SELF-CARE

DEFICIT THEORY
OF NURSING
By: A. Banate and J. Albaladejo
 OBJECTIVES:

 Relate life history of Dorothea Orem

 Explain theoretical sources of Orem’s
theory
 Enumerate Orem’s Metaparadigm in
Nursing
 Explain the acceptance by the nursing
community of this theory
 Analyze and apply the theory to present day
situation ( particularly in Nursing Practice,
Nursing Education, and Nursing Research)
SELF - CARE
DEFICIT THEORY
OF NURSING
DOROTHEA
OREM
1914- June 22, 2007
93 years old
 One of America’s foremost nursing theorists
 in Baltimore, Maryland in 1914.
 She began her nursing career at Providence
Hospital School of Nursing in Washington, D.C,
where she received a Diploma of Nursing in the
early 1930’s.
 Later, she received a BS in Nursing Education
(1939) and MS in Nursing Education (1946) at
Catholic University of America (CUA).
 Her early nursing experiences included OR nurse,
private duty nursing (home and hospital), hospital
staff nursing on pediatric and adult medical-
surgical units, evening supervisor in the ER, and
biology science teaching.

 In 1957, she became a curriculum consultant at

the Office of Education, US Department of
Health, Education and Welfare.
 “Nursing: Concepts of Practice”, was her
first book, published in 1971. Subsequently,
editions of this book were published in
1980, 1985, 1991, 1995, and 2001.
 She was given many honors and awards, to
mention: Honorary Degree of Doctor of Science,
Georgetown University in 1976; Doctor of
Humane Letters, Illinois Wesleyan University in
1988; Linda Richards Award, National League
for Nursing in 1991; Honorary Fellow of the
American Academy of Nursing in 1992. Also,
she was awarded the Doctor of Nursing Honoris
Causae from the University of Missouri in 1998.
 Orem’s many papers and presentations provide
insight to her views on nursing practice, nursing
education and nursing science. Other papers of
Orem and scholars who worked with her in the
development of the theory are archived in johns
Hopkins University.
 She continues working, alone and with
colleagues (NDCG), on the development
of Self-Care Deficit Nursing Theory
( SCDNT).
 THEORETICAL SOURCES

 Well-versed in contemporary nursing literature

and thought, Orem was not influenced directly
by any particular nursing leader. Her association
with nurses over the years provided many
learning experiences.
 Although she does not credit a major influence,
she does cite many other nurses’ works in terms
of their contributions to nursing, including, but
not limited to, Abdellah, Henderson, Johnson,
King, Levine, Nightingale, Orlando, Peplau,
Riehl, Rogers, Roy, Travelbee, and Weidenbach.
 Also cited numerous authors in
other disciplines including, but
not limited to:
 Gordon Allport – Theory of Personality and one
of founding figures of Personality Psychology
 Chester Barnard - Author of pioneering work in
Management Theory and Organizational Studies
 Rene Dubos – pathologist, humanist,
microbiologist ( devoted most of his professional
life to the analysis of environment and social
factors that affect the welfare of humans)
 Erich Fromm – social psychologist,
psychoanalyst, humanistic philosopher and
democratic socialist
 Gartly Jaco – The Social Epidemiology of
Mental Disorders: A Psychiatric survey of Texas
 Robert Katz - American novelist, screenwriter,
and non-fiction author
 Kurt Lewin – Founder of Social Psychology
(nature and nurture interact to shape each person)
 Ernest Nagel – He expounded the different kinds
of explanation in different fields
 Talcott Parsons – sociologist, developed a
general theory for the study of society called
Action Theory (voluntarism and analytical
realism)
 Hans Selye – General Adaptation Syndrome
 Magda Arnold – Appraisal Theory ( reasoning
and understanding of one’s emotional reaction
becomes important for future appraisals or
evaluation
 Bernard Lonergan – philosopher-theologian (by
realism, he affirmed that we make true judgement
of fact and of value)
 Ludwig von Bertalanffy – General Systems
theory ( defined new foundations and development
as generalized theory of systems with applications
to numerous areas of study, emphasizing holism
over reductionism, organism over mechanism)
 MAJOR CONCEPTS AND
DEFINITIONS
Self-Care Deficit Nursing Theory – general theory
 The theory of Self-Care – describes why and how
people care for themselves
 The theory of Self-Care Deficit – describes and
explains why people can be helped through nursing
 The theory of Nursing Systems – describes and
explains relationships that must be brought and
maintained for nursing to be produced. It also
describe how the patient’s self-care needs will be
met by the nurse, patient or both.
 Self-Care- is an activity that promotes a persons
well-being. It is performed by persons who are
aware of the time frames on behalf of maintaining
life, continuing personal development and a
healthy functional living.
 Self-Care Requisites – are insights of actions or
requirements that a person must be able to meet and
perform in order to achieve well-being.
1.Universal Self-Care Requisites – these are
universally set goals that must be undertaken in
order for an individual to function in scope of a
healthy living.
 Maintenance of a sufficient intake of air,
 Maintenance of a sufficient intake of food,
 Maintenance of a sufficient intake of water,
 Provision of care associated with elimination,
 Maintenance of balance between activity and
rest,
 Maintenance of balance between solitude and
social interaction,
 Prevention of hazards to human life, human
functioning, and human well-being; and
 Promotion of human functioning and
development.
2.Developmental Self-Care Requisites –
associated with developmental processes or
derived from a condition
 Health Deviation Requisites – these are
requisites required for a person to be considered
as sick or ill. Disease affects the structures within
the integral part of a person and its functioning.
These healthcare deviations set standards to
which the degree of self-care demand is needed
 Therapeutic Self-Care Demand – These are the
summation of all activities needed to alleviate the
existing disease or illness. Controlling or
managing the factors will result to appropriate
care of plan.
 Self-Care Agency – is a human ability which is
“the ability for engaging oneself in self-care
 Agent – is the individual who is engage in meeting the
needs of a person. They are like bridges that facilitate
what has been done and what needs to be done.
 Dependent Care Agent – These are individuals who takes
full responsibility of taking care of a person who are
incapable of providing care for themselves or those who
are living dependently with others aid.
 Nursing Agency – is set of established capabilities of a
nurse who can legitimately perform activities of care for
a client. Nursing agency helps a person achieve their
health care demand.
 METAPARADIGM IN
NURSING
PERSON
 - According to Orem, human beings are very much
different from other living things in terms of their
capacity. Humans can reflect upon events, themselves and
their environment. They can symbolize experiences that
they have been through by using words or ideas.
 - Human functioning is an integrated system comprised of
physical, psychological, interpersonal, and social aspects.
Orem believes that individuals have the potential to be
developed and learned.
“a substantial or real unity
whose parts are formed and
attain perfection through the
differentiation of the whole
during the process of
development.”
 HEALTH

