Nursing Theorist: Dorothea Orem - Anna E. Marshall MSN Portfolio

Nursing Theorist: Dorothea Orem - Anna E. Marshall MSN Portfolio

Nursing Theorist: Dorothea Orem Self-Care Deficit Theory Presented by MSN Students: Cheryl L Holz RN, BSN Anna Marshall RN, BSN Dorothea Orem 1914- June 22,2007 Born in Baltimore, Maryland Died at home in Skidaway Island

Education: Diploma (early 1930's) Providence Hospital School of Nursing, Washington, DC BSN Ed. (1939) and MSN Ed. (1945) from the Catholic University of America, Washington, DC. Credentials & Background Honorary Doctorates: Doctor of Science from Georgetown University (1976) and Incarnate Word College in San Antonio, Texas (1980) Doctor of Humane Letters from Illinois Wesleyan University, Bloomington, Illinois (1988)

Doctor Honoris Causae, University of MissouriColumbia (1998). Credentials & Background Special Awards: Catholic University of America Alumni Achievement Award for Nursing Theory (1980) Linda Richards Award, National League for Nursing (1991) Honorary Fellow of the American Academy of Nursing (1992). Early Nursing Experiences Clinical

OR Private Duty Nursing (home & hospital) Staff nursing (pediatric & adult medical and surgical units) Evening supervisor-ER Education: Biological science teacher Assistant Director of School of Nursing Consulting: Indiana St. Board of Health (1949-1957) Office of Education, US Department of Health, Education, and Welfare (1957-1959)

Theoretical Sources & Influences Eugenia K. Spaulding-great friend & teacher only Cites no particular nursing leader as a direct influence on her work. Does cite many other nurses works in terms of their contributions to nursing: Abdullah, Henderson, Johnson, King, Levine, Nightingale, Orlando, Peplau, Riehl, Rogers, Roy, Travelbee, and Weidenbach, et al Cites numerous other authors from other disciplines: Chester Barnard, Rene Dubos, Robert Katz, Ernest Nagel, Hans Selye, Ludwig von Bertalanffy, et al

Theoretical Sources & Influences-contd Human organization, action theory An area of philosophy concerned with theories about the processes causing intentional/willful human bodily movements of more or less complex kind http://en.wikipedia.org/wiki/Philosophy_of_action, retrieved 10/10/08 Theoretical Sources & Influences-contd The works of: Aristotle

Thomas Aquinas Barnard (1962) Kotarbinski (1965) Macmurray (1957) Parson, Bales, and Shils (1953) B.J.F Lonergans Insight(1958) [on reflective thinking], Assays by Wallace (1979, 1983) [for recent clarifications]. Orem, D.E (1987). Orems general theory of nursing. (p.73) Origins 1949-1959 Began to develop ideas regarding

the uniqueness of nursing In effort to formalize a framework by which to organize nursing knowledge, she asked the following questions Origins What is nursing? How was it different from other disciplines? How was it similar? What is the domain and what are the boundaries of nursing as a field of practice and a field of knowledge? What condition exists when judgments are

made that people need nursing? Ideas evolved from: Unique experiences of her personal nursing career Observations in practice Study of formal logic and metaphysics Use of resources from many fields Abilities in methods of reflect and questioning Collaborations with students, practitioners, researchers, educators, administrators and scholars Formalization 1960-1980

through extensive reading and self-reflection collaborations with students, practitioners, researchers, educators, administrators and scholars Publications 1971-Nursing: Concepts of Practice Editor for Nursing Development Conference Group (NDCG)-prepared & later revised Concept Formalization in Nursing: Process and Product 1980, 1985, 1991, 1995, and 2001- subsequent editions of Nursing Concepts of Practice

1984: Orem retired Practice First documented use: 1973-John Hopkins Hospital In nurse-managed clinics Various clinical populations & age groups Neonates to the elderly Health promotion practices & care of the sick (The nursing management of pertussis was described from the SCDNT perspective).

