SELF CARE DEFICIT THEORY
Thoeorist – Dorothea Orem

Introduction:
Nature is really great. His miracle gives birth, life and exit. By the nature every livings are able to take self care. Human has much more abilities to take self care for health and well being some times we need “another’s” help.
If we are
Unable to meet own needs
Seeking to achieve new abilities
In relation to health, the another may be the nurse who takes care of people for their health and well being.
This may be the central idea of “ SELF CARE DEFICIT THEORY OF NURSING”
Background of nurse theorist:
Dorothea Elizabeth Orem one of American’s foremost nursing theorist was born in Bltimore, Maryland in 1914.
She did her Diploma in nursing at Providence Hospital, school of nursing in Washington in 1930.
She completed, B.Sc.(N) from catholic university of North America in 1939.
In 1945, she did M.Sc. N from catholic university.
Since 1958 she worked as curriculum consultant in U.S. department of Health, Education and welfare.
In 1971, Orem Published her first book on “ Nursing concepts of practice and II, III and IV in 1980 and 1985, 1991 respectively.
She received Doctor or science degree from Georgetown University in 1976.
She got Catholic university of America’s Alumini Achivement Award for Nursing Theory in 1980.
Purpose of Model/ Origin of the model:
In 1958, she was working as curriculum consultant. She found deficits in the training of practical nurse. This stimulated her to form concept of self care.
When person is able to take care for self, he takes self care. When she is not able to take self care then nurse provides assistance.
Orem’s General theory of nursing:
According to Orem, nursing has it’s special concern the individual’s need self care action and provision and management of it, a continuous basis in order sustain life and health, recover from disease or injury and cope with their effects.
Orem develops, her general theory of nursing in 3 related parts.
1.Self care theory
2.Self care deficit theory
3.Nursing systems theory.
1.Self care theory:
It includes
a.Self care
b.Self care agency
c.Therapeutic self care demand as well as self care requisites.
a. Self care:
It is the practice of activities that individual initiate and perform on their own behalf in maintaining life, health and well being.
Self care effectively performed contributes in specific ways to human structured integrity, human functions and human development.
b. Self care agency:
It is human ability which is the ability for engaging in self care. Self care agency is conditioned by age, development state, life experiences, socio-cultural orientation health and available sources.
Normally adults can take care for them self but children and aged, ill and disabled require complete care or assistance for self care activities.
(Ability to engaging in self care by client).
c. Therapeutic self care demand as well as self care requisites:
Therapeutic self-care demand is the totality of self cares actions to be performed for some duration in outer to meet self-care requisites by using valid methods and related sets of operations and actions.
Self care requisites or requirements are
I.Universal self care requisite
II.Developmental self care requisite
III.Health deviations
Self care requisites defined as actions directed toward provision of self care.
I. Universal self care requisites are associated with life process and maintenance of the human structure and functioning. They are needed to all so it is also called activities of daily living.
Orem identifies self-care requisites
1.The maintenance of sufficient intake of air
2. The maintenance of sufficient intake of water
3.The maintenance of sufficient intake of food
4.Provision of care associated with elimination process of excretion.
5.The maintenance of balance between activity and rest.
6.The maintenance of a balance between solitude and social interaction.
7.The prevention or hazards to human life human functioning and human well-being.
8.The promotion or human functioning and development within social groups in accord with human potential. Known human limitations and human desire to be normal.
(Normalclasy means as per genetic and constitutional characteristics and talent of individuals that all which is essential to human.
II. Development self care requisites:
They are either specialized expression or universal self care requisites that have been particularized for development process or they are new requisites derived from a condition.
Or associated within an event eg, adjustment with new job, adjustment with changed body image (in adolensence or in old age)
III. Health Deviation self care:
It is required in conditions of illness, injury or disease or may result from medical measures to diagnose and correct the condition.
(Might blindness – vit.A., learning walk with crutches after fracture leg).
They are as follows;
1.Seeking and securing appropriate medical assistance.
2.Being aware and attending to the effects and results of pathogence conditions and states.
3.Effectively carrying out medically prescribed measures.
4.being aware of and attending to or regulating the discomfort or deterious effects of prescribed medical measures.
5.Modifying self care concept (4 self image) in accepting onself as being a particular state of health and need of spcific forms of health care.
6.learning to live with effects or pathological condition and states and effects of medical diagnostic and treatment measure in life style that promotes continued personal development.
2.Self care deficit theory:
It is core part of orem’s general theory of nursing as it declineates when, nursing is needed.
Nursing is required when person is incapable or limited in provision of continuous effective self care.
Or care abilities are less than those required for meeting known self care demand.
Or self care or dependent care abilities exceed.
Or dependent care abilities are equal to those required for meeting current self care but may deficit in future.
Orem identified five methods of helping to client by nurse.
a.Acting for or doing for another (patient/ family)
b.Guiding to another.
c.Physically or psychologically supporting to another
d.Providing an environment that promotes
e.Personal development in relation to becoming able to meet present or future demands for action.
f.Teaching another.
Orems conceptual frame work for nursing relationship
Orem identified 6 major concepts
1.Self care
2.Therapeutic self care demand
3.Self care agency
4.Self care deficit
5.Nursing agency
6.Nursing system
1st to four are relation to patient/ person who need nursing.
5th to 6th related to nursing and their actions.
R - Denotes – relationship
< - Indicate deficit relationship
Orem has identified five areas of activity for nursing practice.
1.Entering into and maintaining nurse patient relationships with individuals, families and groups till patient get discharge.
2.Determining if and how patient can be helped through nursing.
3.Responding to patients requests, desires, needs for nurse contacts and assistance
4.Prescribing, providing and regulating direct help to patient and their significant others in the form of nursing.
