Orem’s
Theory
Introduction
·
One of America’s foremost nursing theorists.
·
Dorothea Orem earned her Bachelor of science in
nursing education in 1939 and Master of science in
nursing in 1945
·
During her professional career ,she worked as a
staff nurse ,private duty nurse ,nurse educator and
administrator and nurse consultant
·
Received honorary Doctor of Science degree in 1976
·
Dorothea Orem as a member of a curriculum
subcommittee at Catholic University, recognized the
need to continue in developing a conceptualization
of nursing.
·
Published first formal articulation of her ideas in
Nursing: Concepts of Practice in
1971.second in 1980,and finally in 1995
Development of Theory
·
1949-1957 Orem worked for the Division of Hospital and
Institutional Services of the Indiana State Board of
Health. Her goal was to upgrade the quality of
nursing in general hospitals throughout the state.
During this time she developed her definition of
nursing practice.
·
1958-1960 US Department of Health, Education and Welfare where
she help publish "Guidelines for Developing
Curricula for the Education of Practical Nurses" in
1959.
·
1959 Orem subsequently served as acting dean of the school of
Nursing and as an assistant professor of nursing
education at CUA. She continued to develop her
concept of nursing and self care during this time.
·
Orem’s Nursing: Concept of Practice was first
published in 1971 and subsequently in 1980,1985,
1991, 1995, and 2001.
·
Continues to develop her theory after her retirement in 1984
Definitions of domain
concepts
·
Nursing
– is art, a helping service, and a technology
·
Actions deliberately selected and performed by
nurses to help individuals or groups under their
care to maintain or change conditions in themselves
or their environments
·
Encompasses the patient’s perspective of health
condition ,the physician’s perspective , and the
nursing perspective
·
Goal of nursing – to render the patient or members
of his family capable of meeting the patient’s self
care needs
To
maintain a state of health
To
regain normal or near normal state of health in the
event of disease or injury
To
stabilize ,control ,or minimize the effects of
chronic poor health or disability
·
Health
– health and healthy are terms used to describe
living things … it is when they are structurally and
functionally whole or sound … wholeness or
integrity. .includes that which makes a person
human,…operating in conjunction with physiological
and psychophysiological mechanisms and a material
structure and in relation to and interacting with
other human beings
·
Environment
– environment components are environmental factors
,environmental elements, conditions ,and
developmental environment
·
Human being
– has the capacity to reflect ,symbolize and use
symbols
Conceptualized as a total being with universal
,developmental needs and capable of continuous self
care
A
unity that can function biologically, symbolically
and socially
·
Nursing client-
a human being who has "health related /health
derived limitations that render him incapable of
continuous self care or dependent care or
limitations that result in ineffective / incomplete
care.
A
human being is the focus of nursing only when a self
–care requisites exceeds self care capabilities
·
Nursing problem
– deficits in universal, developmental, and health
derived or health related conditions
·
Nursing process-
a system to determine (1)why a person is under care
(2)a plan for care ,(3)the implementation of care
·
Nursing therapeutics–
deliberate ,systematic and purposeful action
Orem’s General Theory of
Nursing
·
Orem’s general theory of nursing in three related
parts:-
·
Theory of self care
·
Theory of self care deficit
·
Theory of nursing systems
Theory of Self Care
·
Includes :--
·
Self care
– practice of activities that individual initiates
and perform on their own behalf in maintaining life
,health and well being
·
Self care agency
– is a human ability which is "the ability for
engaging in self care"
--
Conditioned by age developmental state, life
experience sociocultural orientation health and
available resources
·
Therapeutic self care demand
– "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-action directed towards
provision of self care
3
categories of self care requisites are:--
·
Universal
·
Developmental
·
Health deviation
Universal self care
requisites
·
Associated with life processes and the maintenance
of the integrity of human structure and functioning
·
Common to all , ADL
·
Identifies these requisites as:
·
Maintenance of sufficient intake of air ,water, food
·
Provision of care assoc with elimination process
·
Balance between activity and rest, between solitude
and social interaction
·
Prevention of hazards to human life well being and
·
Promotion of human functioning
Developmental self care
requisites
·
Associated with developmental processes/ derived
from a condition…. Or associated with an event
·
E.g. adjusting to a new job
·
adjusting to body changes
Health deviation self care
·
Required in conditions of illness ,injury, or
disease .these include:--
o
Seeking and securing appropriate medical assistance
o
Being aware of and attending to the effects and
results of pathologic conditions
o
Effectively carrying out medically prescribed
measures
o
Modifying self concepts in accepting oneself as
being in a particular state of health and in
specific forms of health care
o
Learning to live with effects of pathologic
conditions
Theory of self care deficit
·
Specifies when nursing is needed
·
Nursing is required when an adult (or in the case of
a dependent ,the parent) is incapable or limited in
the provision of continuous effective self care
Orem identifies 5 methods of helping:--
·
Acting for and doing for others
·
Guiding others
·
Supporting another
·
Providing an environment promoting personal
development in relation to meet future demands
·
Teaching another
Theory of Nursing Systems
·
Describes how the patient’s self care needs will be
met by the nurse , the patient, or both
·
Identifies 3 classifications of nursing system to
meet the self care requisites of the patient:-
·
Wholly compensatory system
·
Partly compensatory system
·
Supportive – educative system
·
Design and elements of nursing system define
·
Scope of nursing responsibility in health care
situations
·
General and specific roles of nurses and patients
·
Reasons for nurses’ relationship with patients and
·
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 self care demand
·
Orem recognized that specialized technologies are
usually developed by members of the health
profession
·
A technology is systematized information about a
process or a method for affecting some desired
result through deliberate practical endeavor ,with
or without use of materials or instruments
Categories of technologies
·
Social or interpersonal
·
Communication adjusted to age, health status
·
Maintaining interpersonal ,intragroup or intergroup
relations for coordination of efforts
·
Maintaining therapeutic relationship in light of
psychosocial modes of functioning in health and
disease
·
Giving human assistance adapted to human needs
,action abilities and limitations
·
Regulatory technologies
·
Maintaining and promoting life processes
·
Regulating psycho physiological modes of functioning
in health and disease
·
Promoting human growth and development
·
Regulating position and movement in space
Orem’s Theory and Nursing
Process
·
Orem’s approach to the 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.
·
The steps within the approach are considered to be
the technical component of the nursing process.
·
Orem emphasizes that the technological component
"must be coordinated with interpersonal and social
processes within nursing situations
Comparison of Orem’s
Nursing Process and the Nursing Process
Nursing Process
·
Assessment
·
Nursing diagnosis
·
Plans with scientific rationale
·
Implementation
·
evaluation
Orem’s Nursing. Process
·
Diagnosis and prescription ;determine why nursing is
needed. analyze and interpret –make judgment
regarding care
·
Design of a nursing system and plan for delivery of
care
·
Production and management of nursing systems
Step 1-collect data in six areas:-
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