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Prepared by Chanak Trikhatri
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Dorothea Elizabeth Orem’s Self Care Theory
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Background of TheoristOne of the foremost Nursing Theorist of the world, Dorothea E. Orem
was born on 1914 at Baltimore, Maryland.
Her father was a construction worker, And her mother is a home maker
She was the youngest among two daughters
She died in June 22, 2007.
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Education She started her nursing education by joining at the Providence Hospital School of
Nursing In Washington D.C. in studied Diploma level of Nursing on early 1930’s
She completed her B.S. in Nursing Education on 1939
From Catholic University of America, Washington D.C. she had finished her MSN degree on 1945.
She received Honorary Doctorates: Doctors of Science degree from Georgetown University Washington D.C. on 1976
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Honored Award Orem was decorated with several national award including
Catholic University of America’s Alumni Achievement awarded Orem, for her contributation Nursing Theory in 1980.
Orem was received her second honorary doctor of science award, by Incarnate Word College 1980.
Doctor of humane letter, Illinois Wesleyan University, 1988
Linda Richards award, National League for Nursing, 1991
Honorary fellow of the American Academy of Nursing, 199205/01/23 4Chanak
Experience in Nursing
She involved in nursing practice, nursing service and nursing education
During her professional nursing career, she has worked as a staff nurse, private duty nurse, nurse educator, nurse administrator and nurse consultant.
Occupied important nursing positions, like the directorship of both the nursing school and the department of nursing at Providence Hospital, Detroit (1940 to 1949)
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Orem work for seven years at the Division of Hospital and Institutional Services of the Indiana State Board of Health (1949-1957), Where she was aimed to upgrade the quality of nursing in general hospitals throughout the state. During this time, Orem developed her definition of nursing practice.
In 1957 Orem moved to Washington, D.C., where she was employed by the office of education, U.S. department of health, education, and welfare,[HEW] as a curriculum consultant from 1958 to 1960.
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Experience in Nursing Cont…
•While at HEW she worked on Orem participated in a project to improve practical [vocational] nurse training.
•This works stimulated her to consider the question, “what condition exists in a person when that person or others determine that that person should be nursing care ?”
•Her answer encompassed the idea that a nurse is “another self.”
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Experience in Nursing Cont…
This evolved into her nursing concept of “self care.”That is, when able, individuals care for themselves.When the person is unable to provide self care, then the
nurse provides assistance.In 1959, Orem’s concept of nursing as the provision of
self care was first published.In 1959, Orem became an assistant professors of nursing
education at the catholic university of America.
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Experience in Nursing Cont…
She subsequently served as acting dean of the school of nursing and as associate professor of nursing education.
She continued to develop her concept of nursing and self care
In that period she wrote THE HOPE Of NURSING [1962], which was published in the journal of nursing education.
In 1965,she joined with several faculty members from the Catholic University of America to form a Nursing Model Committee.
In 1968, a portion of the NMC ,including Orem, continued their work through the nursing development conference group [NDCG]
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Experience in Nursing Cont…
This group was formed to produce a conceptual framework for nursing and to establish the discipline of nursing.
Orem’s further developed her nursing concept of self care and in 1971 published Nursing : Concept of Practice.
This was followed by concept formalization in nursing : process and product [1972]
Subsequent editions of nursing concept of Practice were published in 1980, 1985, 1991 and 1995
Orem retired in 1984 and resides in Savannah, Georgia, where she enjoy reading, travelling, consulting, and attending nursing conferences to discuss her theory.
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Experience in Nursing Cont…
She participates in conferences and prepares papers about various conceptual elements of the theory.
Her first edition focused on the individual.