5.co-ordinating and integrating nursing with the patients daily living, other health care needed or being received and social and educational services needed or being received.
3.The theory of nursing system:
This designed by nurse is based on self care needs and abilities of patient to perform self care activities.
Orem identified three classification of nursing system to meet self care requisites.
a.Wholly compensatory system
b.Partly compensatory system
c.Supportive and educative system
The design and elements of nursing system define.
1.The scope of nursing responsibilities in health care situations.
2.The general and specific roles or nurses and patient
3.Reasons for nurses relationship with patients.
4.The kinds of actions to be performed and performance patterns and nurses and patients actions in regulating patients self care agency and meeting their therapeutic self care demand.
a. The wholly compensatory nursing system
Person has not abilities to perform self care activities ie. Nurse performs all the necessary actions.
Eg. Coma or conscious patient needs all nursing care from nurse.
b. Partly compensatory system:
Here nurse and patient share responsibilities of patients care. Some activities carried by nurse for patient and some patient can carry out for self independently. Eg. Post operative patient extremities fracture case.
c. Supportive educative system:
Here patient is able to do activity but needs
Specific education relation to activity
Guidance to select activity
Physical or Psychological support to do self care activities.
Eg. Patient who is going to discharge
Follow up or OPD case
Minor health problem patients.
Orem states that “ One or more of the 3 types may be used for one patient.
Example:
Antenatal case
Supportive – educative system
Labour pains star and she admitted
Partly compensatory system
If she need L.S.C.S. (Cesarean section)
Fully compensatory system
Before discharge
Partly compensatory system
On discharge (prepares go to home)
Supportive educative system
Orem explains:
What means – self care and lists the varies factors that affects its provision (in self care theory)
When – nursing care is needed ie. In self care deficit. (Self care deficit theory )
How – patients self care needs will be met by nurse, patient or both ( The theory of nursing system)
Orem’s theory and the four major concepts of
a.Human being
b.Health
c.Society
d.Nursing in her work
a.Human being:
They having social capacities to
Reflect upon themselves and their environment.
Use of symbolic creations (ideas or words) in thinking, in communication and in guiding efforts to do and to make things that are beneficial for them serves or others.
To symbolize what they experience
Integrate human functioning includes physical, psychological, interpersonal and social aspects.
Orem believes that individual have the potentials for learning and development (meeting need is learnt behaviour).
Factors that affect learning include;
Age
Mental capacity
Culture
Society
Emotional state of human
b.Health:
Orem’ believe WHO’s definition of health. She states that physical, psychological interpersonal and social aspects are inspirable in the individual.
About concept of preventive health care she includes
Promotion and maintenance health – primary precaution
Treatment of disease and injury –secondary prevention
Prevention of complication – Tertiary prevention
c.Nursing:
Orem status:
In modern society, adults are expected to be self reliant and responsible for themselves and for the well being. Helpless, sick, aged, handicapped and deprived should be helped to attain or regain responsibilities within their existing capacities. Thus both self – help and help to others are valued by society. So communities people see nursing is vital service.
Orem speaks several factors related to concept of nursing
Art of nursing includes making comprehensive determination of the reasons why people can be helped by nursing. The help to design nursing system and nursing process.
Nursing prudence is the quality of nursing
Nursing as a human service, nursing help to individual, family and society nursing is deliberate action.
(Nursing agency – Nurses provide nursing care through nursing process or nursing theory, it is termed as nursing agency).
Nursing roles: Patient has different role, person, father, age, sex, job (elected ( teacher).
Nurse play different roles – as nurse, teacher, conselor**, guide, support both role interact for achive goal of self care.
Technologies in nursing:
A technology is systematized information about a process or a method for effecting some desired result through deliberate practical endeavor with or without the use of materials or instruments.
Two technologies used in nursing
a.Social / interpersonal technologies
b.Regulatory technologies
a.Social/ interpersonal technologies includes –
Communication adjusted to age, development state, health state and social cultural orientation.
Keep good IPR and co-ordination in health team.
Maintaining therapeutic relationship (psychological support is one of the part).
Give assisted care to meet health needs.
b.Regulatory technologies
Maintain and promote life process.
Regulation on psychological modes of functioning in health and disease
Prompting human G and A.
Regulating position and movement in space.
Both together promote quality of nursing.
Strengths of orem’s theory:
Provides comprehensive base for nursing practice ( theory includes, physician, psychological, social and interpersonal components)
Can use in nursing practice, nursing education, nursing administration and nursing research.
She specify when nursing is needed. (eg. No self care abilities to meet needs)
Care abilities are less than known self care demand.
Continuing education is integral part of nursing practice.
Define different roles
She emphasize that nursing is education and not trained.
Can apply to individual family and community.
Summary
We discussed, orem’s general theory of nursing composed of three interrelated theories.
a.Self theory
b.Self care deficit theory
c.Nursing system theory
We compared Orem’s theory to four major concepts.
Human being
Health
Society
Nursing
In her work
Correlation of Orem’s theory and nursing process.
Conclusion:
After discussion on self care theory and feel it is not applicable only for nursing practice but even for each aspect of life.
Every one has ability to take self care, but is demands acre more or to learn new abilities, anothers help is needed.
Guru gives and guides a way to reach of life.
Bibliography
1.IGNOU module, BNS-101, Nursing foundation Shagum offset press, Nov-2004. (volume 1).
2.Koziez Erb, fundamentals of nursing, 1st edition, 2004, rearson education company Pvt. Ltd. Singapore.
3.Potter and Perry, Basic Nursing Theory and practice. Copy right 2000. The CV mosby company Washington.
4.Roger Julia
5.Tomey Ann, Nurisng theories and their work, IInd Education, CV Mosby company US.