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DOROTHEA .E. OREM’S THEORY OF SELFCARE DEFICIT

Dorothea Orem was born in 1914 in Baltimore USA, She was a Nurse educator, Administrator and Nurse Consultant. She received her honorary Doctor of science degree in 1976.

Dorothea Orem’s theory was first published in Nursing concepts of practice in 1971, other publications in 1980, 1995, and 2001. Dorothea Orem died in 2007.

Orem’s vision of health is a state characterized by wholeness of developed human structures and of bodily and mental functioning. It includes physical, psychological, interpersonal and social aspect. Nursing care becomes necessary when client is unable to fulfill biological, psychological, developmental or social needs.

MAJOR ASSUMPTION OF OREM’S SELFCARE DEFICIT THEORY

• People are distinct individual.

• People should be self-reliant and responsible for their own care and others in their family needing care.

• Nursing is a form of action-interaction between two or more persons.

• Successfully meeting self-care requisites is an important component of primary care, prevention and ill health.

• A person’s knowledge of potential health problems is needed for promoting self care behaviors.

• Self care dependent cares are behaviors learnt within a socio-cultural contact.

• Orem defined Nursing practice as an art, a helping service and technology.

DEFINITION OF TERMS

a. Self care: Orem explain self care as activities carried out by individual to maintain their own health.

b. Self care agency: This is a human ability which is the acquired ability to perform self care and this will be affected by the basic conditioning factors such as: age, gender, health care system, family system etc.

c. Therapeutic self care demand: This is the totality of self care action to be performed for some duration in order to meet self care requisites by using valid methods and related set of operations and action. The self care carried out is to fulfill self care requisites.

d. Universal self care requisites: These requisites are identified as need for 

• Sufficient air.

• Water.

• Food. 

• Elimination management.

• Balance between activities and rest.

• Hazard protection. 

• Promotion of human functioning.

e. Developmental self care requisites: Are needs for those living conditions that support life and promote development or associated with an event e.g. adjusting to a new job.

f. Health deviation self care requisites: These are required in condition of illness, injury or disease. The requisites are:

• Seeking and securing appropriate medical assistance.

• Being aware of and attending to effects and results of pathologic conditions.

• Carrying out medically prescribed measures.

• Modifying self concept as being in a particular state of health and in specific forms of health care.

• Leaning to live with effects of pathological conditions.

 

THEORY OF SELF CARE DEFICIT

Orem defined Nursing as an art, a helping service and a technology. Nursing is required when an adult is incapable or limited in the provision of continuous effective self care. When an individual is unable to meet their own self-care requisites, a "self-care deficit" occurs. It is the job of the Registered Nurse to determine these deficits, and define a support modality .The deficit is identified through the assessment of the patient.

Orem identified five methods of helping the client:

• Acting for and doing for others 

• Guiding others

• Supporting another.

• Providing an environment that promotes personal development in relation to meet future demands.

• Teaching another.

OREM’S THEORY AND NURSING PROCESS

The nursing process presents a method in determining self care deficits and to define the roles of persons or nurse to meet the self care demands.

Assessment

Step 1- Collect data in six areas

• The person’s health status

• The physician’s perspective of the person’s health status

• The person’s perspective his or her health status.

• The health goals within the context of life history, lifestyle, and health status.

• The person’s requirement for self care.

• The person’s capacity to perform self care.

Step 2-Nursing diagnosis and plans

• The nurse designs a system that is wholly or partially compensatory or supportive educative.

• The two actions are (1) Bringing out a good organization of the components of patients therapeutic self care demands. (2) Selection and combination of ways of helping that will be effective and efficient in compensation for and overcoming patient’s self care deficits.

Step 3-Impleamentation and evaluation

• Nurse assists the patient or family in self care matters to achieve identified and described health and health related results. Collecting evidence in evaluating results achieved against results specified in the nursing system design.

• Actions are directed by etiological component of nursing diagnosis.

APPLICATION OF OREM’S THEORY OF SELF CARE DEFICIT

3 systems with professional nursing practice:

1. Wholly compensatory system: The nurse here is to provide total care for the patient (that which the patient cannot perform by self)

Example: Bedridden orthopedic patient arrive the hospital via ambulance for expert management. He sustained a complete fracture of the spine in a motor vehicular accident. Patient requires oxygen at 2Litres per minutes, continuous tube feeding at 90ml per hour and foley’s catheter. The Nurse in clinic has the following duties:

• Administer medication as at when due.

• Changing dressing around the NG tube due to leaking.

• Administer oxygen at 2Litres per minute.

• Empties foley’s catheter.

• Places patient on bed pan.

• Bedbathing.

• Oral care. Etc

2. Partially compensatory system: The nurse and the patient share responsibility for care. Nurses in this case only assist the patient in self care.

Example: Nurse can assist postoperative client to ambulate, Nurse can bring a meal tray for client who can feed himself.

3. Supportive-educative system

This is 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.”

Example: Nurse guides a mother how to breastfeed her baby, Counseling a psychiatric client on more adaptive coping strategies.