careThe recipient of nursing carenn A being who functions biologically, A being who functions biologically,

symbolically, and socially symbolically, and socially nn Has the potential for learning & Has the potential for learning &

developmentdevelopmentnn Is subject to the forces of natureIs subject to the forces of naturenn Has a capacity for selfHas a capacity for self--knowledge knowledge nn Can engage in deliberate actions, Can engage in deliberate actions,

interpret experiences, and perform interpret experiences, and perform beneficial actionsbeneficial actions

nn Can learn to meet selfCan learn to meet self--care needs care needs (requisites)(requisites)

Person

Model Metaparadigm Model Metaparadigm -- PERSONPERSON

Human beings areHuman beings are distinguished from other distinguished from other living beings by their capacity to:living beings by their capacity to:

nn Reflect upon themselves and their Reflect upon themselves and their environmentenvironment

nn Use symbolic creations (ideas, words) Use symbolic creations (ideas, words) in thinking, communicating, and in thinking, communicating, and guiding efforts to make things that are guiding efforts to make things that are beneficial for themselves and/or for beneficial for themselves and/or for othersothers

nn Man and environment form an Man and environment form an integrated system . A change in either integrated system . A change in either component may affect the selfcomponent may affect the self--care care system.system.

Person

OremOrems Selfs Self--care Theorycare Theory

Based on the concepts of:Based on the concepts of:nn SELFSELF--CARECAREnn SELFSELF--CARE AGENCYCARE AGENCYnn SELFSELF--CARE REQUISITESCARE REQUISITESnn THERAPEUTIC SELFTHERAPEUTIC SELF--CARE DEMANDCARE DEMAND

SelfSelf--care Definitioncare Definition

nn SelfSelf--care care The The practicepractice of activities that mature of activities that mature

person initiates and performs independently person initiates and performs independently within time frame, to promote and maintain within time frame, to promote and maintain personal wellpersonal well--being, healthful functioning being, healthful functioning and continuing development throughout and continuing development throughout lifelife..

OremOrems Selfs Self--care Agencycare Agencynn DefinitionDefinition:: the individualthe individuals s abilityability to perform to perform

selfself--care activities (care activities (capabilitiescapabilities of the person)of the person)nn It is a complex acquired It is a complex acquired abilitiesabilities to meet oneto meet ones s

continuous requirement for care.continuous requirement for care.

nn Consists of TWO agents:Consists of TWO agents:nn SelfSelf--care Agentcare Agent -- person who provides the selfperson who provides the self--

care and has the power to do socare and has the power to do sonn Dependent Care AgentDependent Care Agent -- person other than the person other than the

individual who provides the care (such as a parent) individual who provides the care (such as a parent)

OremOrems Selfs Self--care Requisites care Requisites (also (also called Selfcalled Self--care Needs)care Needs)

nn Definition:Definition: the expressions of action to be the expressions of action to be performed by or for individuals for controlling performed by or for individuals for controlling human and environmental factors that affect human and environmental factors that affect human functioning and development human functioning and development

nn Three types of selfThree types of self--care requisites constitute the care requisites constitute the therapeutic selftherapeutic self-- care demand:care demand:nn UniversalUniversal -- requisites/needs that are common requisites/needs that are common

to all individuals.to all individuals.

1

1-- Air, water and foodAir, water and food

2

2-- elimination and excrementselimination and excrements

OremOrems Selfs Self--care Requisites care Requisites contcontd.d.

3

3-- activity/restactivity/rest

4

4-- solitude (aloneness) /social interactionsolitude (aloneness) /social interaction

5

5--prevention of hazards to life and wellprevention of hazards to life and well--being being (physical , social & psychological hazards).(physical , social & psychological hazards).

6

6--promotion of function and development promotion of function and development within social group based on group norms.within social group based on group norms.

OremOrems Selfs Self--care Requisites care Requisites (also called Self(also called Self--care Needs)care Needs)

DevelopmentalDevelopmental Actions that need to be Actions that need to be performed in relation to human developmental performed in relation to human developmental processes , conditions and events and relation to processes , conditions and events and relation to events that adversely affect development.events that adversely affect development.

Health DeviationHealth Deviation exists for persons who are ill or exists for persons who are ill or injured have specific forms of pathologic conditions injured have specific forms of pathologic conditions (including defects and disabilities & who are under (including defects and disabilities & who are under medical diagnosis and treatment..medical diagnosis and treatment..nnNeeds resulting from illness, injury & disease or Needs resulting from illness, injury & disease or

its treatment its treatment

SelfSelf--Care DeficitCare Deficit

nn The relationship between selfThe relationship between self--care agency (ability to care agency (ability to perform selfperform self--care) and the therapeutic selfcare) and the therapeutic self--care care demand in which self care agency is not sufficient to demand in which self care agency is not sufficient to meet onemeet ones therapeutic selfs therapeutic self--care demands.care demands.

nn DependentDependent-- care deficit exists when the personcare deficit exists when the persons s ability to perform dependentability to perform dependent--care (i.e., dependentcare (i.e., dependent--care agency) is not sufficient to meet the socially care agency) is not sufficient to meet the socially dependent persondependent persons therapeutic self care demand).s therapeutic self care demand).

nn Deficit can be complete or partially and as such Deficit can be complete or partially and as such indicate whether wholly or compensatory system. indicate whether wholly or compensatory system.

