Nursing 510Dot DeAngelo

Dorothea Elizabeth Orem is one of America’s foremost nursing theorists.

She was born in Baltimore, Maryland. Her father was a construction worker & her

mother was a homemaker. She was the younger of two daughters.

(Tomey & Alligood, 2006)

Died in 2007 ending more than 50 years of devotion to the development and refinement of the Self-Care Deficit Nursing Theory

Providence School of Nursing in Washington D.C. receipt of diploma of nursing early 1930s

B.S.N. from Catholic University of America in 1939

M.S. in nursing education in 1945 Receive honorary Doctor of Science and Doctor

of Humane Letters Awards and recognition are many. A few

examples include: CUA Alumni Association Award for Nursing Theory, Linda Richards Award, National League for Nursing and Honorary Fellow of American Academy of Nursing. (Tomey& Alligood 2006)

Early experience included private duty nursing, hospital staff nursing and teaching.

Career has included administrative positions in schools of nursing, universities and hospitals,

Leadership roles, educator, consultant, researcher, writer.

(Tomey & Alligood, 2006)

Began between 1949 and 1957:Worked for the Indiana State Board of Health Division of Hospital

Goal of upgrading the Quality of Nursing in general hospitals

During this time she contemplated and developed her definition of nursing practice and concept of nursing in relation to self-care.

While working as a Curriculum Consultant for the U.S. Dept. of Health, Education, and Welfare (1959) Impetus for Orem’s theory

Addressed the question: “What is the subject matter of nursing?”

Isolated and specified nursing actions. Identified need for proper focus and

clarification of domains of nursing. Continued ideas of self care

(Parker, 2006)

Assistant Professor of Nursing at Catholic University of America and Acting Dean of the School of Nursing

During this time she continued to develop her concepts of nursing and self-care

1971 First published book was Nursing: Concepts of Practice. Subsequent editions published in 1980, 1985, 1991, 1995, and 2001

Philosophical view as “Moderate realism” by Banfield and Orem herselfTenants are that human beings are powerful agents to act on their own behalfDeterminism and causability

Action theory Person as deliberate actor or agent

Concepts of speculative and practical science

(Meleis, 2007)(Tomey &Alligood, 2006)

Components: Systems theory, interaction model, or

developmental theory Needs theory of Henderson Functional theory of Abdellah, Beland,

Martin,& Matheney. Orem’s Theory Unique; extensions and

development(Meleis, 2007)

Two Parts: Orem’s SCDNT demonstrates that human

beings are continually making deliberate efforts to maintain life and to function in an appropriate manner (self- care).

When care of self or a designated group is not adequate, nurses interact with those in need using specific processes, to develop and design guidelines and methods to support and achieve positive health outcomes.

Orem identified self-care as a human need and nursing as a human service.

Focuses on nursing’s special concern for individuals’ needs for self-care and their capabilities for meeting these needs on a continuous basis to sustain life and health or to recover from disease and injury.

(Orem,2001)(Parker, 2006)

Orem describes her self-care deficit theory of nursing as a general theory composed of the following three related theories:

1) The theory of self-care, which describes why and how people care for themselves

2) The theory of self- care deficit, which describes and explains why people can be helped through nursing

3) The theory of nursing systems, which describes and explains relationships that must be brought about and maintained for nursing to be produced

(Orem 2001)(Tomey,2006)

Concepts: Self-care Self-care agency, agent, dependent-care

agent Therapeutic self-care demand, self-care

deficit, nursing agency, and nursing systems, helping systems

(Current Nursing.com, 2008)

REQUISITES:

Universal self-care requisites

Developmental self-care requisites

Health deviation self-care requisites

Adequacy Comprehensive view and framework for

nursing practiceLimitations: appears illness oriented Adult care oriented visual presentation of the boxed nursing system

implies three static conditions of health rather than dynamic (Tomey, 2006) (Meleis,2007)

Clarity & Consistency Terms precisely defined and language of

theory is consistent. No created words. Congruent throughout.

Relationship between and among component theories and entities can be presented in a simple diagram.

(Tomey, 2006) (Meleis,2007)

Logical Development Orem developed propositions linking theory

concepts and addressing at least two of the central concepts of nursing

Began as a needs and functional approach Incorporates medical model Initially developed to guide curricula,

expanded as nursing therapeutic theory to guide multiple nursing practice areas.

