Nursing 510

Dot 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)

 Diedin 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)
 AssistantProfessor 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

 1971First 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 herself
Tenants are that human beings are powerful
agents to act on their own behalf
Determinism 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.
 Oremidentified 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 practice
Limitations:
 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)
 PracticeReflection included:
Concern for care of elderly
Role 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 management
Hospice care
Care 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.
 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.