BAHIR DAR UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES

SEMINAR PRESENTATION ON :- Orem’s self care deficit Theory
Advisor – Gebrie.Y ( Asst professor, PHD fellow)

JUANUARY , 2012
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 Group memebers
Name ID
1. Sahilu Mitiku 07012PR
2. Gerbrie Kassaw 07008PR
3. Melsew Dagne 07010PR
4. Dessie Temesgen 07006 PR
5. Berihun Bantie 07002PR

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 Presentation Out line
 Background of the Theorist
 Introduction of the theory
 Major Concepts and Definitions
 Principles of the theory
 Importance of the theory
 Major Assumptions
 Metaparadigm in Nursing
 Application of the theory
• References
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 Objectives
Up on the compilation of this lesson the students will able to
 explain the fundamental principles, assumptions of Orem's
self care theory
 Identify the main components of the theory
 Analyze the strength and limitation of the theory

 Apply the theory concepts on your clinical as well as

teaching experience .

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 Self-Care Deficit Theory of Nursing
By Dorothea Orem (1914-2007)

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 Background of the theorist
Biography
• was born (July 22, 1914) in Baltimore, Maryland.
• Obtained her Diploma in Nursing in 1934 at the
Providence Hospital School of Nursing In
Washington D.C.
• In 1939 and 1945 she finished B.S. Nursing
Education ( BSN Ed.) and MSN Ed successively in
Catholic University of America, Washington

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 Awards -
• 1976- honorary doctorate degree of science from
Georgetown University
• 1980 – honorary doctorate from in Camate world
collage
• 1998-doctors honors causea, university of
Missouri ,Colombia
• an assistant professor of nursing education at of
Catholic University America (CUA)
• Received the most prestigious nursing award
from Sigma Theta Tau International in 1997.

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 Career
• She worked as a staff nurse, private duty nurse, nurse educator
,nurse administrator and nurse consultant.
• Director of the providence hospital school of nursing in
Detroit , Maryland
• In 1971 she first published her book titled, “Nursing: Concepts
of Practice”. The 2nd, 3rd, 4th, 5th, and 6th editions were
published in 1980, 1985, 1991, 1995, and 2001 respectively..
• Orem died in June 22, 2007.

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 Her publications

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 Origin of the theory
• Dorothea Orem’s general theory of nursing evolved
over a period of four decades from individual work and
through collaboration with students, practitioners,
researchers, educators, administrators, and scholars.
• She began her work by looking for the uniqueness of
nursing. How was it different from other disciplines?
How was it similar? This search for distinctive nursing
knowledge was directed toward answering one
question, “
• What is the domain and what are the boundaries of
nursing as a field of practice and a field of knowledge?

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 Conti--
• What meaning can and should nurses attach to
persons, things, events, conditions, and
circumstances they encounter?”
• After reflecting upon her own nursing
experiences, Orem says the answer came to
her as a “flash of insight, an understanding that
the reason why individuals could benefit from
nursing was the existence of self care
limitations”.

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 Introduction to the theory

Orem’s self-care deficit theory involves around the concept

of self care

Orem’s theory has been called

self care deficit theory of nursing, general theory of nursing

self care deficit nursing theory, and

 self care theory of nursing

But, The specific name for Orem’s general theory of

nursing, however, is self care deficit theory of nursing
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 Theory parts ,concepts and definitions'

 Orem's self care deficit theory considered as a grand

theory of nursing, is one of the most widely used
models in nursing today.
 includes three interrelated theory:
 Theory of self care
 Theory of self care deficit
 Theory of nursing system

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 Conti– concepts
Self care deficit theory of Nursing is composed of six
basic concepts.
• Self care, self care agency, therapeutic self care
demand, self care deficit are related to the patient or the
person in need of nursing,
• whereas nursing agency and Nursing system are related
to the nurses and their action (Potter A Patricia, Perry G
Anne (1992)
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 1. Theory of Self-Care: Major Concept

 Focus on self care that a person performs independently to

him/her self or their dependant's to maintain health .

