Dorothea Orem’s ppt

1MA.ESTRELLA LENA M. PUSAG R.N.

1914- Baltimore, Maryland Early 1930’s – Providence School of

Nursing, washington, D.C. 1939- BSN completed 1945- MS in nursing education 1958- consultant to the Office of

Education where she began working on her Self-Care Theory


1959- first published her theory in “Guides for Developing Curricula for the Education of Practical Nurses” (a government publication)

1976- honorary Doctorate of Science from Georgetown University

1999- last edition of her theory was published


Is the provision of self-care which is therapeutic in sustaining life and health, in recovering from disease or injury, or coping with their effects

Is a service to people, not a derivative of medicine

Is to promote the goal of patient self-care.


human beings environment health nursing


› Person: An individual with physical and emotional requirements for development of self and maintenance of their well-being.

› Environment: Client’s surroundings which may affect their ability to perform their self-care activities.

› Health: “Structural and functional soundness and wholeness of the individual” (Orem 1991).

› Nursing: The acts of a specially trained and able individual to help a person or multiple people deal with their actual or potential self-care deficits.


is the ability to perform activities and meet personal needs with the goal of maintaining health and wellness of mind, body and spirit.is a learned behaviour influenced by the metaparadigm of person, environment, health and nursing.Three components:

universal self care needsdevelopmental self care needshealth deviation

MA.ESTRELLA LENA M. PUSAG R.N. 8

› This includes activities which are essential to health and vitality.

› Eight elements include: air, water, food, elimination, activity and rest, solitude and social interactions, prevention of harm, and promotion of normality.


› These include the interventions and teachings designed to return a person to or sustain a level of optimal health and well being.

› Examples can include such things as toilet training a child or learning healthy eating.


› This encompasses the variations in self care which may occur as a result of disability, illness, or injury.

› In other words the person with a variation is meeting self care and maintaining health and wellness in a more individualize meaning.


› Every mature person has the ability to meet self care needs, but a self care deficit exists when a person experiences the inability to do so due to limitations.

› A person benefits from nursing intervention when a health situation inhibits their ability to perform self care or creates a situation where their abilities are not sufficient to maintain own health and wellness.

› Nursing action focuses on identification of limitation/deficit and implementing appropriate interventions to meet the needs of person.


Persons who take action to provide their own self-care or care for dependents have specialized capabilities for action.

The individual’s abilities to engage in self-care or dependent care are conditioned by age, developmental state, life experience, sociocultural orientation, health, and available resources.

The relationship of individual’s abilities for self-care or dependent care to the qualitative and quantitative self-care or dependent-care demand can be determined when the value of each is known.


The relationship between care abilities and care demand can be defined in terms of equal to, less than, more than.

Nursing is a legitimate service wherein: › (a) care abilities are less than those required for

meeting a known self-care demand [a deficit relationship]

› (b) self -care or dependent-care abilities exceed or are equal to those required for meeting the current self-care demand, but a future deficit relationship can be foreseen because of predictable decreases in care abilities, qualitative or quantitative increases in the care demand, or both.

Persons with existing or projected care deficits are in, or can expect to be in, states of social dependency that legitimate a nursing relationship.


› The ability of the nurse to aid the person in meeting current and potential self care demands.

› Focused on person › Three support modalities identified in

theory including: total compensatory, partial compensatory, and educative/supportive compensatory.

› The client’s ability for self care involvement will determine under which support modality they would be considered.


Nurses relate to and interact with persons who occupy the status of nurse’s patient.

Legitimate patients have existent and projected continuous self-care requisites.

Legitimate patients have existent and projected deficits for meeting their own selfcare requisites.

Nurses determine the current and changing values of patient’s continuous self –care requisites, select valid and reliable processes or technologies for meeting these requisites, and formulate the courses of action necessary for using selected processes or technologies that will meet identified self-care requisites.


Nurses determine the current and changing values of patient’s abilities to meet their self-care requisites using specific processes or technologies.

Nurses estimate the potential of patients to › a) refrain from the engaging in self-care for therapeutic

purposes or › (b) develops or refine abilities to engage in care or in

the future.

Nurses and patients act together to allocate the roles of each in the production of patients’ self-care and in the regulation of patients’ self-care capabilities.

The actions of nurses and the actions of patients that regulate patients’ self-care capabilities and meet patients’ therapeutic self-care needs constitute nursing systems.


Total compensatory support encompasses total nurse care- client unable to do for themselves.


› Partial compensatory support involves both the nurse and the client sharing in the self care requirements.


Educative/supportive compensatory support elicits the help of the nurse solely as a consultant, teacher or resource person. Client is responsible for their own self care.


› The nurse’s role in helping the client to achieve or maintain a level of optimal health and wellness is to act as an: Advocate Redirector support person and teacher

to provide an environment conducive to therapeutic development


In order to help explain this concept, Orem also created three areas of how care can be administrated to a client depending on the physical and mental capabilities of the client. Wholly compensatory, partly compensatory and supportive-educative role

Bedridden oncology patient arrives via ambulance for chemotherapy. Family insists upon keeping patient at home; however, leaves patient alone with nurse in chemo clinic for treatment. Patient requires O2 at 2L/min, continuous tube feeding at 90cc hour, foley catheter, bedpan. Nurse in clinic administers chemo premeds and chemo; changes dressing around g-tube due to leaking; administers O2 at 2L; empties Foley at end of treatment; places patient on bed pan one time.

Preterm labour patient regularly visits clinic for BP monitoring, etc. Patient on bed rest (at home), except for weekly visit to module. Nurse assists patient out of wheel chair into bathroom, assists with urine sample collection, and onto exam table. Nurse administers injection of terbutaline and educates patient regarding oral terbutaline.

Newly diagnosed diabetic patient received diabetic care teaching while in hospital. Now, patient visits module and reports highly variable BS/chemstrip readings. Nurse suspects patient may be performing procedure incorrectly. Nurse assesses that patient has been cutting some of his chemstrips in half to save money. Nurse instructs patient that cutting strips exposes chemicals and inaccurate readings may result. Additionally, nurse assesses that patient's wife (who does family cooking) did not receive any nutritional education while patient was hospitalized. Nurse begins nutritional counseling and provides wife with referral to nutritional services department.


It is believed that Orem’s theory portrays the idea that nursing is the ability to care for another, especially when they are unable to care for themselves. This corresponds to our philosophy of caring for person with the goal of achieving optimal level of health and wellness.

Dorothea Orem’s ppt

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