Dorothea Orem's Theory

 Dorothea Orem’s Theory : The Self-Care or Self-Care Deficit Theory of Nursing

The Self-Care or Self-Care Deficit Theory of Nursing has three interrelated theories which are the theory of self-care, the self-care deficit theory, and the theory of nursing systems. These theories then further classified into wholly compensatory, partially compensatory, and supportive-educative.

First Interrelated Theories : The Theory of Self-Care

This theory focuses on the performance of activities performed by individuals on their own behalf to maintain their life, health and well-being. For example, eating and wash your hands right after are considered as performing self-care on yourself. The Theory of Self-Care has three points, which composed self-care agency, self-care requisites and therapeutic self-care demand

• Self-Care Agency

A person’s ability or power to self-care is affected by various factors that are known as conditioning factors. These factors include age, gender, health state and social orientation. Under socio-demographic charact, nurses will take patient’s age, gender, educational status, marital status. In addition, nurses will also take their place of residence, employment status, income level, social security and family type. Other than that, nurses will take characteristics of patients’ disorder such as, diagnosis type, disorder duration and caregivers.

·         Self-Care Requisites

Self-care requisites or requirements can be explained as actions directed toward the provision of self-care. This can also be known as activities of daily living. It is presented in three categories which are universal self-care requisites, developmental self-care requisites, and health deviation self-care requisites.

Universal self-care requisites are associated with life processes and the maintenance of the human structure and functioning integrity. These are the examples :

ü  The maintenance of a sufficient intake of air

ü  The maintenance of a sufficient intake of water

ü  The maintenance of a sufficient intake of food

ü  The provision of care associated with the elimination process and excrement

ü  Maintaining a healthy balance of activity and relaxation

ü  Maintaining a healthy balance isolation and social engagement

ü  Hazards to human life, human functioning, and human well-being must be avoided

ü  Human functioning and growth within social groups in accordance with human potential, known human constraints, and the human desire to be normal

Normalcy is defined as that which is fundamentally human and in accordance with an individual’s genetic and constitutional traits as well as their talents.

Developmental self-care requisites are “either specialised representations of universal self-care requisites that have been particularised for developmental processes or new requisites generated from a condition or linked with an event”. These are the examples :

ü  Provision of condition that promotes development

ü  Engagement in self-development

ü  Prevention of effects of human condition that threatens life

Health deviation self-care requisites are necessary in cases of illness, injury, or disease, or may arise as a result of medical procedures taken to identify and treat the problem. These are the examples :

ü  Seeking and securing appropriate medical assistance.

ü  Being aware of and attending to the effects and results of pathologic conditions and states

ü  Effectively carrying out medically prescribed diagnostic, therapeutic, and rehabilitative measures

ü  Being aware of and attending to the unpleasant or harmful consequences of recommended medical treatments, as well as controlling them

ü  Accepting one self as being in a certain state of health and in need of specific types of health treatment by changing one’s self-concept ( and self-image )

ü  Learning to live with the consequences of pathologic disease and states, as well as the effects of medical diagnostic and therapeutic procedures, in a way that encourages human growth

·         Therapeutic Self-Care Demand

Therapeutic self-care demand can be define as the totality of “self-care activities to be done over a period of time in order to fulfil recognised self-care requisites by employing valid techniques and associated sets of actions and operations”. These are the examples :

ü  Food and water

ü  Air and rest

ü  Elimination

Second Interrelated Theories : The Self-Care Deficit Theory

This theory identifies when nursing assistance is needed. When an adult ( or in the case of a dependent, the parent or guardian ) is unable or constrained in providing continuous effective self-care, nursing is necessary. Orem found 5 ways to assist :

·         Acting for and doing for others

·         Guiding others

·         Supporting another

·         Providing an environment promoting personal development about meet future demands

·         Teaching another

Third Interrelated Theories : The Theory of Nursing Systems

This theory is the result of a series of interactions between two individuals : a registered nurse and a certified client. When a client’s therapeutic self-care demand reaches the available self-care agency, this system kicks in, resulting in nursing. Nursing systems composed of three system which are wholly compensatory, partial compensatory, supportive-educative.

·         Wholly Compensatory Nursing System

This is represented by a circumstance in which the person is unable to “engage in those self-care tasks requiring self-directed and controlled ambulation and manipulative movement or the medical prescription to refrain from such activity… people with these disabilities are socially reliant on others for their survival and well-being”. For examples :

ü  Care of a newborn

ü  Care of client recovering from surgery in a post-anesthesia care unit

·         Partial Compensatory Nursing System

This is represented by a scenario in which “both the nurse and the patient perform care measures or other activities involving manipulative tasks or ambulation either the patient or the nurse may have a significant role in the performance of care measures”. For examples :

ü  Nurse can assist the post-operative client in ambulating

ü  Nurse can bring a meal tray for a client who can feed themselves

·         Supportive-Educative Nursing System

This is also known as a supportive-developmental system. The person can or should learn to perform needed measures of externally and internally focused therapeutic self-care, but not without assistance. For examples :

ü  Nurse guides a mother on how to breastfeed her baby

ü  Counseling a psychiatric client on more adaptive coping strategies