Nursing Theory of Dorothea Orem : Self-Care Theory

Dorothea Orem is one of America's leading nursing theoretical. Dorothea Orem was born in Baltimore, Maryland in 1914. She received a bachelor of nursing degree in 1939 and Master of Nursing in 1945. According to Orem, nursing care is done in the belief that everyone has the ability to care for themselves so as to help people make ends meet, maintaining the health and well-being, therefore this theory is known as the (self-care) or self-care deficit theory. Adults can take care of themselves, whereas infants, the elderly, and sick people in need of assistance to meet their self-care activities.

Dorothea Orem's Self-Care Theory

Major Concepts

Nursing is as art through which the practitioner of nursing gives specialized assistance to persons with disabilities which makes more than ordinary assistance necessary to meet needs for self-care. The nurse also intelligently participates in the medical care the individual receives from the physician.

Humans are defined as “men, women, and children cared for either singly or as social units,” and are the “material object” of nurses and others who provide direct care.

Environment has physical, chemical and biological features. It includes the family, culture and community.

Health is “being structurally and functionally whole or sound.” Also, health is a state that encompasses both the health of individuals and of groups, and human health is the ability to reflect on one’s self, to symbolize experience, and to communicate with others.

Self-care is the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health and well-being.

Self-care agency is the human’s ability or power to engage in self-care and is affected by basic conditioning factors.

Basic conditioning factors are age, gender, developmental state, health state, sociocultural orientation, health care system factors, family system factors, patterns of living, environmental factors, and resource adequacy and availability.

Therapeutic Self-care Demand is the totality of “self-care actions to be performed for some duration in order to meet known self-care requisites by using valid methods and related sets of actions and operations.”

Self-care Deficit delineates when nursing is needed. Nursing is required when an adult (or in the case of a dependent, the parent or guardian) is incapable of or limited in the provision of continuous effective self-care.

Nursing Agency is a complex property or attribute of people educated and trained as nurses that enables them to act, to know, and to help others meet their therapeutic self-care demands by exercising or developing their own self-care agency.

Nursing System is the product of a series of relations between the persons: legitimate nurse and legitimate client. This system is activated when the client’s therapeutic self-care demand exceeds available self-care agency, leading to the need for nursing.


Subconcepts

Self-care Requisites or requirements can be defined as actions directed toward the provision of self-care. It is presented in three categories:

A. Universal self-care requisites are associated with life processes and the maintenance of the integrity of human structure and functioning.

1. The maintenance of a sufficient intake of air
2. The maintenance of a sufficient intake of water
3. The maintenance of a sufficient intake of food
4. The provision of care associated with elimination process and excrements
5. The maintenance of a balance between activity and rest
6. The maintenance of a balance between solitude and social interaction
7. The prevention of hazards to human life, human functioning, and human well-being
8. The promotion of human functioning and development within social groups in accord with human potential, known human limitations, and the human desire to be normal

Normalcy is used in the sense of that which is essentially human and that which is in accord with the genetic and constitutional characteristics and the talents of individuals.

B. Developmental self-care requisites are “either specialized expressions of universal self-care requisites that have been particularized for developmental processes or they are new requisites derived from a condition or associated with an event.”

C. Health deviation self-care requisites are required in conditions of illness, injury, or disease or may result from medical measures required to diagnose and correct the condition.

1. Seeking and securing appropriate medical assistance
2. Being aware of and attending to the effects and results of pathologic conditions and states
3. Effectively carrying out medically prescribed diagnostic, therapeutic, and rehabilitative measures
4. Being aware of and attending to or regulating the discomforting or deleterious effects of prescribed medical measures
5. 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
6. Learning to live with the effects of pathologic conditions and states and the effects of medical diagnostic and treatment measures in a life-style that promotes continued personal development.

The Three Basic Nursing Systems:

1. 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… Persons with these limitations are socially dependent on others for their continued existence and well-being.”
2. The partly compensatory nursing system is represented by a situation in which “both nurse and 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.”
3. In the supportive-educative system also known as supportive-developmental system, the person “is able to perform or can and should learn to perform required measures of externally or internally oriented therapeutic self-care but cannot do so without assistance.”

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