 - Orem supports the World Health

Organization’s definition of health as the “state
of complete physical, mental, and social well-
being and not merely the absence of disease
or infirmity.”
 - Health should be perceived this way since she
believes that these integrated aspects of health
are inseparable.
 ENVIRONMENT

 Orem’s view of health as a phenomenon affected

by inseparable entities shows her view of the
surrounding environment as an external source of
influence in the internal interaction of a person’s
different aspects.
 NURSING

 Nursing is helping clients to establish or identify

ways to perform self-care activities. Nursing
actions are geared towards the independence of
the client.
 - Further, she defines nursing as a human service.
It is distinguished human service since its focus is
on persons with inabilities to maintain continuous
provision of healthcare.
“an art through which the
practitioner of nursing gives
specialized assistance to persons with
disabilities of such a character that
greater than ordinary assistance is
necessary to meet daily needs for self
care and to intelligently participate
in the medical care they are receiving
from the physician”
Self – Care Deficit Theory of
Nursing

Self
care
R R
Therap
Self eutic
R Self
Care
care
Agenc deman
y ds
Deficit

R R
Nursing
Agency

R – relationship
< - deficit relationship, current or projected
 DOROTHEA OREM’S
THEORY

ACCEPTANCE BY THE NURSING

COMMUNITY
 EVIDENCES:

MAGNITUDE OF PUBLISHED
MATERIALS
– Over 800 references can be found
through computerized search dealing
with a variety of subjects
LITERATURE, PHONE CALLS
AND E-MAIL MESSAGES AND
QUESTIONS RECEIVED IN THE
SCDNT WEB PAGE
– Reflects that it has great appeal to
practicing nurses.
WORLD WIDE
– Translated into several languages
like Italian, French, Spanish, Dutch,
and Japanese.
– Some of her work was also
translated German, Thailand and
Norway
 PRACTICE
 First documented use is in John hopkin’s
Hospital in a nurse-managed clinic as a basis for
structuring practice
 Clinical populations and other age groups
– Pain management in Mexican-American culture
– Management of DM
– Community population-based care in Vancouver was
formulated using Orem’s theory.
 Occupational health nursing had based their
practice in SCNDT.
– Health hazards and job related factors that
nurses must be aware of had been discussed.
– Learns how to identify, interpret and draw
correct conclusion.
Orientation process
– For new graduate nurses. To be
clarified from school teaching conflicts
with the actual work settings or values.
To define various nursing roles:
– Clinical nurse specialist
– Case management role
– Advance practice role
– Primary care role
 Development of clinical measurement
approach
– Which focus around the universal self
requisites and health deviation self requisites
– Which then leads to the development of
Dependent Care Agent Questionaire which was
used to measure mother’s performance care for
their children
 IN VARIOUS SETTINGS
– COMMUNITY POPULATION BASED CARE
– OCCUPATIONAL HEALTH NURSING
 NOTE

