Dorothea E. Orem Self – Care Deficit Theory 7.

Prevention of hazards to human life, human

functioning, and human well – being
- She was born in Baltimore, Maryland in 1914. 8. Promotion of human functioning and development
- began her nursing career at Providence Hospital
School of Nursing in Washington, D.C., where she Developmental Self – Care Requisites:
received a diploma of Nursing in the early 1930s 1. Associated with developmental processes, derived
- later received her BS in Nursing from the from a condition, or associated with an event.
Catholic University of America in 1939. In 1946, 2. The following are actions to be undertaken that will
she received an MS in Nursing Education. provide developmental growth:
- She also held the directorship of both the  Provision of conditions that promote development
nursing school and the department of nursing at
 Engagement in self – development
Providence Hospital in Detroit.
 Prevention of the effects of human conditions that
Orem’s Model threatens life

 “Ordinary people in contemporary society want to be

Health Deviation Requisites:
in control of their lives” (Black, 2014)
 Required in conditions of illness, injury, or disease.
Assumption:
These includes:
 Normal people who live in the community want to
remain as independent and in control as possible. a) Seeking and securing appropriate medical assistance
 Individuals are responsible for their own care. b) Being aware of and attending to the effects and
 Formalized three nursing theories which are results of pathologic conditions
interconnected into one model (Black, 2014) c) Effectively carrying out medically prescribed
1. Theory of Self – Care measures
2. Theory of Self – Care Deficit d) Modifying self-concepts in accepting oneself as being
3. Theory of Nursing Systems in a particular state of health and in specific forms of
4. health care
I. Theory of Self – Care e) Learning to live with effects of pathologic conditions
a) Self-Care – The practice of activities that individuals II. Theory of self – care deficit
initiate and perform independently. The practice of  Specific when nursing is needed because the person
taking action to preserve or improve one’s own cannot carry out self – care.
health.  Nursing is required when an adult (or in the case of a
b) Self-Care Agency – It is the skill to initiate or perform dependent, the parent) is incapable or limited in the
health activities in order to maintain one’s life, provision of continuous effective self – care.
 Orem identified 5 methods of helping:
health, and well – being.
1. Acting for and doing for others
c) Therapeutic Self – Care Demand – “Totality of self – 2. Guiding others
care actions to be performed for some duration in 3. Supporting another
order to meet self – care requisites by using valid 4. Providing an environment to promote patient’s ability
methods and related sets of operations and actions”. 5. Teaching another
d) Self-Care Requisites – Actions directed towards
provision of self – care. III. Theory of Nursing Systems
 Describes how the patient’s self – care needs will be
3 Categories of Self – Care Requisites: met by the nurse, the patient, or both.
 Identifies 3 classifications of nursing systems to meet
a) Universal the self – care requisites of the patient:
b) Developmental 1. Wholly Compensatory System
c) Health Deviation 2. Partially Compensatory System
3. Supportive – Educative System
Universal Self – Care Requisites:
1. Maintenance of a sufficient intake of air I. Wholly Compensatory System
2. Maintenance of a sufficient intake of food  The patient is dependent.
3. Maintenance of a sufficient intake of water  The nurse is expected to accomplish the entire
patient’s therapeutic self – care or to compensate for
4. Provision of care associated with elimination
the patient’s inability to engage in self – care or when
5. Maintenance of balance between activity and rest
the patient needs continuous guidance in self – care.
6. Maintenance of balance between solitude and social II. Partially Compensatory System
interaction  The patient can meet some needs.
  Needs nursing assistance. 1. Novice - the person has no background experience of
 Both the nurse and the patient engage in meeting self the situation in which he or she is involved. This
– care needs. level applies to the students of nursing.
III. Supportive – Educative System
2. Advance Beginner – can demonstrate marginally
 The patient can meet self – care requisites, but needs
assistance with decision making or knowledge and acceptable performance, has enough experience to
skills to learn self – care. grasp aspects of the situation.
3. Competent - consistency, predictability and time
Metaparadigm management are important in competent
performance. A sense of mastery is acquired through
A. Person planning and predictability.
A total being with universal, developmental
4. Proficient – the performer perceives the situation as
needs and capable of continuous self – care.
a whole (total picture) rathe than in terms of aspects,
 A human being who has “health
and the performance is guided by maxims. Has an
related/health derived limitations that
render him incapable of continuous self – intuitive grasp of the situation based on background
care or dependent care or limitations that understanding
result in ineffective/incomplete care”. 5. Expert – the expert performer no longer relies on
 A human being that is the focus of nursing analytical principle. Nurse as having intuitive grasp
only when self – care requisites exceed self of the situation and as being able to identify the
– care capabilities. region of the problem without losing time
B. Health considering a range of alternative diagnoses and
 When human beings are structurally and solutions. ‘Knows the patient’.
functionally whole or sound.
 Wholeness or integrity includes that which
makes a person human operating in
Benner’s Domains of Nursing Practice
conjunction with physiological and
psychophysiological mechanisms and a
material structure and in relation to and 1. The Helping Role Model – establishing a healing
interacting with other human beings. relationship, providing comfort measures, and
C. Environment inviting active patient participation and control in
 Components are environmental factors, care.
environmental elements, conditions, and 2. The Teaching-Coaching Function Domain –
developmental environment. includes timing, readying patients for learning,
D. Nursing motivating, change, assisting with lifestyle alteration.
 Is an art, a helping service, and a
3. The diagnostic and Patient-Monitoring Function
technology.
Domain – refers to competencies in on-going
- According to Orem, nursing is helping
clients to establish or identify ways to assessment and anticipation of outcomes
perform self – care activities. Nursing 4. The effective Management of Rapidly Changing
actions are geared towards the situations Domain – includes the ability to
independence of the client. contingently match demands with resources and to
 She also added that nursing is based on asses and manage care during crisis situation
values. 5. The administering and Monitoring Therapeutic
interventions and Regimens Domain – include
Patricia Benner – “The Primacy of Caring” competencies related to preventing complications
- She was born in Hampton, Virginia and spent her during drug therapy, wound management, and
childhood in California hospitalization.
- A professor in the Department of Physiological 6. The Monitoring and Ensuring the Quality of
Nursing at the University of California, San Health Care Practices Domain – includes
Francisco competencies with regard to maintenance of safety,
- Dr. Benner is the author of nine books including continuous quality improvement, collaboration, and
“From Noviceto Expert” named an American journal consultation with physicians, self-evaluation, and
of Nursing of the year. management of technology.
7. The Organizational and Work- Role
Major Concepts and Definitions Competencies Domain – includes competencies in
“Stages of Expertise” priority setting, team building, coordinating, and
providing for continuity.