A ) self – care

• Is the performance or practice of activities that

individuals initiate and perform on their own behalf to
maintain life, health, and wellbeing.

• Self-care is learned through interpersonal relations and

communications.
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 Conti--
B) Self-Care Agency-

 The human’s acquired powers and capabilities to engage

in self-care

 The ability to engage in self-care activities are influenced

by “Basic Conditioning Factors ( age, educational

status, health status, enviromental factors.

• In usual circumstances adult care for themselves.

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 Conti-

C) Therapeutic Self-Care Demand

• is the totality of self care actions needed be
performed for some duration in order to meet self care
requisites by using valid methods and related sets of
operations and actions.
• Is modeled on deliberate action that is intentional

performed by some members .

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 Conti--
D) Self-Care Requisites-
• An additional concept that defines it as the reasons for
which self-care activities occur
• These are the self-care needs categorized into three
distinct requirements:
a. Universal Self-care Requisites
b. Developmental Self-care Requisites
c. Health Deviation Self-care Requisites

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 A. Universal self care requisites/ADLs

 Associated with life processes and the maintenance of the

integrity of human structure and functioning

Common to all; activities of daily living

Identifies these requisites as:

• Maintenance of sufficient intake of air ,water, food

• Provision of care associated with elimination process

• Balance between activity and rest, between solitude

and social interaction

• Prevention of hazards to human life well being .

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 B. 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
• It includes life cycle changes like intrauterine life,
birth, infancy, childhood , pregnancy
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 C. Health deviation self care requisites

• Required in conditions of illness, injury, or disease.

• These include:
 Seeking and securing appropriate medical assistance
 Being aware of and attending to the effects and results
of pathologic conditions
 Effectively carrying out medically prescribed measures
 Learning to live with effects of pathologic conditions.

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 2.Theory of Self-Care Deficit

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 Theory of Self-Care Deficit: Major
Concepts
• Is the basic element of the general theory of self-care
• It delineates WHEN nursing is required.
• Nursing is required when adults or parents for their
child are incapable of providing continuous effective
self-care.
• If there are more demands than abilities (Self-Care
Agency), nursing is needed.

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 Conti --
Nurse can help patient recover from Self-Care deficit by
five methods of helping:
• Acting for and doing for others
• Guiding and directing
• Providing physical and psychological support
• Providing and promoting an environment that supports
personal development
• Teaching
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 3. Theory of Nursing Systems
• Describes how the patient’s self care needs will be met by the
nurse , the patient, or both.
• Orem recognized that specialized technologies are usually
developed by members of the health profession
• Identifies 3 classifications of nursing system to meet the self
care requisites of the patient:-
 Wholly compensatory system

 Partly compensatory system

 Supportive – Educative system
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Types of Definitions Conti-- Example
Nursing
Systems

Wholly Is represented by the Patients under coma,

Compensat situation in which the anesthesia, with
ory individual is unable to carry fractures
out needed self-care actions, spinal dysfunctions,

Partly when the patient and nurse Patients with major

surgeries, and temporal
Compensa are both physically active in limitation of physical
meeting the patient’s self-
tory activity by casting
care needs
Supportive Represented by the person Clients wishing to
Educative has the capability to perform know
independently . about contraceptive
In either case, the person Methods, counseling
needs some manner of on breast feeding
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 Conti--

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 Conceptual framework of the theory

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 Three Steps by Orem versus Nursing
Process
Nursing Orem’s self care theory
process
ASSESMENT Step 1- collect information on 06 areas of assessment ( The
persons health status, the persons perspective of his
health , the persons health goals in the context of , the
persons requirements , the persons capacity/ agency/ ,
medical problem and plan,

NURSING Step 2. design nursing system that is wholly or partly

DIAGNOSIS, compensatory or supportive education, plan for
PLANNING
therapeutic self care demand
Implementation Step 3. A nurse assists a patient or family in self care
Evaluation matters
 actions are identified based on etiologic component on
nursing matters
 evaluation of the plan.

