Functional Assessment in the Older Adult


Dorothea Orem's Theory of Nursing 

About Dorothea Orem: 

  • Born:  1914 in Baltimore, Maryland
  • Earned her diploma at Providence Hospital - Washington DC
  • 1939 - Earned BSN
  • 1945 - Earned MSN
  • Worked as a staff nurse, private duty nurse, nurse educator and administrator and nurse consultant
  • Received honorary Doctorate of Science in 1976

Major Assumptions of her theory:

  • People should be self-reliant and responsible for their own care and other in their family needing care
  • People are distinct individuals
  • Nursing is a form of action - interaction between two or more people
  • Successfully meeting universal and development self-care requisites is an important component of primary care prevention and ill health
  • A person's knowledge of potential health problems is necessary for promoting self-care behaviors
  • Self care and dependent care are behaviors learned within a socio-cultural context

Orem's theory specifics:  

Theory of self care
  • Self care - practice of activities that individuals initiates and performs by themselves.
  • Self care agency- the ability to engage in the act of self care
  • Therapeutic self care demands - the overall actions of self care to be performed for a duration in order to meet self care requisites
  • Self care requisites - actions directs towards provision of self care, universal self care requisites, developmental self care requisites, health deviation self care requisites

1.  Universal self care requisite -  

  • Associated with life processes and the maintenance of structure and functioning
  • Activities of daily living
  • maintains sufficient intake of air , water and food
  • Provision of care associated with elimination process
  • Balance between activity and rest
  • Prevention of hazards
  • Promotion of function
2.  Developmental self care requisite - 

  • Associated with development process such as adjustment to new job or body changes
3.   Health deviation self care

  • seeking and securing appropriate medical assistance
  • Being aware of and attending to the effects of illness
  • Effectively carrying out medically prescribed measures
  • Modifying self concepts in accepting a state of health 
  • Learning to live with effects of illness

Theory of self care deficit

  • specifies when nursing is needed
  • Nursing is required when an adult is incapable or limited in continuous effective self care
  • Five methods of helping:  acting for and doing for others, guiding, supporting, teaching, and providing an environment promoting development of future needs

Theory of nursing system

  • Describes how patient's self care needs will be met by the nurse and patient
  • Identifies three classifications of nursing system to meet self care requisites of the patient:  Wholly compensatory system, partly compensatory system, and supportive - educative system
  • Scope of nursing responsibility in health care situations
  • general and specific roles of nurses and patients
  • Reasons for nurses' relationships with patients
  • Technology

Orem's Theory and the Nursing Process

  • Nursing process presents a method to determine self care deficits and defines the roles of the nurse or staff to meet the patients self care needs
  • A technical approach to the nursing process
  • Must coordinated with interpersonal and social processes within a nursing situation

1.  Assessment -

  • Diagnosis and prescriptions; determines why nurse is needed
  • Plan for delivery of care
  • Collect the person health status
  • Doctors perspective of patient's health status
  • Individual perspective on health status
  • The health goals: lifestyle, health status, life history
  • Individual requirements for self care
  • Individuals's capacity for performing self care 

2.  Nursing Diagnosis and Plan -

  • Nurse designs a system that is wholly or partly compensatory or supportive-educative
  • Create an organized plan of care that is therapeutically self care focused
  • Selection of interventions that will effectively and efficiently compensate and help patient overcome self care deficits

3.   Implementation and Evaluation -

  • Nurse assists the patient and family in self care interventions to achieve identified and described health related objectives
  • Collect evidence in evaluating results achieved against results specified in the nursing system design.
  • Action are directed by nursing diagnosis
  • Evaluation of process and reassessment

Strengths of theory -

  • Provides a comprehensive bases to nursing practice
  • Specifies when nursing is needed
  • It utility for professional nursing in the are of nursing practice, nursing curriculum, nursing education and administration, and nursing research
  • contemporary self care approach including health promotion and health maintenance.

Limitations of theory -

  • Health is viewed as dynamic and ever changing
  • Illness oriented theory  (Nursing theories, 2012)


Dorothea Orem's Self Care Theory
Dorothea Orem Self Care Theory Application

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