The second edition was expanded to include multi person units [families, group, and communities]
The third edition has evolved to present Orem's general theory of nursing which is constituted from three related theoretical construct
1.The Theory of Self care2.The Theory of self care deficit 3.The Theory of nursing system
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Experience in Nursing Cont…
Major Assumption The Theory was formalized in the early 1970s and were first presented at Marquette University School of Nursing in 1973 Orem identifies the five premises underline the general theory of nursing
1.Human being require continuous deliberate input to them selves and their environment to remain alive and function in accord with natural human endowments
2.human agency, the power to act deliberately, is exercised in the form of care of self and others in identifying needs for and in making needed inputs
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Major Assumption Cont……
3. Mature human beings experiences privations in the form of limitation for actions in care of self and others involving and making of life- sustaining and function.
4. Human agency is exercised in discovering, developing and transmitting to others ways and means to identify needs for and make inputs to self and other
5. Groups of human beings with structured relationship cluster tasks and allocate responsibility for providing care to group members who experience privations for making required deliberate input to self and other
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Orem’s General Theory of Nursing
According to Orem, “nursing has as its special concern the individual's need for self-care action and the provision and management of it on a continuous basis in order to sustain life and health, recover from disease or injury, and cope with their effects.” She develops her general theory of nursing in three related parts.
1. The Theory of Self care2. The Theory of self care deficit 3. The Theory of nursing system
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The Theory of Self Sare
The theory of self care includes self care, self care agency and therapeutic self care demand as well as self care requisites.
Self care is the “practices of activities that individual initiates and perform on their own behalf in maintaining life, health and wellbeing.”
Self care agency – it is a human ability which is “the ability to perform self care.” -conditioned by age developmental state, life experience sociocultural orientation , health and available resources.
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The theory consists of four components
1. Self-care is the "practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being." "Self-care…. effectively performed contributed in specific ways to human structural integrity, human functioning and human development.“
2. Self-care agency is a human ability, which is "the ability for engaging in self-care." "The individual's abilities to engage in self-care are conditioned by age, developmental state, life experience, sociocultural orientation, health, and available resources.”
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The Theory of Self Care Cont
The therapeutic self-care demand is the “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 or requirements can be defined as actions directed toward provision of self care. [action or measure used to provide self care]. Orem’s present 3 categories of self care requisites
1 Universal2 Developmental3 Health deviation
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The Theory of Self Care Cont
Universal self care requisites are associated with life processes and the maintenance of the integrity of human structure and functioning. They are common to all human beings during all stages of the life cycle and should be viewed as interrelated factors, each affecting the others. Such as
The maintenance of a sufficient intake of air
The maintenance of a sufficient intake of water
The maintenance of a sufficient intake of food
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Universal Self Care Requisites
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The provision of care associated with elimination processes and excrements
The maintenance of a balance between activity and rest
The maintenance of a balance between solitude and social interaction
The prevention of hazards to human life human functioning and human well-being
The promotion of human functioning and development within social groups in accord with human potential, known human limitation, and the human desire to be normal.
Universal Self Care Requisites Cont..
Developmental Self Care Requisites
Developmental self care requisites are specialized universal self care requisites that results from maturation or new requisites that develop as a result of a condition or event such as adjusting to the loss of a spouse, adjusting to a new job, or adjusting to body changes such as facial lines or gray hair.
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Health Deviation Self Care
Health deviation self care is required in conditions of illness, injury or disease or may result from medical measures required to diagnose and correct the condition. E.g. right upper quadrant abdominal pain when greasy foods are eaten, or learning to walk using crutches following the casting of a fractured leg.
Health deviation of self care requisites are Seeking and securing appropriate medical
assistance05/01/23 Chanak 21
Health Deviation Cont.. Being aware of and attending to the effects and results of
pathologic condition and states
Effectively carrying out medically prescribed measures. Being aware of and attending to or regulating the discomforting or deleterious effects
Modifying the self concept [and self image] in accepting oneself as being in a particular state of health and in need of specific forms of health care
Learning to live with the effects of pathological conditions and states and effects of medical diagnostic and treatment measures in a life style that promotes continued personal development
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The Theory of Self Care Deficit The theory of self care deficit is the core of Orem’s general theory
of nursing because it delineates when nursing is needed When an adult is incapable or limited in the provision of continuous
effective self care Nursing may be provided if the “care abilities are less than those
required for meeting a known self care demand [or] self care or dependent care abilities exceed or are equal to those required for meeting the current self care demand but a future deficit relationship can be foreseen because of predictable decrease in care abilities, qualitative or quantitative increases in the care demand, or both.”
