OREM’S THEORY OF NURSING

Dorothea Orem,1971, Developed a definition

of Nursing which emphasizes the client’s self
care needs. She defines self care as a
learned,goal oriented activity directed toward
the self in the interest of maintaining
life,health,development & well being. The goal
of this theory is “To Help The Client To
Perform Self Care.”
The goal of Nursing is To Increase The
Client’s Ability To Independently meet All The
Needs.
 DESCRIPTION
Acc. To Orem,”Nursing has special concern
about individual’s need for self care action
provision & management of it on a continues
basis in order to sustain life & health, recover
disease or injury, & cope with their effects.”
Orem develops her general theory of nursing
in 3 related parts:-
a) Self Care
b) Self Care Deficit
c) Nursing Systems
 THEORY OF SELF CARE
It includes self care,self care agency &
therapeutic self care demand as well as
self care requisites.
Self care is practice of activities which
individuals initiate & perform on their own
behalf in order to maintain life, health &
well being.
Self Care Agency is human ability for
engaging in self care conditioned by age,
developmental state,life exp,health etc
Therapeutic Self Care Demand is
totality of self care actions to be
performed for some duration to meet self
Contd…

3 Categories of self care requisites

are:-

 Universal

 Developmental

 Health Deviation
Contd…
UNIVERSAL:- Associated with life processes
& maintenance of integrity of human
structure & functioning. They are common
to all for eg sufficient intake of
air,water,food,elimination process, balance
between activity and rest ,prevention of
hazard to human life and well being etc
DEVELOPMENTAL:- Related to
developmental processes or derived from
some condition or event.eg- adjusting to a
new job or adjusting to body changes.
Contd….
• HEALTH DEVIATION:- Required in
conditions of illness, injury or disease
which required to be diagnosed &
correction of the condition.These include
seeking appropriate medical assistance,
being aware of and attending to the effects
and results of pathologic condition,
carrying out medically prescribed
measures and learning to live with effects
of pathologic condition.
 THEORY OF SELF CARE
DEFICIT
It is the core of Orem’s theory. It explains nursing is
needed when a adult is incapable or limited in the
provision of continous effective self care. Nursing
action focuses on identification of limitation/deficit
and implementing appropriate intervention to meet
the need of the person.
Secondly nursing is required when an
adult or in the case of dependent i.e. the parent is
incapable or limited in the provision of continous
effective self care.
In this Orem’s identifies 5 methods of
helping:-
 Acting for or doing for another.
 Guiding or directing others.
 Supporting (physical and psychological)
 Providing environment which promotes
personal development to meet future
demands for action.
 Teaching another
CONCEPTUAL FRAMEWORK
FOR NURSING
SelfssCare

Therapeutic
Self Care Self Care
Agency Demand

Nursing
Agency
 Orem’s Five Areas Of Activity For
Nursing Practice Are:-
Entering into and maintaining nurse
patient relationship with indivdual
family,orgroups
Determining if and how patients can
be helped through nursing
Responding to patients requests,
desires and needs for nurse contacts
and assistance
Prescribing, providing and regulating
direct help to patient and their
significant others in form of nursing
Coordinating and integrating social
and educational nursing services
with the patient daily living, other
health care needed or care provided.
 Theory Of Nursing System
 It is based on self care needs
and the ability of patient to
perform self care activities.
 The three classification of
nursing system to meet self
care requisites are:-
Partly compensatory system
Wholly compensatory system
Supportive educative system
BASIC NURSING SYSTEMS
 WHOLLY COMPENSATORY
SYSTEM
It is represented by situation
in which individual is
unable to engage in those
self care actions which
require self directed &
controlled ambulation &
manipulative movement.
These persons are socially
dependent on others for
their existence like persons
in coma, with mental
retardation etc.
 PARTLY COMPENSATORY
SYSTEM
It is represented by situation
in which both nurse &
patient performs care
measures or other actions
involving manipulative tasks
or ambulation. In this either
nurse or the patient may
have the major role in
performance of care
measures e.g. patient with
recent abdominal surgery.
 SUPPORTIVE EDUCATIVE
SYSTEM
In this the person is able to
perform or can perform &
should learn to perform required
measures of externally or
internally oriented therapeutic
self care but cannot do so
without assistance. Also
patient’s requirements for help
are confined to decision
making, behavior control &
acquiring knowledge &
skills.And nurses role is to
promote patient as self care
agent.
 Design and elements of nursing
system :-
1. Itnursing
defineresponsibilities in
health care situation
2. General and specific roles of
nurses and patients
3. Reasons for nurses
relationship with patients
4. Kinds of action to be
performed and performance
Patterns and nurses and
patient action in regulating
pt self care agency and
meeting self care demand
•Orem recognized that specialized technologies
are usually developed by members of the health
profession
•A technology is systematized information about
a process or a method for affecting some desired
result through deliberate practical endeavor ,with
or without use of materials or instruments
 Categories of technologies

