DOROTHEA OREM: SELF CARE Erin Rice

11/9/2018

NURSING DEFICIT THEORY NU 504

Theories in Nursing
PURPOSE STATEMENT

The purpose of this presentation is to examine the background, influence and the use
of Dorothea Orem’s Self-Care Deficit Nursing Theory in advance practice, nursing
education, nursing research, and wellness and illness care.
DOROTHEA OREM EARLY LIFE
• Born July 15, 1914 in Baltimore, MD
• Youngest of two daughters to Benjamin and Adelaide Orem
• Father was a bricklayer
• Mother was a homemaker
• One aunt was a pharmacist and other aunt was a nurse supervisor in the operating
room
• Died June 22, 2007 in Savannah, GA
DOROTHEA OREM’S EDUCATION
• Nursing Diploma Providence School of Nursing in Washington, DC in early 1930s
• BSN 1939 & MSN 1945 from the Catholic University of America in Washington, DC
• Honorary Doctorate of Science from Georgetown University in 1976
• Honorary Doctorate of Science from Incarnate Word College in 1980
• Honorary Doctorate of Humane Letters from Illinois Wesleyan University in 1988
• Doctorate Honoris Causae from the University of Missouri in Columbia in 1988
WORK EXPERIENCE
• 1934 -1939 • 1949- 1947
• Providence Hospital & St. John’s Hospital • Indiana State Board of Health in the Division of Hospital and
• Operating room Institutional Services
• Adult med-surg • Improve the quality of nursing in hospitals throughout the state
• Pediatrics • Start of the development of her theory
• Evening supervisor at the ER
• Biological technician • 1959 – 1970
• Private duty • Catholic University of American
• Assistance professor
• 1939-1941 • Associate professor
• Providence School of Nursing in Detroit, MI – taught biological • Acting dean of the school of nursing
sciences
• Curriculum consultant for many colleges and universities
• 1945 – 1949
• Teaching, administration and research • Consultant to United States Department of Health,
• Director of Providence School of Nursing in Detroit, MI
Education and Welfare
• Upgrade nurse education

• Consultant to the Center for Experimentation and

Development in Nursing at John’s Hopkins University
• Director of Nursing of John’s Hopkins University, Wilmer Clinic
THEORY INTRODUCTION
Self-Care Deficit Theory of Nursing (SCDNT)
“What condition exists in a person when judgements are made that a nurse(s) should be
brought into the situation”(Alligood, 2014)
• Nurses provide direct care to patients who require care due to their current health
status or health care requirements (Alligood, 2014)
• Relationship between those who need care and those who provide care
GRAND THEORY
Provides a conceptual framework under which the key concepts and principles of the
discipline can identified (currentnursing.com, 2012).
 Self-Care Deficit Theory of Nursing
Grand Theory
Needs Theory: Based around helping individuals fulfill their physical and mental
needs.
MOTIVATION
• Personal experience in nursing
• Personal reflection
• Well versed in contemporary nursing literature and thought
• Familiar with literature outside of the practice of nursing
THEORY DEVELOPMENT AND INFLUENCE
• Personal nursing experience
• Philosophical System of Moderate Realism

•Nursing Contributions include: •Non-Nursing Contributions include:

• Abdellah • Allport
• Henderson • Arnold
• Johnson • Barnard
• King • Fromm
• Levine • Harre
• Nightingale • Macmurray
• Orlando • Maritain
• Peplau • Parsons
• Riehl • Plattel
• Rogers • Wallace
• Roy
• Travelbee (Alligood, 2014)
• Wiedenbach
CONTINUED DEVELOPMENT
Four Categories that reflect a modern realist position
1. Persons in space and time localizations
2. Attributes or properties of these persons
3. Motion or change
4. Products brought into being

(Alligood, 2014)
FOUNDATION
“The view of human beings as dynamic, unitary beings how exist in their environments,
who are in the process of becoming, and who possess free-will as well as other essential
human qualities” (Alligood, 2014).
1. Person
2. Agent
3. User of symbols
4. Organism
5. object
OREM’S SELF-CARE THEORY
CONCEPTUAL FRAMEWORK

SELF-CARE

CONDITIOING FACTORS
CONDITIONING FACTORS

SELF-CARE SELF-CARE
AGENCY DEMANDS

DEFICIT

NURSING
AGENCY
FRAMEWORK MODEL
• Every human is an individual who has their contributing factors that surround them
• Self-care, self-care deficit, self-care demands and the self-care agency are all
interconnected.
• The nursing agency responds to the deficit and is part of closing the circle so the patient can return to
self-care