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 Principles of the theory
• These statements are foundational to theory and serve
as the basis for theory testing and theoretical
application to practice
Principles self –care Theory
 Self-care is intellectualized as a human regulatory
function
 Its concreteness is directed and deliberate that is
responsive to persons’ knowing of how human
functioning and development .
 Self care that is performed over time can be
understood (intellectualized)
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 Principles of self –Care Deficit Theory

 Persons who take action to provide their own self-care or

for dependents have specialized capabilities for action

 The individual‘s abilities to engage in self care or

dependent care are conditioned by age, developmental
status, health status etc..

 Nursing is a legitimate service

 The relationship between care abilities and care demand can

be defined in terms of equal to, less than, more than
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 Principle of Nursing system theory
• Nurses relate to and interact with persons who occupy the
status of nurse’s patient.
• Nurses determine valid and reliable solutions for meeting
self care requests.
• The action of nurses and patients constitute nursing system.
• Nurses and patients act together to allocate in the
production and in the regulation of patients’ self care
capacities.

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 Major assumptions of orem’s theory
Orem (1991) described several sets of general
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

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 conti…

• Successfully meeting universal and development self-

care requisites is an important component of primary
care prevention and ill health.
• A person’s knowledge of potential health problems is
necessary for promoting self-care behaviors.

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 Meta-paradigm
Person (Man):

• Man is the total being who can function biologically,

symbolically and socially….

• Man is self-reliant and responsible for self-care and

wellbeing of his or her dependents.

• Man is a logical organism with rational powers.

• patient is an individual who is in need of assistance in

meeting specific health-care demands because of lack of
knowledge, skills, motivation, or orientation.
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 Conti-
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 patient, physicians and nursing
perspectives of patient condition
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 Conti,…

• Encompass a wide range of nursing agency

• Goal of nursing – to render the patient or
members of his family capable of meeting the
patient’s self care needs.

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 Conti-
Health
• State of wholeness or integrity of the individual human
beings, his parts, and his modes of functioning
• This concept is inherent in her nursing systems since
the goal in each system is optimal wellness relative to
that system.
• Responsibility of a total society and all its members.

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 Conti-
Environment
• Encompasses the elements external to man but she
considered man and environment as an integrated
system related to self-care.
• Environment components are enthronement factors,
elements, conditions, and developed environment

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 Strengths and Limitations Orem's Theory

Strengths
 It provides a comprehensive base to nursing practice
 Specifies when nursing is needed and expanded her
focus of individual self care to include multi person
units
 has utility on the nursing practice ,nursing curricula
,nursing education administration ,and nursing research

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 Limitation
• In general system theory a system is viewed as a single
whole thing while Orem defines a system as a single whole,
thing.
• Although the family, community and environment are
considered in self care action, the focus is primarily on the
individual.
• Health is often viewed as dynamic and ever changing

• Appears that the theory is illness oriented rather with no

indication of its use in wellness settings.

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 Importance of the theory
A) Nursing practice
• Many articles document the use of the self-care theory as a
basis for clinical practice.
• Orem’s self-care deficit theory has been used in the context
of the nursing process
B) education
• Orem’s self-care deficit theory has been the focus of the
curriculum in nursing education at many schools of nursing.