Therapeutic SelfTherapeutic Self--care Demandscare Demands

nn The sum of selfThe sum of self--care measures/ actions, care measures/ actions, required to meet the specific selfrequired to meet the specific self--care care requisites of a person at a point in time.requisites of a person at a point in time.

Assumptions & Propositions

Assumptions (explicit) Assumptions (explicit)

For the sakeOf others

Performed By

nurses

Helping service

purposeful

deliberate

Nursing

nn Nursing is a deliberate , purposeful helping Nursing is a deliberate , purposeful helping service performed by nurses for the sake of service performed by nurses for the sake of others over a period of time.others over a period of time.

Assumptions (explicit) Assumptions (explicit)

Dependentmember

For self

PerformSelf-care

Capable & willing

Person

For self

nn Persons are capable and willing to perform selfPersons are capable and willing to perform self--care for self or for dependent members of the care for self or for dependent members of the family.family.

Well being Human development

Health

Self care necessity

nn Self care is part of life that is necessary for Self care is part of life that is necessary for health human development & wellhealth human development & well--being.being.

Assumptions (explicit) Assumptions (explicit)

Culture

Education

Individual

Assumptions (explicit) Assumptions (explicit)

nn Education and culture influence individuals.Education and culture influence individuals.

Assumptions (explicit)Assumptions (explicit)

communication

Humaninteraction

Self-care is learned through

nn SelfSelf--care is learned through human interaction and care is learned through human interaction and communication.communication.

Assumptions (explicit)Assumptions (explicit)

Needs for care

PerformedTo meet

Systematicactions

deliberate

Self-care

nn SelfSelf--care includes deliberate and systematic actions care includes deliberate and systematic actions performed to meet needs for care.performed to meet needs for care.

AssumptionsAssumptions (implicit)(implicit)

Dependent others in the family

Own careneeds

Responsible for

Self-reliant

People Should be

nn People should be selfPeople should be self-- reliant and responsible for reliant and responsible for their own care needs as well as others in the family their own care needs as well as others in the family who are not able to care for themselves. who are not able to care for themselves.

Assumptions (implicit)Assumptions (implicit)

Environment Distinct fromothers

Entities

people

nn People are individuals with entities that are distinct People are individuals with entities that are distinct from others and from their environments. from others and from their environments.

Person and nursing client:Person and nursing client:nn Human beings have capabilities to provide their own selfHuman beings have capabilities to provide their own self--care care

or care for dependents to meet universal, developmental and or care for dependents to meet universal, developmental and heath deviation selfheath deviation self--care requisites.care requisites.

nn Self care abilities are influenced by age, developmental state Self care abilities are influenced by age, developmental state experiences and experiences and socioculturalsociocultural background. background.

nn SelfSelf--care deficits are to balance between selfcare deficits are to balance between self--care demands care demands and selfand self--care capabilities and an indication of a state of social care capabilities and an indication of a state of social dependency..dependency..

Propositions

Nursing TherapeuticNursing Therapeuticnn Therapeutic selfTherapeutic self--care includes actions of nurses, care includes actions of nurses,

patients, and others that regulate self care capabilities patients, and others that regulate self care capabilities and meet selfand meet self--care needs.care needs.

nn Nurses assess the abilities of patients to meet their Nurses assess the abilities of patients to meet their selfself--care needs.care needs.

nn Nurses engage in selecting valid and reliable Nurses engage in selecting valid and reliable processes , or technologies or action for meeting selfprocesses , or technologies or action for meeting self--care demands. care demands.

nn Components of therapeutic selfComponents of therapeutic self--care are wholly care are wholly compensatory, partly compensatory and supportive compensatory, partly compensatory and supportive educative. educative.

Propositions Cont

OremOrems General Theory of s General Theory of NursingNursing

nn Consists of three related theories Consists of three related theories collectively referred to as collectively referred to as OremOrems General s General Theory of NursingTheory of Nursing::

1.

1. SelfSelf--care Theorycare Theory

2.

2. SelfSelf--care Deficit Theorycare Deficit Theory

3.

3. Nursing Systems TheoryNursing Systems Theory

OremOrems Selfs Self--care Theorycare Theory

Based on the concepts of:Based on the concepts of:

nn SELFSELF--CARECAREnn SELFSELF--CARE AGENCYCARE AGENCYnn SELFSELF--CARE REQUISITESCARE REQUISITESnn THERAPEUTIC SELFTHERAPEUTIC SELF--CARE DEMANDCARE DEMAND

SelfSelf--care Definitioncare Definition

SelfSelf--care comprises those activities care comprises those activities performed independently by an performed independently by an individual to promote and maintain individual to promote and maintain personal wellpersonal well--being throughout life.being throughout life.