 MUCH OF PUBLISHED LITERATURE

IS LIMITED TO SELF CARE AND SELF
DEFICIT THEORY
 THE THEORY OF JURSING PRACTICE
CAN BE INFERRED FROM
LITERATURE; IT IS NOT USE
EXPLICITLY, PERHAPS BECAUSE OF
THE COMPLEXITY OF THE PRACTICE.
 EDUCATION

 THEORY WAS ARTICULATED BY 1950’s

 PUBLISHED IN 1972
 GUIDES FOR DEVELOPING
CURRICULUM FOR EDUCATION OF
PRACTICAL NURSES-1959
 FOUNDATION OF NURSING ANS IT’S
PRACTICE
 SCNDT
 HAD BEEN USED AS BASIS FOR A
CURRICULUM
in Sinclair School of Nursing.
– PRESERVICE NURSING EDUCATION IN
TEACHING
– USED AT ALL LEVELS FOR CONTINUING
EDUCATION
– FRAMEWORK FOR CURRICULAR
DESIGN
1. DEVELOPMENT OF RESEARCH
RESEARCH
INSTRUMENTS FOR MEASURING THE
CONCEPTUAL ELEMENTS OF THE THEORY
like in the development of Exercise of Self Care
Agency
2. STUDIES THAT TEST ELEMENTS OF THE
THEORY IN SPECIFIC POPULATION like in
the use of Appraissal of Self Care Agency with ill
and well population in a number of cukture
3. DEVELOPMENT OF NEW MODELS OR
MIDDLE RANGE THEORY
 ANALYSIS
 SIMPLICITY
– It is presented in a straight forward manner
– Her theory comprises of self care, self care deficit and
nursing systems
– SELF CARE DEFICIT THEORY includes self
care(and dependent care), self care agency(and
dependent care agency), therapeutic self care demand,
self care deficit, nursing agency and nursing system.
GENERALITY
– Operates upon the combination of several
conceptualized properties or features
common to all instances of nursing
– The theory also helps nurses to validate
nursing knowledge and in teaching and
learning the nursing profession.
ACCESSIBILITY . It must be noted
that Orem’s theory has been used for
research using both qualitative and
quantitative methodologies. The
theoretical entities are well defined and
lend themselves to being measurable;
however, instruments have not been
developed for all of the entities, for
example, nursing agency.
 IMPORTANCE. The Self-Care Deficit
Nursing Theory differentiates the focus of
nursing from other disciplines. The theory
of nursing systems provides the unique
focus for nursing. There is ample evidence
in the literature that the theory is useful in
developing and guiding practice and
research
EMPIRICAL PRECISION
– Generating hypotheses
– Additional knowledge
– The significant value of her theory is in
it’s scope, complexity and clinical
usefulness
– It could be effectively used in generating
hypothesis and adding to the body of
knowledge of nursing
 DERIVABLE CONSEQUENCES
– give direction to nursing specific outcomes (FOCUS)
– Her theory gives direction to nursing-specific
outcomes related to identifying and meeting the
therapeutic self care demands and self management
systems.
– She also defined nursing as a scientific structure and
as practical as science with on going develoment of
the nursing knowledge
THE SELF CARE DEFICIT THEORY OF
NURSING IS NOT AN EXPLANATION OF THE
INDIVIDUALITY OF A PARTICULAR
CONCRETE NURSING PRACTICE
SITUATION, BUT RATHER THE EXPRESSION
OF A SINGULAR COMBINATIONOF
CONCEPTUALIZED PROPERTIES OR
FEATURES COMMON TO ALL INSTANCES
OF NURSING. AS A GENERAL THEORY, IT
SERVES NURSES ENGAGED IN NURSING
PRACTICE, IN DEVELOPMENT AND
VALIDATION OF NURSING KNOWLEDGE
AND IN TEACHING AND LEARNING
NURSING
SITUTATION