Practice-contd Ethnically & culturally diverse populations Orems SCDNT: translated into Italian, French, Spanish, Dutch, and Japanese Currently, translations of some or all of her most recent work in Germany, Thailand, and Norway, et al. Used throughout the world Great Britain, Taiwan, Thailand, Japan, Korea, Canada, Australia, New Zealand, South Africa, Israel, Germany, Spain, Italy, France, Belgium, the Netherlands, Bolivia, Colombia, Uruguay, and Mexico Central Philosophy

The philosophy of Orems SCDNT is based upon: patients wish to care for themselves moderate realism Conceptual Theoretical Model R=relationship; <=deficit relationship, current or projected (Tomey & Alligood, 5th Ed., 2002, pg 192) R R Conditioning

Factors < R Conditioning Factors R Conditioning Factors Deficit

R Internal/External Stimuli SCDNT: A General Theory Composed of Three Related Theories THEORY OF SELF-CARE: How and why people care for themselves. THEORY OF SELF-CARE DEFICIT: Describes and explains why people can be helped through nursing.

THEORY OF NURSING SYSTEMS: Describes and explains relationships that must be brought about and maintained for nursing to be produced. Three Types of Nursing Systems Wholly Compensatory Doing for the patient Partially Compensatory Helping the patient do for him/herself

Supportive-Educative Helping the patient learn to do for him/herself Concepts & Principles SELF-CARE: Activities individuals do on a daily basis within time frames, on their own behalf In the interest of maintaining life & healthful functioning To continue personal development & well being Concepts & Principles-contd SELF-CARE REQUISITES (SCRs):

Groups of needs or requirements Classified as: UNIVERSAL SELF-CARE REQUISITES those needs all individuals have (six SCR common to men, women, and children) DEVELOPMENTAL SELF-CARE REQUISITES those needs that relate to the development of the individual HEALTH DEVIATION REQUISITIES those needs that arise as a result of an individuals condition Concepts & Principles-contd

THERAPEUTIC SELF-CARE DEMAND: Controlling or managing factors identified in the requisites; the values of which are regulatory of human functioning (air, water, and food) Fulfilling the activity element of the requisite (maintenance, promotion, prevention, and provision) Concepts & Principles-contd SELF-CARE AGENCY: Complex acquired ability to meet ones continuing requirements for care that regulates life processes, maintains or promotes integrity of

human structure and functioning and human development, and promotes well-being. (Marriner-Tomey, 1994, pg. 184) Concepts & Principles-contd AGENT: The person taking action SELF-CARE AGENT: The provider of self-care DEPENDENT-CARE AGENT: The provider of infant care, child care, or

dependent adult care Concepts & Principles-contd SELF-CARE DEFICIT: When a patient is very unable to meet their own self-care requisites (refer to slide 21) NURSING AGENCY: Educated nurses Ability to act, know, & help patients Concepts & Principles-contd NURSING DESIGN:

Professional function (done before and after nursing diagnosis and prescription)Basis of reflective practical judgments PurposeProvide guides for achieving needed and foreseen results in production of nursing toward the achievement of nursing goals Concepts & Principles-contd NURSING SYSTEMS: Constructed through actions of nurses and nursespatients. Deliberate practical actions of nurses Performed at times in coordination with actions of their patients to know & meet components of

their patients therapeutic self-care demands. To protect and regulate the exercise or development of patients self-care agency Conceptual Theoretical Model R=relationship; <=deficit relationship, current or projected (Tomey & Alligood, 5th Ed., 2002, pg 192) R R Conditioning Factors

< R Conditioning Factors R Conditioning Factors Deficit

R Fawcetts Criteria & Pertinent Questions for Evaluation of Nursing Theories Explication of Origins Are the philosophical claims on which the nursing model is based explicit? Yes, Orems Self-Care Framework is based on philosophical, theoretical, and scientific knowledge about human behavior Philosophical claims stated in the form of: assumptions,

presuppositions, and premises Orem: Philosophy will help you think about things, but will not tell you your subject matter Explication of Origins Are the scholars who influenced the model authors thinking acknowledged and are bibliographic citation given? YES; scholars from a variety of disciplines cited Bibliographical citations provided. Aristotle, Thomas Aquinas, T. Parsons et al (1953), J. Macmurray (1957), B.J.F Lonergan (1958), M.B. Arnold (1960), M. Black (1962), T. Kotarbinski (1965), R. Harre (1970), Paul Weiss (1980), William A. Wallace (1983, 1996)