Continued to be revised, refined, extended (Parker, 2006) (Meleis, 2007)

Level of Theory Development

Development of research instruments to measure Orem’s theoretical concepts have enabled testing of elements of the SCDNT

SCDNT being used to guide research programs to identify self-care requisites and self care behaviors of specific clinical populations

Theory being used to identify self-care requisites and self care capabilities, and relationships to other characteristics such as self concept.

(Parker, 2006)

SCDNT has potential to make difference in lives of people are affected by acute or chronic conditions with limited self-care abilities.

Focus of health care on wellness and community will need extensions and refinement of SCDNT

Prevention & health promotion efforts need expanded method to identify self-care deficits i.e. health benefits/assets , resources, etc.

Theory promotes “partner” in care but elements of patient as dependent persist in theory

(Meleis,2007)

Used world wide in practice, research, administration

Cross cultural utility noted “Individualism” concept prevalent in U.S.

may be a constraint for use in other cultures.SCDNT may benefit with adaptations to meet needs of use in other cultures.

(Meleis,2007)

Practice Reflection included:Concern for care of elderlyRole of nurse and need to be prepared to meet patients’ complex needs—

physical, emotional, psychological, developmental

Respect of individuals and emphasis on each individual’s self worth.

Practice Problem: Care of older adults presents special

challenges in nursing. Promoting optimum level of health and

functioning is a priority of care for the elderly across all health care setting, including palliative and hospice care.

Multiple factors may limit older adults’ ability to care for themselves and maintain an optimum level of health: normal age related changes, chronic and acute health conditions, social, & psychological factors.

Selected articles include Orem’s Self Care Deficit Theory of Nursing in research related to the care of older adults.

Topics include:Urinary incontinence managementHospice careCare of home dwelling elderly

Urinary incontinence represents a decrease in functional level for many older adults.

Significant social problem and affects ability for self care.

Use of Orem’s Self-Care Deficit Theory of Nursing is used to guide nursing practice.

Bernier, F. (2002). Relationship of pelvic floor rehabilitation program for urinary incontinence to Orem’s self-car deficit theory of nursing: part 1. Urologic Nursing, 22 (6), 378-391.

Hospice or palliative care is often needed for the care of the elderly.

Increasing involvement of patients and families in healthcare decision making, choice of care, and self-care.

Focus of nursing care is to support the strengths of the client and family

Case study demonstrates use of Orem’s Theory in provision of nursing care.

Laferiere, R.H. (1995). Orem’s theory in practice: Hospice nursing care. Home Healthcare nurse 13(5), 50-54.

(Laferriere, 1995)

Many elderly continue to live and function in their own homes.

Studies that identify factors that may positively impact or influence the ability to stay at home are important.

Principles of Orem’s SCDNT may be used in this effort.

Soderhamn,O., Lindencrona, C., & Ek, A. (2000). Ability for self-care among home dwelling elderly people in a health district in Sweden. International Journal of Nursing Studies, 37,361-368.

Bernier, F. (2002). Relationship of pelvic floor rehabilitation program for urinary incontinence to

Orem’s self-car deficit theory of nursing: part 1. Urologic Nursing, 22 (6), 378-391.

Current Nursing (2008). http://currentnursing.com/nursing_theory/self_care_deficit_theory.htm Retrieved October 12,2009

Laferiere, R.H. (1995). Orem’s theory in practice: Hospice nursing care. Home Healthcare nurse 13(5), 50-54.

Marriner-Tomey & Alligood, M.R (1998). Nursing theorists and their work (6th ed.). St. Louis Missouri: Mosby-

Year Book, Inc.

Meleis, A.I. (2007). Theoretical nursing: Development & progress (4th ed.). Philadelphia: Lippincott Williams & Wilkins.

Orem, D. (2001). Nursing: Concepts of practice (6th ed.). New York: McGraw Hill.

Parker, M.E. (2006). Nursing theories & nursing practice (2nd ed.). Philadelphia: F.A. Davis Company.

Soderhamn,O., Lindencrona, C., & Ek, A. (2000). Ability for self-care among home dwelling elderly people in a health district in Sweden. International Journal of Nursing Studies, 37,361-368.