Dorothea Orem Self Care Deficit Theory 1971 (USA)

Dorothea Orem Self Care Deficit Theory 1971 (USA)
Dorothea Elizabeth Orem born on 1971 received her diploma in nursing from Providence Hospital School of Nursing, her Bachelor of Science and Master of Science in nursing education from Catholic University of America. She received several honorary degrees and national awards including Catholic University of America’s Alumni Association Award for nursing theory.
Orem (2001) states her general theory as follows: “Nursing has as its special concern man’s need for self care action and provision and maintenance of it on a continuous basis in order to sustain life and health, recover from disease and injury and cope with their effects. The condition that validates the existence of a requirement for nursing in an adult is the health associated absence of the ability to maintain continuously that amount and quality of self care that is therapeutic in sustaining life and health, in recovery from diseases or injury or in coping with their effects. With children, the condition is the inability of the parent or guardian as associated with the child’s health state to maintain continuously for the child the amount and quality of care that is therapeutic”.
Orem developed self care deficit nursing theory, which is composed of three interrelated theory:

1. Theory of self care
2. Theory of self care deficit
3. Theory of nursing system

Under these three theories, there are six central concepts and one peripheral concept:

1. Self care and dependent care
2. Self care agency and dependent care agency
3. Therapeutic self care demand
4. Self care deficit
5. Nursing agency
6. Nursing system

The peripheral concept is basic conditioning factors
Theory of self care
The concepts are self care, self care agency, self care requisites and therapeutic self care demand. Self care is the activities that individuals do it for themselves. Self care agency is the human’s acquired power and capabilities to engage in self care and is affected by basic conditioning factors such as age, gender, health state and pattern of living etc. The therapeutic self care demand is the total of activities needed over a period of time to meet the person’s known requirements for self care. Self care requisites are the reasons self care activities occur and are an expression of the hoped for results. It is categorized into three: universal, developmental and health deviation. Universal requisites means activities of daily living such as intake of air, water, food, rest etc. Developmental self care requisites are specific to the process of growth and development during life cycle changes. Health deviation self care requisites are related to change in human structure due to genetic variation or other defects. In the theory of self care, Orem explains what is meant by self care and list the various factors affect it.
The theory of self care deficit
When therapeutic self care demand exceeds self care agency, a self care deficit exists and nursing is required. Nursing may be necessary when individuals need to carry out complex self care or during illness or injury. Orem identifies the following five methods of helping that nurses may use:

1. Acting for or doing for another
2. Guiding and directing
3. Providing psychological support
4. Providing an environment to support personal development
5. Teaching

In clinical nursing practice, Orem (2001) has identified work operations include:

• Entering into and maintaining interpersonal relationships
• Design, plan and implement nursing care
• Respond to patient requests
• Coordinate nursing care
• Continue the patient care
• Use multisectoral approach
• Discharge the patient from nursing care

The theory of nursing systems
It includes nursing agency and nursing system. Nursing agency is a complex attribute of mature or maturing people educated and trained as nurses that enables them to act, to know and to help others meet their therapeutic self care demands. It is a power that nurse has to engage in effective nursing practice. Orem has identified three classification of nursing system to meet the self care requisites of the patient. The design and elements of the nursing system make four elements: the extent of the responsibility of the nurse in the health care situation, the various roles of the people in the situation, the reason for these being a nurse patient relationship and the actions to be carried out by the nurse and patient to meet therapeutic self care demand. These nursing systems are wholly compensatory, partly compensatory system and supportive-educative system.
Wholly compensatory system includes:

• Accomplishes patient’s self therapeutic care
• Compensates for patient’s inability to engage in self care
• Supports and protects the patient

Partly compensatory system includes:

• Performs some self care measures for patient
• Compensates for self care limitation of patient
• Assist the patient as required
• Performs some self care measures
• Regulates self care agency
• Accepts care and assistance from nurse

Supportive- educative system includes:

• Accomplishes self care
• Regulates the exercise and development of self care agency

To conclude, Orem indicates that nursing service to families and patients generally require some combination of aspects of two nursing systems, namely, the partly compensatory and supportive and educative nursing systems. It is applicable in nursing care with individuals in clinical side and community health practice.