The Nursing Development Conference Group Orem Study Group Comprehensiveness of Content Does the nursing model provide adequate descriptions of all four concepts of nursings metaparadigm? Yes, the descriptions of all four of nursings metaparadigm concepts are adequate. Nursing-Person Emphasis Comprehensiveness of Content Do the relational propositions of the nursing

model completely link the four metaparadigm concepts? Yes, linkages are specified between concepts throughout the editions However, only ONE statement links all 4 concepts- in the 2nd edition of Orems book (1980) Nursing is made or produced by nurses. It is a service, a mode of helping human beingsNursings form or structure is derived from actions deliberately selected and performed by nurses to help individuals or groups under their care to maintain or change

conditions in themselves or their environments. This may be done by individuals or groups through their own actions under the guidance of a nurse or through the actions of nurses when persons have health-derived or health-related limitations that cannot be immediately overcome (Orem, 1980, p.5) Comprehensiveness of Content Is the researcher given sufficient direction about what questions to ask and what methodology to use? Purpose: to develop knowledge for the practical sciences

of nursing Methods associated with: Empiricist research paradigm, Interpretive research paradigm most consistent with Orems Framework See Fawcett Table 8-2, Table 8-3 for examples Comprehensiveness of Content Does the educator have sufficient guidelines to construct a curriculum? The framework has been used as a conceptual guide to nursing curriculums in a number of programs: associate degree, diploma,

baccalaureate, masters and doctorate levels. Comprehensiveness of Content Does the administrator have sufficient guidelines to organize and deliver nursing services? Yes, the Self-Care Framework provides ideas to guide: 1. The focus of nursing in the health-care institution 2. The purpose of nursing services 3. Characteristics of personnel 4. Settings for nursing services 5. Management strategies and administrative policies

Comprehensiveness of Content Is the practitioner given sufficient direction to be able to make pertinent observations, decide that an actual or potential need for nursing exists, and prescribe and execute a course of action that achieves the goal specified in a variety of practice situations? Purpose: to help people with health-related self-care deficits Concepts encompass people across the lifespan and in a variety of diverse settings Nursing Process: Professional-Technological Operations of Nursing Practice (see Fawcett Table 8-1) Logical Congruence

Does the model reflect more than one world view? No, only that of reciprocal interaction is noted Does the model reflect characteristics of more than one category of nursing knowledge? Characteristics are congruent with classification as a developmental model. Logical Congruence Do the components of the model reflect logical translation or reformulation of diverse perspectives? Yes, the content of Orems Framework is logically

congruent with her philosophical claims Orems thinking was influenced by a variety of perspectives and resources from a range of disciplines Generation of Theory What theories have been generated from the nursing model? Orems Self-Care Deficit Theory of Nursing Middle-Range Theory of relating factors & concepts of selfcare agency & dependent-care agency of school-aged children & their mothers. (Gaffney & Moore, 1996). Middle-Range Theory of Testicular Self-Examination (Fessenden, 2003).

Credibility of the Nursing Model: social utility, social congruence, social significance Are education and special skill training required before applying the nursing model in nursing practice? Yes, it is a rather unique framework in: focus, content, style and vocabulary. Need to learn specific style of thinking and communicating nursing (Orem, 2001, p.137) Familiarity with language of the theories of deliberate human action enhances understanding of Orems work.