The individual needs help “ in recovery from disease or injury, or in coping with their effects.”
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The Theory of Self Care Deficit Cont..
Orem identifies five methods of helping, these are –
1.Acting for or doing for another
2.Guiding another
3.Supporting another [physically or psychologically]
4.Providing an environment that promotes personal development in relation to becoming able to meet present or future demand s for action
5.Teaching another
Note - Nurse may help individual by using any or all of these methods to provide assistance with self care
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Orem presents a model to show the relationship between her concepts. From this model it can be seen that at a given time an individual has specific self care abilities as well as self care demand. If there are more demand than abilities, nursing is needed. Orem identified five areas of activity for nursing practice
1.Entering into and maintaining nurse patient relationship with individual, families or groups until patients can legitimately be discharged from nursing
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The Theory of Self Care Deficit Cont..
2. Determining if and how patients can be helped through nursing
3. Responding to patient requests, desires and needs for nurse contacts and assistance
4. Prescribing providing and regulating direct help to patient and their significant others in the form of nursing
5. Coordinating and integrating nursing with the patient’s daily living, other health care needed or being received, social and educational services needed or being received
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The Theory of Self Care Deficit Cont..
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The Theory of Nursing System
The nursing system, designed by the nurse, is based on the self care needs and abilities of patient to perform self care activities. Orem has identified 3 classification of nursing system These are
1.Wholly compensatory system2.The partly compensatory system3.The supportive educative system
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These systems are the wholly compensatory system, the partly compensatory system, and the supportive-educative system. The design and elements of the nursing system define;
1. The scope of nursing responsibility in health care situation 2. The general and specific roles of nurses and patients3. Reasons for nurses relationship with patients 4. The kinds of actions to be performed and the performance
patterns and nurses and patients actions in regulating patients’ self care agency and in meeting their therapeutic self care demand
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The Theory of Nursing System Cont..
Wholly Compensatory Nursing System
The wholly compensatory nursing system is represented by a situation in which the individual is unable “to engage in those self care actions requiring self directed and controlled ambulation and manipulative movement or the medical prescription to refrain from such activity person with these limitation are socially dependent on others for their continued existence and well being
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Wholly compensatory system are nursing systems for people who are
1. Unable to engage in any form of deliberate action for example, person in coma
2. Aware and who may be able to make observations, judgments and decisions about self care and other matters but can not or should not perform actions requiring ambulation or manipulative movements
3. Unable to attend to themselves and make reasoned judgments and decisions about self care and other matters but who can be ambulatory and may be able to perform some measures of self care with continuous guidance and supervision
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Wholly Compensatory Cont….
Partly Compensatory Nursing SystemThe partly compensatory nursing system is represented by a
situation in which “both nurse and patient perform care measures or other actions involving manipulative tasks or ambulation…..[either] the patient or the nurse may have the major role in the performance of care measures.”
E. g. an individual who has had recent abdominal surgery.
This patient might be able to wash his or her face and brush teeth but needs the nurse for help in ambulating and in changing the surgical dressing
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Supportive Educative System
The third nursing system is the supportive educative system. In this system the patient is doing all of his self care and the “patient’s requirements for help are confined to decision making, behavior control, and acquiring knowledge and skills.”
