Dorothea Elizabeth Orem Self Care Deficit Theory of Nursing Individuals, families, groups and communities need to be taught

self care BY: Mark Elben G. Teodoro,RN Theorist: Dorothea Orem (1914-2007) Born 1914 in Baltimore, US Earned her diploma at Providence Hospital Washington, DC 1939 BSN Ed., Catholic University of America 1945 MSN Ed., Catholic University of America She worked as a staff nurse, private duty nurse, nurse educator and administrator and nurse consultant. Received honorary Doctor of Science degree in 1976. Theory was first published in Nursing: Concepts of Practice in 1971, second in 1980, in 1995, and 2001.

MAJOR ASSUMPTIONS People should be self-reliant and responsible for their own care and others in their family needing care. People are distinct individuals. Nursing is a form of action interaction between two or more persons. Successfully meeting universal and development self-care requisites is an important component of primary care prevention and ill health. A persons knowledge of potential health problems is necessary for promoting self-care behaviors. Self care and dependent care are behaviors learned within a socio-cultural context. Metaparadigm in Nursing Orems theory addresses clients self-care needs. It is define as goal-oriented activities that are set towards generating interest in the part of the client to maintain life and health development. The theory is aimed towards making the clients perform self care activities in order to live independently. Person According to Orem, human beings are very much different from other living things in term of their capacity. Humans can reflect upon events, themselves, and their environment. They can symbolize experiences that they have been through by using words or ideas. Such symbols could be used creatively in guiding and communicating in their efforts towards the attainment of something beneficial to them. Human functioning is an integrated system comprised of physical, psychological, interpersonal, and social aspect. Orem believes that individuals have the potential to be developed and learned. Health Orem supports the World health organization definition of health as the state of physical, mental, social well-being and not merely the absence of disease or infirmity. Orem believes that health should be perceived this way since she believes that these integrated aspects of health are inseparable.

Oftentimes, Orem presents health based on preventive health care. This model of health care includes the promotion and maintenance of health, the treatment of disease or injury, and the prevention of complications. Environment Orems view of health as a phenomenon affected by inseparable entities shows her view of the surrounding environment as an external source of influence in the internal interaction of a persons different aspects. Nursing According to Orem, Nursing is helping clients to establish or identify ways to perform self care activities. Nursing actions are geared towards the independence of the client. If the client is highly dependent, there is a need for the nurse to assist and address the needs of the client. Further, Orem defines nursing as a human service. It is a distinguished human service since its focus is on person with inabilities to maintain continues provision of healthcare. She added that nursing is based on values. Self Care Deficit Theory of Nursing Self-Care Self care is an activity that promotes a persons well-being. It is performed by persons who are aware of the time frames on behalf of maintaining life, continuing personal development and a healthy functional living. Self Care Requisites Self care requisites are insights of actions or requirements that a person must be able to meet and perform in order to achieve well-being. These are reasons for any actions of self-care that must be undertaken. The two elements of self care requisites are: 1. The factor to be controlled or managed to keep as aspects of human functioning and development within the norms compatible with life, health and personal well-being and; 2. The nature of required action. Universal Self-Care Requisites These are universally set goals that must be undertaken in order for an individual to function in scope of a healthy living. The eight self-care requisites common in men, women and children are as follows: 1. Maintenance of sufficient intake of air, 2. Maintenance of sufficient intake of food, 3. Maintenance of sufficient intake of water, 4. Provision of care associated with elimination, 5. Maintenance of balance between activity and rest, 6. Maintenance of balance between solitude and social interaction, 7. Prevention of hazard to human life, human functioning and human well-being; and 8. Promotion of human functioning and development.

