Nursing Philosophies

Martha Rogers
Dorothea Orem
Imogene King
Myra Levine

Martha Rogers Dorothea Orem Imogene King Myra Levine

Unitary Human Beings Self-Care De Goal Attainment Theory Conservation Theory
f
Dorothea Orem
Self-Care De icit Theory

— Bachelor of Science degree in Nursing Education & Master’s of

Science degree in Nursing Education from Catholic University of
America (CUA)

— Nursing experiences: operating room nursing, private duty

nursing (home and hospital), hospital sta nursing on pediatric
and adult medical and surgical units, evening supervisor in the
emergency room, and biological science teaching.
f
ff
Self-Care De icit Theory
Dorothea Orem's Self-Care De icit
Theory proposes that patients have the
innate ability and responsibility to care
for themselves.

A nurse's role goes beyond tending to patients'

physical needs; it involves supporting them on
their journey to regain independence.
f
f
 The self-care de icit theory is a general theory composed of the following
4 related theories:

1. The theory of self-care — why and how people care for themselves

2. The theory of dependent-care — how family members and/or friends

provide dependent-care for a person who is socially dependent

3. The theory of self-care de icit — which describes and explains why people
can be helped through nursing

4. The theory of nursing systems —which describes and explains relationships that must be brought
about and maintained for nursing to be produced
f
f
MAJOR CONCEPTS & DEFINITION
Self-care comprises the practice of activities that maturing and mature persons initiate and
perform, within time frames, on their own behalf in the interest of maintaining life, healthful
Self-care functioning, continuing personal development, and well-being by meeting known requisites for
functional and developmental regulations.

Dependent-Care
Care that is provided to a person who, because of age or related factors, is
unable to perform the self-care needed to maintain life, healthful functioning,
continuing personal development, and well-being.
 MAJOR CONCEPTS & DEFINITION
Actions to be performed that are known to be necessary in the regulation
Self-Care Requisites of an aspect of human functioning and development.

Universal Self-Care Requisites Developmental Self-Care Requisites Health Deviation Self-Care Requisites
8 Self-Care Requisites: — supporting growth & development throughout life
Health deviation self-care requisites exist for
1. Air Three sets of DSCRs have been identi ied:
persons who are ill or injured, who have speci ic
2. Food 1. Provision of conditions that promote development
forms of pathological conditions or disorders,
3. Water 2. Engagement in self-development
including defects and disabilities, and who are
4. Elimination processes and excrements 3. Prevention of or overcoming e ects of human
under medical diagnosis and treatment.
5. Balance between activity and rest conditions and life situations that can adversely

6. Balance between solitude and social a ect human development

interaction
7. Prevention of hazards to human life
8. Promotion of human functioning and
development
within social groups and the human desire to
be normal Family creating a nurturing and stable
home environment for a child.
ff
ff
f
f
MAJOR CONCEPTS & DEFINITION
Therapeutic Self-Care Demand
Therapeutic self-care demand consists of the summation of care measures
necessary at speci ic times or over a duration of time to meet all of an
individual’s known self- care requisites.

Therapeutic Self-Care Demand is performed by the individual (self-care agent).

Dependent-Care Demand
Dependent-care demand is the summation of care measures at a speci ic point
in time or over a duration of time for meeting the dependent’s therapeutic self-
care demand when his or her self-care agency is not adequate or operational.

Dependent-Care Demand is performed by a caregiver (dependent-care

agent) for someone who cannot do it themselves.
f
f
MAJOR CONCEPTS & DEFINITION

Self-Care Agency
— is the human’s ability or power to engage in self-care
and is affected by basic conditioning factors.

Dependent-Care Agency
— refers to the acquired ability of a person to know and meet the
therapeutic self-care demand of the dependent person and/or
regulate the development and exercise of the dependent’s self-
care agency.
MAJOR CONCEPTS & DEFINITION

Self-Care De icit
The individual cannot meet their own self-care needs due to
physical or mental limitations and requires external support or
nursing care.

A 62-year-old patient has su ered a stroke, which has left them with limited mobility on the left side of their body
and di iculty speaking (aphasia). As a result, they are unable to perform many basic self-care activities.

Dependent-Care De icit
The caregiver cannot adequately meet the self-care
needs of a dependent person and requires assistance,
training, or resources to provide proper care.