The nurse’s role, then is to promote the patient as a self agent
E.g. a sixteen year old who is requesting birth control information
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Orem states that “one or more of the three types [of systems] may be used with a single patient
E.g. a women in a labor may move from a supportive-educative system in early labour to a partly compensatory system as her labor advances
If she require a cesarean delivery, her care might require her to be in a wholly compensatory system
She would then progress to a partly compensatory system as she recovers from the anesthetics
Later, as she prepares to go home, a supportive educative system would again be appropriate
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Supportive Educative System Cont..
Nursing Metaparadigm for Orem’s
PERSONHuman beings are distinguished from other living
beings by their capacity to:Reflect upon themselves and their environmentSymbolize what they experienceUse symbolic creations (ideas, words) in thinking,
communicating, and guiding efforts to make things that are beneficial for themselves and/or for others
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The Person is recipient of nursing care. Integrated human functioning includes physical, psychological, interpersonal, and social aspects.
Individual has the potential for learning & developmentThe way an individual meets his or her self care needs is not instinctual
but is a learned behavior. Has a capacity for self-knowledge Can engage in deliberate actions, interpret experiences, and perform
beneficial actionsCan learn to meet self-care needs (requisites), If for some reason, the
person can not learn self care measures, other must provide the care .Factors that affect learning are age , mental capacity, culture, society,
and emotional state of individuals.
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Nursing Metaparadigm for Orem’s
ENVIRONMENTEnvironment consists of environmental factors, environmental elements [not defined by Orem]. Environmental Conditions - external physical & psychosocial surroundings.
Developmental Environment:- Promotion of personal development through motivation to establish appropriate goals & to adjust behavior to meet those goals; concludes formation of or change in attitudes and values, creativity, self-concept and physical development. Environment can positively or negatively impact a person’s ability to provide self-care
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Nursing Metaparadigm for Orem’s
HEALTH
Orem’s supports WHO definition of health as the state of physical, mental, and social well-being and not merely the absence of disease or infirmity
She states physical, psychological, interpersonal and social aspects of health are inseparable in the individual.
Health includes promotion and maintenance of health, treatment of illness, and prevention of complication
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Nursing Metaparadigm for Orem’s
NURSING
In modern society, adults are expected to be self reliant and responsible for themselves and for wellbeing of their dependents.
Most social groups further accept that person who are helpless, sick, aged, handicapped or deprived should be helped to attain or regain responsibility within their existing capacities.
Thus, both self help and help to others are valued by society as desirable activities
Nursing as a specific type of human service is based on both values.
In most communities people see nursing as a desirable and necessary service.
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Nursing Metaparadigm for Orem’s
Art of Nursing Orem speaks about the Nursing: the art and prudence of nursing, nursing as a
service, role theory related to nursing, and technology in nursing It includes making a comprehensive determination of the reason why people can be
helped through nursing. This decision require a theoretical base in nursing disciplines and in sciences, art,
and humanities. Nursing prudence is the quality of nurses that enables them 1. To seek and take counsel in new or difficult nursing situation 2. To make correct judgment 3. To decide to act in a particular way and4. To take action The development of individual nurse’s art and prudence is affected by unique life
and nursing experiences.
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Human ServiceA mode of helping men, women, and children and not
tangible commodity.
It is a deliberate action, a function of the practical intelligence of nurses, to bring about humanely desirable conditions in person and their environments
nursing is distinguished from other human services
The specialized abilities that enables nurses to provide nursing care to individual or multiperson units when conceptualized as a unit is termed nursing agency
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Role Theory Related to Nursing
The nurse’s and the patients roles define the expected behavior for each in the specific nursing situation
Factors that influence the expected role behaviors are culture, environment, age, sex, the health setting and finances
Roles of nurses and patient are complimentary, i.e. certain behaviors of the patient elicits a certain response in the nurse and vice versa. Both work together to accomplish the goal of self care
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Technologies in Nursing
A technology is systematized information about a process or a method for affecting some desired result through deliberate practical endeavor, with or without a use of materials and instruments
Two categories of technologies used in nursing are social or interpersonal technologies and regulatory technologies.