Development Self-Care Requisites The following are actions to be undertaken that will provide developmental growth:

1. Prevision of conditions that promote development; 2. Engagement in self care-development and; 3. Prevention of the effects of human conditions that threatens life. Health Deviations Requisites These are requisites required for a person to be considered as sick or ill. Disease affects the structure within the integral part of a person and its functioning. These health care deviations set standards to which the degree of self-care demand needed is needed. Therapeutic Self Care Self-Care Demand These are the summation of all activities needed to alleviate the existing disease or illness. Controlling or managing the factors will result to appropriate care plan. Self Care Agency These are complex set of activities required to purposively regulate the actions needed for planning a care plan for a client. Agent An agent is the individual who is engage in meeting the needs of a person. They are like bridges that facilitate what has been done and what needs to be done. Dependent Care Agent These are individuals who takes full responsibility of taking care of a person who are incapable of providing care for themselves or those who are living dependently with others aid. Nursing Agency Nursing agency is a set of established capabilities of a nurse who can legitimately perform activities of care for a client. Nursing agency helps a person achieve their health care demand. Nursing Design These are professional functions that must be performed by the nurse in order to meet clients need. It serves as a guideline of needed and foreseen results. Acceptance of the Nursing Community Practice Orems Self Care Deficit Theory has been used in studies in patients having heart problems, cancer and mental illness. Orems theory had been widely used in dealing with geriatric cases, especially those having chronic illnesses. The use of her theory gave way for further studies in health promotion, selfcare and family caregiver stress. In the communities, several government health agencies used her theory to practice as well. In other areas of nursing such as occupational health, Orems Concept is used to design nursing activities that deals with job-related hazards. The ability to identify health problems, interpret data, and come up with conclusion is very important in occupational health nursing. Orems theory was being used in defining the roles of the nurse in multiple settings. There are also several reports that the self-care deficits theory settings. There are also several reports that the self-care deficits theory is used in the development of clinical measurement approaches.

Education The use of Orems theory in curriculum development was reported in late 1970s. The theory is used at all levels of curriculum and in continuing education. Some American universities continuously use her theory as a strong and effective framework for curricular design. Gradually, focus on preventive health care is being introduced also in nursing schools. Research A number of researches derived from Orems theory can be classified relating to the development of research instruments for scientific measurement of the components of her theory and studies that test these components. One of the first instruments developed is the exercise of self-care agency (ESCA) which is published in 1979 another instrument developed is the Appraisal of Self-care Agency or ASA. This scale was utilized developed measure the core concepts of Orems self-care deficit theory. Both of these instrument tools are used to assess basic conditioning factors and self-care abilities related to the care of well and the ill. Critique Simplicity Orems theory is expressed in limited number of terms. This term are defined and used consistently in her theories. The self-care deficit theory of nursing is a systematic synthesis of knowledge about the theoretical entities such as self-care, self-care agency, therapeutic self-care-demand, and the relational entity self-care deficit and nursing agency. In terms of simplicity, the theory could be well understood as the theory is presented in a straight forward manner. Generality As Orem describe her theory, Self-care Deficit Theory assists nurses in different areas in any clinical setting. This is true as the theory operates upon the combination of several conceptualized properties or features common to all instances of nursing. Moreover the theory she proposed helps nurses develop and validate nursing knowledge, and in teaching and learning the nursing professionals. Empirical Precision Orems theory is used in both qualitative and quantitative methodologies. Although widely used by researches, several components of the theory still need instrument development in order for them to be measured accurately. The significant value of Orems theory is in its scope, complexity, and clinical usefulness. It could be effectively used in generating hypothesis and adding to the body of knowledge of nursing. Derivable Consequences Orems theory differentiates nursing from other disciplines in terms of focus. Although other disciplines use the instruments developed from Orems theory, the theory of nursing systems in t erms of focus and emphasis sets the nursing process apart. Orems theory gives direction to nursing specific outcomes related to identifying and meeting the therapeutic self-care demands and self-management systems. Orems contribution to the profession extends far beyond than the formulation of self-care deficit theory. In her works, she defines nursing as a scientific structure and as a practical science with on-going development of the nursing knowledge. Shes a visionary when she saw how far the profession could go in its development and maturity.