An 8-year-old child with cerebral palsy (CP) is dependent on their parents for daily care. The child has limited motor
function and cannot walk, feed, or dress themselves independently.
ff
f
ff
f
MAJOR CONCEPTS & DEFINITION

Nursing Agency
— Nursing agency comprises developed capabilities of persons educated as nurses.
— To help persons meet their therapeutic self- care demands.
— Nursing agency also incorporates the capabilities of nurses to assist persons who provide dependent-care to
regulate the development or exercise of their dependent-care agency.
MAJOR CONCEPTS & DEFINITION

Nursing Design
— Refers to the plan or framework that
nurses develop to guide their care for
patients with self-care de icits.

— The purpose of nursing design is to provide

guides for achieving needed and foreseen
results in the production of nursing toward
the achievement of nursing goals; these units
taken together constitute the pattern that
guides the production of nursing.
f
MAJOR CONCEPTS & DEFINITION

Helping Methods
— Sequential series of actions that will overcome or
compensate for the health-associated limitations of
individuals
• Acting for or doing for another
• Guiding and directing
• Providing physical or psychological support
• Providing and maintaining an environment that supports
personal development
• Teaching
MAJOR CONCEPTS & DEFINITION

Basic Conditioning Factors

Basic conditioning factors condition or a ect the value of the therapeutic self-care demand and/or the self-care
agency of an individual at particular times and under speci ic circumstances.

• Age
• Gender
• Developmental state
• Health state
• Pattern of living
• Health care system factors
• Family system factors
• Sociocultural factors
• Availability of resources
• External environmental factors
ff
f
 The Three Basic Nursing Systems

The wholly compensatory nursing system

— the individual is unable “to engage in those self-care actions requiring self-
directed and controlled ambulation…” Persons with these limitations are socially
dependent on others for their continued existence and well-being.

The partly compensatory nursing system

—“both nurse and patient perform care measures or other actions involving
manipulative tasks or ambulation… [Either] the patient or the nurse may have the
major role in the performance of care measures.”

The supportive-educative system

— also known as supportive-developmental system
—the person “is able to perform or can and should learn to perform required measures of externally or
internally oriented therapeutic self-care but cannot do so without assistance.”
Example: Nurse guides a mother how to breastfeed her baby, Counseling a psychiatric client on more
adaptive coping strategies.
1. Wholly Compensatory
◦ Feeding a patient who is unconscious.
◦ Turning and repositioning a bedridden.
◦ Performing all hygiene care (bathing & oral care) for a patient with advanced paralysis.
◦ Ventilator management for a patient with respiratory failure.
2. Partially Compensatory
◦ Assisting a post-operative patient in walking while they regain strength.
◦ Helping a patient with limited mobility to dress or bathe.
◦ Providing set-up assistance for meals to a patient who can feed themselves.
◦ Guiding a patient with mild dementia to remember daily hygiene routines.
3. Supportive-Educative
◦ Teaching a diabetic patient how to monitor blood glucose levels and administer insulin.
◦ Educating a patient about wound care and infection prevention.
◦ Providing dietary counseling to a patient with hypertension.
◦ Supporting a patient with asthma by teaching them how to use an inhaler correctly.
◦ Teaching lifestyle changes to promote long-term heart health.
 Self-Care - all activities that individual’s
initiate and perform to maintaining life, health
and well being.

Self-Care Agency: The

individual's ability to
perform self-care. This is
Therapeutic Self-Care
in luenced by factors like
Demand is performed by
age, developmental state,
the individual (self-care
health, and environmental
agent).
conditions.
f
 CLARITY The terms Orem used are de ined precisely.

Orem’s theory is expressed in a limited number of terms. These terms are

SIMPLICITY de ined and used consistently in the expression of the theory.

GENERALITY A review of the research and other literature attests to the generality of the theory.

As a general theory, the SCDNT provides a descriptive explanation of why persons

ACCESIBILITY require nursing and what processes are needed for the production of required nursing
care.

The signi icance of Orem’s work extends far beyond the development of the SCDNT. In her
IMPORTANCE works, she provided expression of the form of nursing science as practical science, along with a
structure for ongoing development of nursing knowledge in the stages of theory development.
f
f
f