      Social or interpersonal

•  Communication adjusted to age, health status
•  Maintaining interpersonal ,intragroup or
intergroup relations for coordination of efforts
•  Maintaining therapeutic relationship in light of
psychosocial modes of functioning in health and
disease
•  Giving human assistance adapted to human
needs ,action abilities and limitations     
Cont..
Regulatory technologies
•Maintaining and promoting life processes

•Regulating psycho physiological modes of

functioning in health and disease
•Promoting human growth and development

•Regulating position and movement in space

 Overview
Dorothea PURPOSE: PERSON: Biopsychosocial
E Orem being capable of self care.
To provide Includes physical,
(1971) care & to psychological , interpersonal &
Nursing: assist the social aspects of human
Concepts client to functioning.
of attain self Env: External & Internal stimuli.
Practice. care. Requisites for self care have
their origins in human beings &
their env.
Health: State of wholeness.
Nursing: Creative effort of one
human being to help another.
Consists of 3 nursing systems:-
Wholly compensatory, partially
compensatory &
supportive/educative.
NURSING ( Acc.To Orem)
“Human service….a mode of
helping men, women &
children & not a tangible
comodity.” Nursing is
deliberate action,…a function
of practical intelligence of
nurses,…to bring about
humanly desired conditions in
persons & their environments.
The specialised abilities that
enable nurses to provide
nursing care to individuals is
termed as NURSING
AGENCY.
 OREM’S THEORY &
NURSING PROCESS
Orem’s approach to nursing process presents a
method to determine the self care deficits &
then to define the role of a person or nurse to
meet the self care demands.
 NURSING
COMPARISON
PROCESS OF OREM’S NURSING
PROCESS & NURSING PROCESSS
NURSING PROCESS OREM’S NSG PROCESS
 Assessment Step 1:- Diagnosis &
prescription, determine why
 Nursing diagnosis nursing is needed. Analyze
& interpret-make
judgements regarding care.
 Plans with scientific Step 2:- Design of nursing
rationale system & plan for delivery
of care.
 Implementation Step 3;- Production &
management of nursing
systems.
 Evaluation
Step 1- :- Diagnosis & prescription, determine why nursing is
needed.
collect data in six areas:
 The person’s health status
 The physician’s perspective of the person’s health status
 The person’s perspective of his or her health
 The health goals within the context of life history ,life style,
and health status
 The person’s requirements for self care
 The person’s capacity to perform self care
Step 2 Design of nursing system & plan for delivery of
care.
 Nurse designs a system that is wholly or partly
compensatory or supportive- educative.
The 2 actions are:-
 Bringing out a good organization of the
components of patients’ therapeutic self care
demands
 Selection of combination of ways of helping
that will be effective and efficient in
compensating for/ overcoming patient’s self care
deficits
Step 3 Production & management of nursing
systems.
Nurse assists the patient or family in self
care matters to achieve identified and
described health and health related results
collecting evidence in evaluating results
achieved against results specified in the
nursing system design
Actions are directed by etiology component
of nursing diagnosis
evaluation
 UTILITY OF OREM’S
THEORY
It has utility for
professional nursing
in areas of nursing
education, clinical
nursing practice,
nursing
administration &
nursing research.
APPLICATION OF THEORY TO PRACTICE

 Used as a philosophical guide to nursing practice

 Provide examples of nursing process using a case
study to develop a plan of care for an individual client in
many in- patient and out- patient
settings.
 It can be even extended to the use of family settings
and describe how parents can give care for children
with various self-care demands
 It can be used in community, when the community is
viewed as an aggregate of individuals with various self-
care demands
 APPLICATION IN NURSING EDUCATION

 Self-care framework has guided in the formation of

curriculum for nursing programs
 It facilitate the student in the development of
nursing care plans
 It can be used as a clinical assessment tool
 It helps the students to develop a contract of care
with the patient
 Application in Nursing Research