 KUYA EDDIE, A 45 YEAR-OLD DRIVER SUFFERED A

VEHICULAR ACCIDENT ALONG HIS WAY HOME.
HAVING FOUND STILL ALIVE BY THE
PARAMEDICS HE WAS RUSHED TO THE HOSPITAL.
HE WAS GIVEN EMERGENCY TREATMENT FOR
BLOOD LOSS. HIS LEFT LOWER LEG WAS TORN
OFF DUE TO IMPACT. UPON ASSESSMENT, IT WAS
FOUND OUT THAT HE SUFFERED A SEVERE
FRACTURE OF THE LEG, SEVERE INJURY IN RIGHT
INNER THIGH AND FOOT, MUSCLE DAMAGE AND
HEAD INJURIES.
 EMERGENCY SURGERY WAS GIVEN TO
REPAIR THE DAMAGE BUT HE WENT INTO
COMA DUE TO DEVELOPED BLOT CLOT IN
THE BRAIN. ANOTHER OPERATION WAS
DONE TO REMOVE THE BLOOD CLOT,
AND IT WAS SUCCESSFUL. HOWEVER,
KUYA EDDIE DID NOT WAKE UP AFTER
THE SURGERY. PHYSICIANS STARTED TO
GIVE UP BUT HIS FAMILY STILL PRAYS
FOR HIS MIRACULOUS RECOVERY.
 THEN, AFTER A MONTH, HE WOKE UP BUT
HIS BODY WAS LIKE A VEGETABLE AND
SEEMED TO BE PARALYZED FOR LIFE.
 KUYA EDDIE, BEING A MAN OF FAITH DID
NOT LOSS HOPEA AND STATED THAT
NOTHING IS IMPOSSIBLE WITH GOD.
 EVERYDAY, WITH THE DESIRE BURNING
IN HIS FOCUSED MIND, HE WILLED
HIMSELF TO WALK. HE IMAGINE HIMSELF
WALKING AS THE NURSES DO PASSIVE
RANGE OF MOTION EXERCISES,
MASSAGED, CARED AND CLEANED HIS
BODY.
 AFTER A FEW MONTHS OF THERAPY, THE
PHYSICIANS WERE VERY MUCH
SURPRISED TO SEE HIM SITTING AT HIS
BEDSIDE. HE COULD MOVE HIS LEGS
LITTLE BY LITTLE BUT AFTER A AFEW
WEEKS HE COULD STAND AND WALK
WITH A LIMP. HE WAS INSTRUCTED TO
USE CRUTCHES AS AN AID BY NURSE
LISSA AND SHE ALSO PERFORMS HEALTH
TEACHINGS AND GIVE GUIDANCE TO
KUYA EDDIE.
 ASSESSMENT
– IDENTIFICATICATION OF PATIENT’S
NEEDS
• START AT A WHOLLY
COMPENSATORY STATE
• PROCEED TO PARTIALLY
COMPENSATORY
• PATIENT WAS TAUGHT THE USE OF
ASSISTIVE DEVICE
• NURSE TEACHES THE USE OF
CRUTCHES, POSTURE AND PACING
 DIAGNOSIS

– SELF CARE DEFICIT RELATED TO TOTAL

PARALYSIS
– KNOWLEDGE DEFICIT RELATED TO USE
OF CRUTCHES
– POTENTIAL FOR IMPAIRED SKIN
INTEGRITY RELATED TO TOTAL
PARALYSIS
 PLANNING
– COLLABORATE WITH PATIENT IN
SETTING ATTAINABLE GOALS
– WITH EMPHASIS ON CLIENT
EMPOWERMENT AND ATTAINING
INDEPENDENCE AS QUICKLY AS
POSSIBLE
 IMPLEMENTATION
1. ASSESS PATEINT’S PERCEPTION ON
DISABILITY, LIFESTYLE CHANGES, AND
COPING MECHANISMS
2. DEMONSTRATE THE USE OF CRUTCHES
USING VISUAL AIDS, DEMO, AND THERAPEUTIC
COMM.
3. INVOLVE SUPPORT SYSTEM
4. REFER TO PT FOR COLLABORATIVE MGT
AND FURTHER GUIDANCE
5. ASK CLX TO DEMONSTRATE KNOWLEDGE
AND COMPETENCY TO EVALUATE SELF CARE
CAPACITY
 EVALUATION
– THE NURSE, YOGETHER WITH THE CLIENT
AFTER A FEW DAYS OF INSTRUCTION AND
COUNSELING, WOULD AGREE ON WHETHER
THE GOAL IS MET OR NOT. EDDIE WOULD
THEN BE ENCOURAGED TO SET NEW GOALS
FOR HIMSELF.