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Social and Interpersonal TechnologyCommunication adjusted to age and developmental state, to
health state, and to sociocultural orientation
Bringing about and maintaining interpersonal, intragroup, or intergroup relations for coordination of effort
Bringing about and maintaining therapeutic relations in light of psychosocial modes of functioning in health and disease
Giving human assistance adapted to human needs and action abilities and limitation
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Regulatory Technologies
Maintaining and promoting life process
Regulating psycho physiological modes of functioning in health and disease
Promoting human growth and development
The effective integration of social and interpersonal technologies with regulatory technologies promotes quality professional nursing.
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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.
Orem emphasizes that the technological component "must be coordinated with interpersonal and social processes within nursing situations
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The steps of Orem’s nursing process
Step 1-the initial and continuing determination of why a person should be under nursing care
Step 2- the designing of a system of nursing and planning for the delivery of nursing according to the designed system
Step 3- the initiation, conduction and control of assisting action to
a. Compensate for the patients self care limitationsb.Overcome when possible self care limitationc. Foster and protect the patient’s self care abilities
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Comparison of Orem's Nursing Process and the Nursing Process
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Application of Orem’s Nursing Process
Situation Ms M. a well groomed university faculty member of Italian Catholic
descent, is 48 years old, 5 feet 2 inches, and weighs 175 pounds.She smoke 1 and ½ packs of cigarettes per day. She was very
happily married for 25 years and has been widowed for six month. She and her husband enjoyed social activities, including playing
bridge, collecting antiques. She has not participated in any of these activities since her husband’s
death because of lack of interest and energy. Currently, she engages in no regular exercise, eats mainly fast-food
during her 12 hour working day, and eats a late evening meal before retiring.
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Situation
Ms. M’s mother died of a stroke and her father had a heart attack at age 50. during her annual physical 2 weeks ago, her vital signs were 138/86, P -92, R- 30, T-98.4.
Her laboratory values were all with in normal limits except a blood cholesterol of 280mg.
Her physician advised her to loss 40 pounds, but recognize that she has inadequate knowledge of basic nutrition and has not been motivated to lose weight.
She foresees potential problems related to cardiovascular disease.
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Step 1
Specific data are gathered in the areas of individuals universal, developmental, and health deviation self care needs and their relationship.
Once the data have been gathered, they must be analyzed.Analyzing Ms. M’s data: in the category of universal self care
needs, Ms. M demonstrates a deficit in adequate air, water, and food intake –she is 5’2’’, weight 175 pounds, consumes excessive calories and cholesterol from fast food and late night meals.
Ms M shows imbalance between activity and rest since she has minimal exercise.
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There is also an imbalance between her solitude and social interaction since her husband’s death
This represents a significant loss for her in the mid life developmental needs category.
Ms M’s elevated cholesterol levels when interrelated with her family history of stroke and heart attack present a hazard to her life, functioning, and well being
Physician gave advise to loss weight 40 pounds She has limited nutritional knowledgeShe has motivational deficit to lose weight because her Italian
cultural tradition associates food with family and love. 05/01/23 53Chanak
Step 1 Cont…
Based on the analysis of data, she has potential hazards to her health related obesity, high cholesterol, smoking , social isolation and decreased exercise
Prioritize the self care deficit Formulate nursing diagnosis and must include response and
etiology pattern. Within Orem’s frameworks the nursing diagnosis would be
stated as an inability to meet the self-care demand[ response] related to self care deficit
E.g potentials for impaired cardiovascular functioning related to lack of knowledge about how her current life style increases her risk heart attack and stroke
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Step 1 Cont…
Step 2
The goals are congruent with the nursing diagnosis enabling the patient to become an effective self care agent
The goal for Ms M. would be – decrease her risk of cardiovascular impairment
Once the goals have been determined, the objectives can be stated e.g. Ms M. will state that high cholesterol levels increase her risk for cardiac impairment
Other objectives might relate to the risk factors of obesity, lack of exercise, smoking, and family history.