• Self-care agency and self-care demands are related by the individual demands
required by each person to be healthy and the skills each person develops to
maintain or acquire as they mature to meet these demands.
SO WHAT IS SCDNT EXACTLY?
1. The theory of self-care
2. The theory of dependent-care
3. The theory of self-care deficit
4. The theory of nursing systems
SELF-CARE
 Air
 Food
 Water
 Elimination process and excrement
 Balance activity and rest
 Balance solitude and social interaction
 Prevent hazard to human life, functioning, well-being
 Promotion of human functioning and development in social groups
 potential
 human limitations
 desire for normalcy
OREM’S GOAL
Orem described nursing as a foundational knowledge that is specialized and put to
use in concrete situations (Alligood, 2014).
A nurses knowledge is what drives them to react to a situation, they make judgements
and decide implementation based on their develop capabilities and knowledge
(Alligood, 2014).
The outcome that the nurse desires, is to return the patient back to a point where self-
care is possible and nursing is no longer needed (Alligood, 2014).
METAPARADIGM
PERSON
person under the care of a nurse; a total being with universal, developmental, and health deviation
needs, who is capable of self-care
ENVIRONMENT
Physical, chemical, biologic, and social contexts within which human beings exist. Environmental
components include environmental factors, environmental elements, environmental conditions, and
the developmental environment
HEALTH
A state characterized by soundness or wholeness of developed human structures and of bodily and
mental functioning
NURSING
Therapeutic self-care designed to supplement self-care requisites. Nursing actions fall into one of
three categories: wholly compensatory, partly compensatory, or supportive-educative system
(Thompson, 2017)
WELLNESS & ILLNESS
• Ultimate goal of the theory is to return a patient to a self-care situation to promote
wellness
• Illness can be the driver of deficit and the reason for nursing care
• Nurse and patient relationship based on returning patient to a wellness, self-care
state
• Nursing fulfills a self-care deficit when there is a failure in care by the patient
(Whelan, 1984)
STRENGTHS
• Formalized and expression of a general concept of nursing
• Inductive and deductive thinking about nursing
• logically congruent
• Descriptive expression of why people require nursing and what is needed for good
nursing care
• Differentiates the focus of nursing from other disciplines
WEAKNESSES
• Simple idea, but complex breakdown
• Only applicable to a deficit and not part of prevention or health maintenance
• Four theories inside of one grand theory
• Does not take into account individualized variables
• How would this theory relate to physical, mental and emotional deficits that prevent someone from
ever having self-care (healthresearchfunding.org, 2018)

• Based specifically on illness

• Assumptions are made you are healthy and can maintain self-care if free from illness
• Does not take into account trauma or other concerns (healthresearchfund.org, 2018)
RESEARCH IN NURSING
• Qualitative and Quantitative are appropriate
• Build on a body of knowledge-related nursing practice
• Comprehensive descriptive studies of specific populations
• Self-care requisites
• Self-care practices