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 conti
C) Research
• The self-care theory provided conceptual
framework for many researches.
Ex
 Self-care requirements for activity and rest:
an Orem nursing focus
 Orem's theory in practice. Hospice nursing
care

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Applying Orem’s self-care deficit
theory of nursing to continence care
 Base line data
Name- Demeke Ambachew
Age- 30 years old
Sex- Male
Occupation- Farmer
Marital status- married
Religion- orthodox Christian
Dx. – Tibular Fracture
Theory applied- Orem’s theory
 Case history
• He came to Debre-tabor general hospital with
complaints of pain, loss of function ,deformity
of extremity, oedema on right lower leg after
sustaining crashing force accident .
• He was apparently healthy before this injury.
• He was unable to do ADL by him-self after
injury
 Assessment using Orem's model
1) Heath care status the patient
• Health status –acutely ill due to fracture
• Socio-cultural orientation- no formal education

• Health care system- institutional health care

• Family system- married, farmer and lead the home
• Patterns of living- at home with partner
• Environment- rural area, items for activity of daily living
not easy
• Perception of his health status – Severely ill
 2) Universal self care requisites
• Air- breath without difficulty
• Water- fluid intake sufficient
• Food- loss appetite , non nutritious food intake
• Elimination- Can void, but assisted
• Activity/rest- Impaired activity, rest is required
due to pain, deformity over there
• Social interaction- communicates well, good
• Prevention of hazards- needs counsel on bed
rest, on diet, on immobilization
 3) Developmental self-care requisites
Maintenance of developmental environment
 sociable, able to communicate
 Impaired performance of daily activity
 Disturbed self image
 Free of any risk personal behaviors.

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 4) Health deviation self care requisites'

• Adherence to medical regimen- he needs continuity of

care and cooperates with the medicines
• Not much aware about the treatment options for his
problem
• Not aware about the side effect of the management
• Needs counseling about body self image modification
until healing
 5) Medical problem and plan

• medical diagnosis- right leg tibular fracture

• medical Treatment- immobilization using cast
application, anti-pain( Tramadol 50 mg Iv TD)
• Supportive therapy- Physiotherapy and
Nutritional
6. Areas of inadequacy ( self care demand and agency

• Food Intake –Imbalanced

• Elimination- assisted elimination
• Activity- frequent rest is required, activity level has
come down , pain is not completely removed
• Activity of daily living- impaired

• stress and coping- He feels stressed.

Self care agency/ ability - inadequate

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 Nursing diagnosis
• Altered self care activity related to injury of
the arm and leg
• Acute pain related to fracture
• Disturbed body self image related to injury .
• Lack of knowledge about disease condition
re/to patient verbalization
 Outcome and plan
The patient needs whole compensatory care such as
 Relieve pain,
 Improve dieting
 Improved nutrition
 Improve self image
• Method of helping
 Teaching , counseling
 Treating
 Immobilizing him for short period of time .
 Implementation
• Teaching
• Treating pain
• Assisting in dress, bath, toileting,
• Immobilizing the patient with cast…
 Evaluation
• The pt. understood importance the best
treatment options
• The patients self image improves
• The patients self care activities improved.
• He verbalized that “I will take proteinous diet”

• He stated that relative pain free period

 Acknowledgment
• Our deepest gratitude and appreciation goes to
our instructor Gebre. y( Asst professor, PHD
fellow ) for his excellent teaching skill &
guidance on the course theoretical foundation
of nursing and for giving this chance to
present nursing theory

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 Summary
• Orem describes nursing as a creative effort of one human
being to help another human being
• Orem’s general self care deficit theory of nursing has
three interrelated theories.
• The general Self care deficit theory is composed of six
basic concepts
• Orem’s theory is applied in various models of practice
and education.
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 References
• Alligood, M.R. & Tomey, A.M. (2010).Nursing Theory
Utilization and Application(4th ed.).St. Louis, Missouri:
Mosby.
• George, J. B. (2011).Nursing theories: The base for
professional nursing practice(6thed.) Boston: Pearson
• Parker, M. (2001).Nursing Theories and Nursing
Practice. Philadelphia: F. A. Davis.
• Taylor, S.G. (2006). Dorthea E. Orem: Self-care deficit
theory of nursing
• Tomey. M.A. & Alligood, M.R. (2010).Nursing
Theorists and Their Work (7th ed.). St. Louis, Missouri:
Mosby.
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