The designed nursing system for Ms M. would be the supportive –educative nursing system
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Step 3Etiology component - lack of knowledge about how her current life style
increases her risk heart attack and stroke when nurse and patient implement this supportive educative system, each has specific roles e.g. together they would develop contract that would relate to the goal of cholesterol reduction
Ms M. keep a 3 day food diaryThe nurse would provide information about cholesterol and its effect on
cardiovascular function. The nurse would provide information about specific foods that are low in
cholesterol, those food items that help reduce cholesterol , and a list of fast food restaurant that offer low cholesterol food items
Together they analyze 3 day food diary and decide how Ms. M. modify her diet to reduce her cholesterol intake
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They will determine which Italian dishes are low in cholesterol or how these recipes can be adopted
During this implementation, the nurse teaches, guides, and supports Ms. M. while providing a developmental environment
Includes evaluation- together do the evaluationQuestion might ask are – does she understand that her present life
style may increase her risk of developing a heart attack or stroke ? Did she select low cholesterol fast foods ?Did she attain her goal of reducing her cholesterol levels ? Evaluation is an on going process. It is essential that the nurse and
patient continually evaluate any changes in the data that would affect the self care deficit, self care agent, and the nursing system.
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Step 3 Cont….
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Characteristics of a Theory Theories can interrelate concepts in such a way as to create a
different way of looking at a particular phenomenon Theories must be logical in nature Theories should be relatively simple yet generalizable Theories are the base for hypothesis that can be tested Theories contribute to and assist in increasing the general body of
knowledge within the discipline through the research implemented to validate them
Theories must be consistent with other validated theories, laws and principles
Theories can be used by the practitioners to guide and improve their practice
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Relevance of Orem’s Theory Nursing EducationThe second stage of development - the nursing models
committee at the Catholic University of America.Guidelines for developing Curriculum for the Education of
Practice Nurses (1959)Number of reports- Basis for the curriculum. At least 45 schools of nursing are known to use this theoryTaylor (1985)- described the use of the theory in pre-service
nursing education and in teachingFirst articulated in 1950’s
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Nursing Education Contd….Formalized and published in 1972 for the purpose of “laying
out the structure of nursing knowledge and explicating the domains of nursing knowledge”
Sinclair School of Nursing University of Missouri at Columbia since 1978
Some Nursing schools in the United StatesUseful in developing and guiding practice, research, and
educationUsed at all levels of the curriculum as well as continuing
education and elective undergraduate course
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Nursing Education Contd….
Useful in designing curricula for pre-service, graduate, and continuing nursing education
Give direction to nursing and nurse-specific outcomes
Indicates most of the skills, techniques and methods that an individual must learn to become a nurse practitioner
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Nursing Profession The first documented use of Orem’s theory - Johns Hopkins Hospital in
1973 Variety of age groups Number of ethnically and culturally diverse populations Variety of clinical populationso Endocrinologyo Nephrologyo Oncologyo Psychiatry and Mental Healtho Cardiology and Pulmonologyo Pain Managemento Occupational Health Nursingo Neurology05/01/23 66Chanak
Nursing Profession Contd… The Vancouver Health Department - Designing community
populationNewark Beth Israel - Structure the delivery of nursing and the
documentation systemBinghamton General hospital- Orientation process for their new
graduate nursesFuture uses- User friendly intuitive computerized information
systemsDefine and describe various roles for nurses within multiple
settingso Clinical nurse specialist roleo Management role o Administrative role 05/01/23 67Chanak
Nursing Profession Contd… Teaching this theory to multi-skilled workers and nurse aidesUse of this theory in the development of clinical measurement
approachesHorn and Swain- developed criteria measures of nursing careNumber of other clinical instruments have been developed based
on this theoryo Moore and Gaffney , 1989 - the dependent Care Agent (DCA) o Hayward et. Al. - Kidney Transplant Recipient Stress scale
(KTRSS) o Appraisal of self care Agency (ASA) scale