 Numerous master's theses and doctoral

dissertations have used the self-care framework as a
guide
 Self-care framework has guided a wide range of
research designs from psychometric studies to
experimental studies
 Most of the psychometric research has focused on
development of instruments to measure self- care
agency
 CONT…..
 Orem’s theory has been used as the basis for
the development of research instruments to assist
researchers in using the theory
 A self care questionnaire was developed and
tested by Moore(1995) for the special purpose of
measuring the self care practice of children and
adolescents
 The theory has been used as a conceptual
framework in degree programs (Fenner 1979) in
many nursing schools
 Application in Nursing Administration
 Self-care framework has been used as a basis
for patient classification system
 The model emphasizes changes in nursing
strategies as the patients health status changes
 It is used to guide development of measures of
the quality of nursing care
 The most innovative use in nursing
administration is the development of a computer
software package, professional care system for
nursing documentation
 Application of the Orem’s
theory
Examlpe:
to nursing process
For Mrs. X……
1.She came to the hospital with complaints of pain& stiffness
over all the joints, which is more in the morning and reduced by
the activities.
2. She has these complaints since 5 years and has taken
treatment from local hospital.
3. The symptoms were not reducing and came to –MC, Hospital
for further management.
4. Patient was able to do the ADL by herself but the way she
performed and the posture she used was making her prone to
develop the complcations of the disease.
5. She is also malnourished and is not aware about the
deficiencies and effects.
 DATA COLLECTION ACCORDING TO THE
OREM’S THEORY OF SELF CARE DEFECIT
BASIC CONDITIONING FACTORS
AGE 56 YEAR
Gender Female
Health State Disability due to health condition, not able to meet therapeutic
self care demand.
Development state Ego integrity vs despair
Sociocultural No formal education, Indian, Hindu.
orientation
Health care Institutional health care
system
Family system Married, Husband working.
Pattern of living At home with partner.
Environment Rural area, for ADL not in easy reach, no special precautions
to prevent injuries.
Resources Husband, Daughter, sister’s son.
 2. UNIVERSAL SELF CARE REQUISITIES
Air Breaths without difficulty, no pallor cyanosis
Water Fluid intake is sufficient.

Food Hb-9.6%, BMI=14. Food intake is not adequate or the

diet is not nutritious.
Elimination Voids and eliminated bowel without difficulty.
Activity/rest Frequent rest is required due to pain.
Pain not completely relieved,
Activity level has a come down.
Deformity of the joint secondary to the disease process.

Social interaction Communicates well with neighbours and interact with

daughter on phone need for medical care is
communicated to the daughter.

Prevention of hazards Need instruction on care of joints and prevention of falls.

Need instruction on improvement of nutritional status.
Promotion of normalcy Has good relation with daughter.
 DEVELOPMENTAL SELF CARE
REQUISITES
Maintenance of development
environmental
Prevention/management of
the conditions threatening the
normal development.
Able to feed self, difficult to
perform the dressing, toileting
etc.
Feels that the problems are
due to her own behaviors and
discuss the problems with
husband and daughter.
 4. HEALTH DEVIATION SELF CARE REQUISITES
Adherence to medical regimen
Awareness of potential problem
associated with the regimen
Modification of self image to incorporates Has adopted to limitation in mobility.
changes in health status
Reports the problems to the
physician when in the hospital. Co-
operates with the medication, not
much aware about the use and side
effects of medicines
Not aware about the actual disease
process.
No complaint with the diet and
prevention of hazards. Not aware about
the side effects of the medications
The adoption of new ways for activities
leads to deformities and progression of
the disease.

Adjustment of lifestyle to accommodate Adjusted with the deformities.

changes in the health status and medical Pain tolerance not achieved.
regimen
 5. MEDICAL PROBLEM AND PLAN
O Physician’s perspective of the condition:
Diagnosed with rheumatoid arthritis and is on the
following medications:
T. Valus SR OD
T. Pan 40 mg OD
T. Tramazac 50 mg OD
T.Recofix Forte BD
T. Shelcal BD
Syp. Heamup 2tsp TID
Medical Diagnosis: Rheumatoid arthritis
Medical Treatment: Medication and physical therapy.
 STRENGTHS
 She specified when nursing is needed.
 Included continuing education as part of
professional component of nursing education.
 Promoted concept of professional nursing, defined
roles of vocational, technical & professional nurses.
 Self care is comparable to holistic health,
promoting individual’s responsibility for health care.
 Expanded her focus of individual health care to
multiperson units.
 Emphasized the selection of one or more type of
nursing system for achieving the desired regulation
of patient’s self care agency & meeting their self
care requisites.
Contd…

 Recognized term client as regular

seeker of services & preferred the term
patient for one who is under care of
nurses, physicians or health care
providers.

 Defined system as a “ Single, Whole

Thing”
 LIMITATIONS
Some terms
need more
clarification i.e.
diagnosis,
prescription,
technologies,
therapeutic self
care demands.
 LIMITATIONS CONT……..

 Health is often viewed as dynamic and

ever changing .Orem’s visual presentation of
the boxed nursing systems implies three
static conditions of health
 Appears that the theory is illness oriented
rather with no indication of its use in wellness
settings
 a nk
T h
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