OremOrems Selfs Self--care Deficit care Deficit TheoryTheory

nn Is the central focus of OremIs the central focus of Orems Grand Theory of s Grand Theory of NursingNursing

nn Explains when nursing is neededExplains when nursing is needednn Describes and explains how people can be helped Describes and explains how people can be helped

through nursingthrough nursingnn Results when the SelfResults when the Self--care Agency (patient) cancare Agency (patient) cant t

meet her/his selfmeet her/his self--care needs or administer selfcare needs or administer self--carecarenn Nursing meets these selfNursing meets these self--care needs through five care needs through five

methods of helpmethods of help

OremOrems Nursing Systems s Nursing Systems Theory Describes...Theory Describes...

nn Nursing responsibilities Nursing responsibilities nn Roles of the nurse and patientRoles of the nurse and patientnn Rationales for the nurseRationales for the nurse--patient relationshippatient relationshipnn Types of actions needed to meet the patientTypes of actions needed to meet the patients s

demandsdemands

OremOrems Nursing Systems s Nursing Systems TheoryTheory

nn Refers to a series of actions a nurse takes to Refers to a series of actions a nurse takes to meet a patientmeet a patients selfs self--care needscare needs

nn Is determined by the patientIs determined by the patients selfs self--care needscare needsnn Is composed of Is composed of THREE systemsTHREE systems::nn Wholly compensatoryWholly compensatorynn Partly compensatoryPartly compensatorynn SupportiveSupportive--educativeeducative

Three Nursing SystemsThree Nursing Systemsnn Wholly CompensatoryWholly Compensatory:: a patienta patients selfs self--care care

agency is so limited that s/he depends on agency is so limited that s/he depends on others for wellothers for well--being being

nn Partly CompensatoryPartly Compensatory:: a pt can meet some a pt can meet some selfself--care requisites but needs a nurse to help care requisites but needs a nurse to help for others.for others.

nn SupportiveSupportive--educativeeducative:: a pt can meet selfa pt can meet self--care requisites but needs help in decisioncare requisites but needs help in decision--making, behavior control, or knowledge making, behavior control, or knowledge acquisitionacquisition

Orem's theory, Nursing process Orem's theory, Nursing process &Critical thinking operations&Critical thinking operations

Critical Thinking OperationsIt includes four cognitive operations

Diagnostic OperationDiagnostic OperationIdentify selfIdentify self--care practice,care practice,

its limitation its limitation Perspective Perspective

OperationsOperationsSelect the appropriate therapeutic Select the appropriate therapeutic methodmethod and explaining it to clientand explaining it to client

Regulatory operationsRegulatory operationsDesign plan and implement it.Design plan and implement it.

Control operationsControl operationsEvaluation of the effectivenessEvaluation of the effectiveness

of regulatory operationsof regulatory operations

Nursing processAssessment Diagnosis Planning

ImplementationEvaluation

Intellectual PhaseIntellectual Phase

Step IStep I: : the initial and the initial and determination of needsdetermination of needsStep II:Step II: the designing the designing of system (Planning).of system (Planning).

Practical phasePractical phase::Step IIIStep III: : Initiation,Initiation,

conductionconduction& controlling& controlling

of assisting actionsof assisting actions. .

Dorothea OremSlide61 Time oriented Peplau: Published at 1952.Orem: Published at 1959.Roy: Published at 1960.Rogers: Published at 1970.King: Published at 1971Newman: Published at 1989Dorothea OremC.V.Dorothea OremC.V.PublicationsOriginOrigin contd.Origin contd.Philosophical viewPhilosophical view contd.World ViewWorld View contd.Conceptual ModelsTheory Development StrategyTheory Development Strategy contd.Theory Development Strategy contd.Basic Elements in the ModelSlide93Slide94Slide44Slide45Model MetaparadigmNursingMethods of Nursing HelpModel MetaparadigmHealthModel MetaparadigmHealthModel Metaparadigm- ENVIRONMENTModel Metaparadigm - PERSONModel Metaparadigm - PERSONOrems Self-care TheorySelf-care DefinitionOrems Self-care Agency Orems Self-care Requisites (also called Self-care Needs)Orems Self-care Requisites contd.Orems Self-care Requisites (also called Self-care Needs)Self-Care DeficitTherapeutic Self-care DemandsSlide1Assumptions (explicit) Assumptions (explicit) Slide96Assumptions (explicit) Assumptions (explicit)Assumptions (explicit)Assumptions (implicit)Assumptions (implicit)Slide6Slide9Orems General Theory of NursingOrems Self-care TheorySelf-care DefinitionOrems Self-care Deficit TheoryOrems Nursing Systems Theory Describes...Orems Nursing Systems TheoryThree Nursing SystemsSlide30Orem's theory, Nursing process &Critical thinking operationsSlide5