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Nursing Profession Contd… Translated into Italian, French, Spanish, Dutch and
Japanese Practitioners of nursing use of Orem’s theory.Little work on the theory of nursing systemOrem’s theory of nursing systems is also evident in
the current practice
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Nursing Research
The research related to or derived from Orem's theory can be classified as relating to:Development of research instruments for measuring the conceptual elements of the theory Studies the test element of theory in specific populations.First instrument – exercise the self-care agency (ESCA), (Kearney & Fleisher's 1979) DSCAI (Denye's Self Care Agency Instrument) – 198005/01/23 70Chanak
Nursing Research Contd…. Hanson and Bickel's Perception of Self Care Agency – 1981 Self-As-Carer Inventory (SCI) Comparative analysis of above mentioned instruments -
McBride Results supported the multidimensionality of Orem's concept
of self care agency. Appraisal of Self-Care Agency (ASA), (Diabetes Self-Care
Practice Instrument) DSCPI (McCaleb and Edgil ), SCI, Maieutic Dimensions of Self Care Agency Scale (MDSCAS)
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Critique 1. Clarity The terms used by Orem are precisely defined. The language of the theory is consistent with the
language used in action theory and philosophy.There are no created wordsThe terminology of the theory is congruent throughout.The term self care has multiple meanings across
disciplines Orem has defined the term and elaborated the substantive
structure of the concept in a way that is unique but also congruent with other interpretation .
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2. Simplicity Orem’s general theory comprise 3 constitute theories, that of self
care, self care deficit, and nursing system. Self care deficit theory of nursing is a synthesis of knowledge
about the theoretical entities self care ( and dependent care ), self care agency (dependent care agency), therapeutic self care demand, the relational entity self care deficit and nursing agency.
The entity nursing system is also included The development of the theory using these six entities is
parsimonious. The relationship between among these entities can be presented
in a simple diagram05/01/23 73Chanak
Critique Contd…
3. GeneralityOrem herself commented on the generality or universality of the
theoryThe self care deficit theory of nursing is not an explanation of the
individuality of a particular concrete nursing practice situation, but rather the expression of a singular combination of conceptualized properties or features common to all instances of a nursing.
As a general theory, it serves nurses engage in nursing practice, in development and validation of nursing knowledge and in teaching and learning nursing
A review of the research and other literature attests to the generality of theory
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Critique Contd…
4. Empirical precisionOrem’s theory has been used for research using both
qualitative and quantitative methodologies.The theoretical entities are well define and lend themselves to
being measurable ; however, instrument have not been develop for all of the entities, for e.g. nursing agency
Furthermore the values of the theoretical entities are not constant across population
The most appropriate methods of inquiry for this theory, as well as for all nursing theories, are yet to be determine
The beauty of Orem’s theory lies in the scope, complexity, and clinical usefulness; it is useful for generating hypotheses and adding to body of knowledge i.e. nursing
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Critique Contd…
5. Derivable consequencesThe SCDNT differentiates the focus of nursing from other
disciplines While other disciplines find the theory of self care helpful and
contributes to its development, the theory of nursing system provides unique focus for nursing
There is ample evidence in the literature that the theory is useful in developing and guiding practice and research
It gives direction to nursing- specific outcomes related to knowing and meeting the therapeutic self care demands, regulating the development and exercise of self care agency , establishing self care and self management system, and others.
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Critique Contd…
The theory is also useful in design of curriculum for pre service, graduate and continuing nursing education
The theory also gives direction to nursing administrationThe development of theory base computer system, assessment form
and the over all structuring of the delivery of care attests to the usefulness of the theory
The significance of Orem’s work extends far beyond the development of the SCDNT
In her works she has provided us with the expression of the form of nursing sciences as practical science, with a structure for on going development of nursing knowledge in the stages of development of theory
She has presented a visionary view of contemporary nursing practices, and knowledge development expressed through the general theory.