(Alligood, 2014)
RECENT RESEARCH
• Association between perceived severity of illness and executive function and self-
care of an adult with type II diabetes (Gatlin, 2014).
• A diagnosis of diabetes requires a tremendous amount of self-care
• Research has shown that type II diabetics have low self-care, why?
• Hypothesis 1: Increased severity of type II diabetes is associated with lower
performance measures of executive function (Gatlin, 2014).
• Hypothesis 2: Lower performance measures of executive function are associated with
lower indicators of self-care (Gatlin, 2014).
Hypothesis 3: Executive function mediates the effects of severity of type II diabetes
on diabetes self-care (Gatlin, 2014).
SCDNT AND NURSING EDUCATION
• Present in many BSN programs across the United States
• Advance as a field of knowledge
• Advance as a field of practice
• Models of the operation of nursing
• Valid, reliable, general theory of nursing
• Model of practice
• Foundation for the development of a body of knowledge
(Alligood, 2014)
OREM’S GUIDELINES FOR CURRICULUM
THE RELATIVELY UNCHANGING FACTORS UNDERLYING NURSING AND ITS PRACTICE ARE
PRESENTED AND APPLIED IN THE DEVELOPMENT OF CURRICULUMS FOR THE EDUCATION
OF PRACTICAL NURSES. THE GUIDE FOR DEVELOPING CURRICULUMS WAS PREPARED BY A
REGISTERED NURSE IN COOPERATION WITH SEVERAL GROUPS AND MANY INDIVIDUALS,
INCLUDING TWO PROGRAM SPECIALISTS OF THE PRACTICAL NURSE EDUCATION SECTION
OF THE U.S. OFFICE OF EDUCATION AND THE NATIONAL ADVISORY COMMITTEE ON
PRACTICAL NURSE EDUCATION. SOME OF THE TOPICS ARE -- (1) THE ART OF NURSING, (2)
THE ROLES OF THE PRACTICAL NURSE IN NURSING PATIENTS, (3) GENERAL
CHARACTERISTICS OF EDUCATION FOR NURSING PRACTICE, (4) ELEMENTS OF NURSING
THAT CONDITION NURSING EDUCATION, (5) QUALIFICATIONS OF THOSE WHO DESIRE
TO BECOME PRACTICAL NURSES, (6) GUIDING AND TEACHING STUDENT PRACTICAL
NURSES, (7) NURSING SITUATIONS, (8) DESIGNING A CURRICULUM, (9) CURRICULA FOR
THE EDUCATION OF PRACTICAL NURSES, AND (10) DEVELOPMENT OF THE AREAS OF
LEARNING OF THE CURRICULUM. (Orem, 1966)
NURSING EDUCATION & SCDNT
• Anderson University School of Nursing
• University of Tennessee at Chattanooga School of Nursing
• Southern University Baton Rouge School of Nursing
• Conceptual frameworks to guide curriculum
• Relationship between what the nurse learns and what they do as nurses (Berbiglia,
2011)
ADVANCE PRACTICE NURSING
• Assessment
• Interventions
• Goals
• Independence
CASE STUDY
55y/o male who has always been very independent and healthy. He has recently
suffered an heart attach and had to have open heart surgery. He has been married
for 40 years. His wife has always cooked and cleaned and he has always mowed the
lawn and completed chores outside. He is an avid runner, but does not eat very well.
He has never had to have anyone help him and still works a very competitive job that
requires him to travel a lot and is very stressful. He is not needing assistance with
bathing, wound care, he cannot run, he is not allowed to travel or drive and a few
months, he cannot complete any outside chores and his wife has to help him get
dressed. He has been diagnosed with heart disease and also has to make some
dietary changes and find a way to reduce the stress at work.
CASE STUDY AND THEORY
• What is his self-care deficit?
• What was baseline and how can we get him back there?
• What has changed in his life?
• What is making him seek nursing care?
CONCLUSION
• What made you become a nurse
• What does being a nurse really mean
• What sets nursing apart from all other disciplines
• Why is nursing such a trusted profession
 REFERENCES
Nursing Theory. (2016). Dorothea Orem – Nursing Theorist retrieved from
http://nursing-theory.org/nursing-theorists/Dorothea-E-Orem.php
Currentnursing.com. (2012). Nursing Theories: An Overview retrieved from
http://currentnursing.com/nursing_theory/nursing_theories_overview.html
Why I Want to be a Nurse. (2011). Dorothea Orem retrieved from
http://www.whyiwanttobeanurse.org/nursing-theorists/dorothea-orem.php
Alligood, M. (2014). Nursing Theorists and Their Work. St. Louis, MO. Elsevier
Thompson, C. (2017). What is the Nursing Metaparadigm?. The Nursing Education
Expert: In Pursuit of Nursing Excellence. Retrieved from
https://nursingeducationexpert.com/metaparadigm/
Whelan, E. (1984). Analysis and Application of Dorothea Orem Self-Care Practice Model.
Journal of Nursing Education. 23(8) 342-245
 REFERENCES
Gatlin, p. (2014). The Role of Executive Function Between Severity of Type 2
Diabetes and Self-Care. Self-Care, Dependent Care & Nursing 21(01)
Orem, D. (1966). Guides for Developing Curricula for the Education of Practical Nurses. (Office of
Education ED 013 305) retrieved from https://files.eric.ed.gov/fulltext/ED013305.pdf

Berbiglia, V. (2011). The Self-Care Deficit Nursing Theory as a Curriculum Conceptual Framework in
Baccalaureate Education. Nursing Science Quarterly 24(2) 137-145

Tadaura, H., Sato, A., Ueda, E., Saita, T., Ishiaki, H., & Kikuchi, T., (2014). Connecting Nursing Theory
with Practice Through Education Based on Self-Care Deficit Nursing Theory and Utilized in
Nursing Practice. Self-Care, Dependent Care & Nursing 21(01)

Younas, A. (2017). Foundational Analysis of Dorothea Orem’s Self-Care Theory and Evaluations of it
Significance for Nursing. Creative Nursing 23 (1)