Credibility of the Nursing Model: social utility, social congruence, social significance Is it feasible to implement practice protocols derived from the nursing model and related theories? Despite the need for special training and education, the implementation of Self-Care Framework-based practice protocols is feasible. Patients of all ages, across diverse practice settings Credibility of the Nursing Model: social utility, social congruence, social

significance To what extent is the nursing model actually used to guide nursing research, education, administration, and practice? Actual application of Orems model takes many forms in all of the above arenas. World-wide use: clinics, hospitals, home-health, health promotion practices & screenings Credibility of the Nursing Model: social utility, social congruence, social significance Does the nursing model lead to nursing activities

that meet the expectations of the public and health professionals of various cultures and in diverse geographic regions? Yes, it does; however, the emphasis on self-care may not be completely congruent with some peoples expectations of nursing practice Credibility of the Nursing Model: social utility, social congruence, social significance Does the application of the nursing model, when linked with relevant theories and appropriate empirical indicators, make important and positive

differences in the health conditions of the public? Yes, much empirical evidence supports Orems claim that nurses contribute to maintaining health, preventing disease, and disability and restoring or maintaining life processes by overcoming health-associated human limitations for engagement in self-care or dependent-care (Orem, 2001, p. 81). Contributions to the Discipline of Nursing What is the overall contribution of the nursing model to the discipline of nursing? Orems framework presents an optimistic view of patients contributions to their health care and an explicit focus on

what matters to nurses. Orem has identified the domain and boundaries of nursing as a science and an art as well as nursings unique contribution to health-care. Contrast of Theories Conceptual Model Person Environment Health

Nursing Orems Self-Care Framework Self-care agent Therapeutic self-care demand made up of: 1-universal SCRs 2-developmental SCRs 3-Health deviation SCRs

The persons external environment Soundness or wholeness of developed human structures & of bodily & mental functioning Definition: a helping service, creative effort to help people Goal: help people to meet their own therapeutic self-care demand

Actions: wholly/partly, compensatory, supportiveeducative nursing systems. Assist by acting for or doing, guiding, physical &/or psychological support, providing a developmental environment, teaching. Rogers Science of Unitary Human Beings A unitary human being, a

patterned, open, pandimensional energy field A patterned, open, pandimensional energy field An expression of the life process Definition: A learned profession that is both a science and an art. Goal: Help people achieve maximum well-being Action: Deliberative mutual

patterning that involves environmental patterning to promote helicy, integrality, and resonancy. Kings Interacting Systems Framework Personal system: Focus on perception, self, growth & development, body image, time, space, learning

Interpersonal system: Focus on interaction, communication, transaction, role, stress, coping. Social system: Focus on organization, authority, power, status, decision-making, and control. Internal/external Dynamic life experiences of a human being.

Ability to function in social roles Definition: Perceiving, thinking, relating, judging, and acting vis-vis the behavior of individuals who come to a nursing situation. Goal: Help individuals maintain their health so they can function in their roles Actions: A process of action, reaction, interaction, and transaction directed toward establishment of goals and goal attainment.

Peer Discussion We need to order home health for Mr. Orem before he is discharged. The Orem Model of Nursing or Self Care Deficit Nursing Theory states nurses have to administer care when the patients cannot provide care to themselves. Eastern Kansas VA Home Based Primary Care (HBPC) Mission Statement to provide compassionate care to veterans at home

and in the community, promoting optimal independence of the veteran and support to the caregiver. References Chinn, P., & Kramer, M. (1991). Theory and Nursing (3rd Ed.). St. Louis: Mosby. Fawcett, J. (2005). Contemporary Nursing Knowledge: Analysis and Evaluation of Nursing Models and Theories (2nd Ed.). Philadelphia, PA: F.A. Davis Company. Hartweg, D. L. (1995). Dorothea Orem: Self-Care Deficit Theory. In C.M. McQuiston & A.A. Webb (Eds.), Foundations of Nursing Theory: Contributions of 12 Key Theorists (pp. 139-202). Thousand Oaks, CA: Sage Publications, Inc. Marriner-Tomey, A. (1994). Nursing Theorists and Their Work (3rd Ed.). St Louis: Mosby.

Marriner-Tomey, A., & Alligood, A. (2002). Nursing Theorists and Their Work (5th Ed.). St Louis: Mosby. Orem, D. E. (2001). Nursing: Concepts of Practice (6th ed.). St. Louis, MO: Mosby, Inc. Wikipedia: Philosophy of action. (Oct. 7, 2008). Retrieved October 10, 2008, from Wikipedia: http://en.wikipedia.org/wiki/Philosophy_of_action

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