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Critique Contd…
Strengths of Orem’s Theory The theory of nursing provides a compressive base for nursing
practice. It has utility of professional nursing in the areas of nursing education curricula, clinical nursing practice ,nursing administration ,and nursing research .
A major strength of Orem's theory is that she specifies when nursing is needed.
She also includes counting education as part of the professional component of nursing education .
Theory promotes the concepts of professional nursing ,so she defines the roles of vocational ,technical, professional nurses, and recognizes the importance of each besides that ,she also emphasizes nurse are educated ,not trained .
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Her self care premise is contemporary with the concepts of health promotion and health maintenance. self care in Orem ‘s theory is comparable to holistic health in that both promote the individual ‘s responsibility for health care it is relevant with today’s emphasis on early hospital discharge, home care ,and out patient services .
Orem has expanded her focus of individual self care to include multiperson units (families , groups , and community ). she recognizes the value of family members and significant others for the individual’s provision of self care
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Strengths of Orem’s Theory Contd…
Orem ‘s theory to be more clinically applicable when more than one system is used currently .
Orem recognizes the term “client” as regular seeker of services but prefer the term “patient “one who is under the care of nurses, physicians ,or other direct health care providers .
Orem defines a system as a “single” ,whole thing. in general system theory , a system viewed as a dynamic flowing process .
Health is often viewed as dynamic and ever-changing
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Strengths of Orem’s Theory Contd…
Limitations of Orem’s Theory The ambiguity of applying theory to nursing practice may lie in the fact that one theory does not always specifically support all aspects of nursing care
Orem’s self care deficit theory may not encompass all aspects of care and needs of a specific client. For e.g. having an unclear definition of family, the nurse-society relationship and public education areas are weak.
These issues are essential in the management and treatment plan in caring for patients. Although the family, community and environment are considered in self care action, the focus is primarily on the individual (Balabagno, et.al, 2006).
Another limitation is the definition of health as being dynamic and ever changing with states ranging from health or non health, wellness or illness (Fitzpatrick JJ, 2005). This definition of health directly contradicts the experience of some patients with varying needs and levels of care requirements.
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Limited recognition of an individual’s emotional needs is present within the theory (George JB., 1995).
It focuses more on physical care and gives lesser emphasis to psychological so, there is a limited acknowledgement of the emotional needs of humans
There are no self created wordsThere is no clarification e.g. diagnosis, prescription,
technologist, and other therapeutic self care deficit demands
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Limitations of Orem’s Theory Cont..
The term self care is used with Nemours connections, this multitude of terms ,such as self care , self care agency ,self care demand ,self care premise ,self care deficit, and universal self care can be confusing to read
When third edition was published in1985, some of her references could be out dated . for e.g. articles many of the journals in her lists of selected reading are from the 1960 are not accompanied by companion or articles from the 1980s
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Limitations of Orem’s Theory Cont..
Summary
Orem’s general theory of nursing is composed of three constructs self care, self care deficit and nursing system. It has utility for professional nursing in the areas of nursing practice nursing curricula, nursing education administration, and nursing research. Health is often viewed as dynamic and ever changing. Orem’s visual presentation of the boxed nursing systems implies three static conditions of health. Appears that the theory is illness oriented rather with no indication of its use in wellness settings.
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References
George, B. Julia (1990), Nursing Theories The base for professional Nursing Practice (3rd edn). Norwalk, Appleton & Lange. 91-110
George, B. Julia (2011), Nursing Theories The base for professional Nursing Practice (6rd edn). Norwalk, Appleton & Lange. 91-110
Tomey, A. M.(1998).Nursing Theorist and Their Work.(4th edn). Mosby Year Book, St. Louis. 175-187
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