Orem’s Self-Care Framework
World View: Reciprocal Interaction World View
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Holistic view of persons as unitary beings
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Human beings are not isolated from their environments
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Person is viewed as an active agent who can take deliberate actions
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Changes in the developmental and health-related changes that occur in the demand for therapeutic care. Those changes are necessary for survival as the person matures
Content of the Nursing Model: thoroughly utilizes 4 concepts (human beings, environment, health, nursing) and NONRELATIONAL propositions or constitutive definitions.
Human Beings uses the term “patient”: receiver of care of a health care professional currently in someplace (the unit of service for nursing practice). Individual: the person or an individual member of a multiperson unit. Multiperson Unit: more than one person (2) types; 1. Those who make a collective such as shared space, situation, relationship & 2. Families and communities:
Therapeutic Self-Care Demand: all required regulatory care in the life cycle. (8) Universal Self-Care Requisites: self-care that’s common in all stages of life; air, food, water, elimination, activity/rest, solitude/social interaction, prevention of hazards, promotion of normalcy
(3) Developmental Self-Care Requisites: provision of conditions to promote development (maintain a safe environment and prevent sensory deprivation and overload), engagement in self-development (maintain a sense of purpose in life), interferences with development (i.e. handicap):
- 2 goals for these requisites provide conditions and promote behaviors that; will prevent the occurrence of debilitating effects on development & mitigate or overcome existent barriers to development
- (6) actions of Health Deviation Self-Care Requisites: seek and secure medical attn., be aware of and attend to pathology, carry out the medical plan of care, be aware of an attend to side-effects, modify self-concept (i.e. the patient acceptance of the diagnosis), modify lifestyle.
Self-Care: actions taken by individuals to regulate their function and development; carries the dual connotation of care ‘for oneself’ and ‘given by oneself’
Self-Care Agent: the person who acts; able to identify and decide what actions are needed for self-care requisites and can perform those actions.
Self-Care Agency: the individual’s ability to meet his or her continuing requirements for self-care, which varies throughout the life span (3 dimensions):
- Development: the individual’s learning to perform self-care in a consistent and effective manner.
- Operability: the individual’s actual performance of self-care.
- Adequacy: self-care performed adequately to meet an actual or potential therapeutic demand.
(10) Basic Conditioning Factors: an individual’s ability to perform required self-care; age, gender, developmental state, health state, health-care sys. factors, family sys. factors, available resources, patterns of living, sociocultural factors.
Power Components: the initiation that enables the performance of required reactions (answers are you able to carry out the demands?)
- (10) Self-Care Agency Power Components: maintain attn., physical energy, body ctrl, reasonability, MOTIVATION, make decisions, to acquire knowledge, communication skills, order discrete self-care actions, consistent ability
- (10) Nursing Agency Power Components: valid knowledge, practical skills, willingness, unify different actions towards achievement, consistent performance, adjusting in emerging conditions, ability to self-manage
Deficit: the relationship between therapeutic self-care demand and self-care agency
Self-Care Deficit: when the therapeutic demands exceed self-care agency
Dependent-Care Deficit: when self-care demands of the dependent exceed dependent-care agency
Environment: The metaparadigm concept of environment is represented by environmental features that have 2 dimensions:
- Physical, Chemical, and Biologic Features: weather conditions, pollution & infectious diseases, animals
- Socioeconomic-Cultural Features: avail resources, crime, poverty, community
Health: the metaparadigm concept of health is represented by
- Health-State: the stage of an individual that reflects wholeness or soundness of the physical and mental self; a person’s complete and actual state of existence. Classification of nursing situations by health focus by 7 groups:
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Group 1: Life cycle refers to growth and development; aging/biological
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Group 2: Recovery is the process of overcoming disease or injury (compensating)
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Group 3: Illness of undetermined origin; focus on illness or disorder
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Group 4: Genetic and Developmental Defects and Biologic Immaturity
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Group 5: Cure or Regulation; the effects of the illness or disability
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Group 6: Stabilization of Integrated Functioning
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Group 7: Quality of Life Irreversibly Affected or Terminal Illness
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- Well-Being: individual’s perceived condition of existence- state characterized by experiences of contentment, happiness, spiritual experiences, one’s fulfillment.
- Disease: abnormal biological process with characteristic symptoms. Illness considered; acute, chronic, disability.
Nursing: the metaparadigm concept of health is represented by Nursing Agency (3) dimensions:
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Social System: the contractual relationship of nurses and persons who require nursing care, desirable nurse characteristics; courteous and considerate of others
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Interpersonal System: helping, resolving relationship
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Professional-Technological System: the nursing process (Practice Methodology)
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Goals of Nursing Agency: To Compensate for or Overcome Known or Emerging Health-Derived or Health-Ass. Limitations of Legitimate Patients for Self-Care or Dependent-Care.
Relational propositions which link ALL 4 (nursing, human being, environment, health) metaparadigm concepts: Nursing is made or produced by nurses. It’s a service for helping human beings maintain their environments through nursing actions when a person has health-related problems.
Practice Methodology
Professional Technological Operations of Nursing Practice (7) Components;
- Case Management Operations: a case management approach
- Diagnostic Operations: identifies the unit of service for nursing practice, nurse collects demographic
- Prescriptive Operations: nurse identifies roles
- Regulatory Operations: Design of NURSING SYSTEMS for Performance of Regulatory operations: If there’s a deficit: Wholly Compensatory Nursing System: nurse does everything -> Partly Compensatory Nursing System: partial care -> Supportive-Educative Nursing System: nurse selects supportive-educative nursing systems -> Methods of Helping: guiding and supporting the patient
- Regulatory operations: Planning for regulatory Operations; nurse specifies what is needed to produce the nursing system(s) selected for the patient
- Regulatory Operations: Production of Regulatory Care: coordinate and direct nursing care, assist the individual with tasks
- Control Operations: nurse makes observations and evaluates
Grand Theories
- Theory of Self-Care: central idea is “self-care is a human regulatory function that individuals must, with deliberation, perform for themselves of having performed for them (dependent-care) to supply and maintain a supply of material and conditions to maintain life; to keep physical and psychic functioning and development within norms compatible with life.
- Theory of Self-Care Deficit: central idea is “requirements of persons for nursing are associated with the subjectivity of mature and maturing persons to health-derived or health-related action limitations associated with their own or their dependents’ health states that render them completely or partially unable to know the existence and emerging requisites for regulatory care for themselves or their dependents. (i.e. diabetic/blood sugar/diet education)
- Theory of Nursing System: the central idea is all action systems that are nursing systems are formed (designed and produced) by nurses for legitimate recipients of nursing by exercising their powers of nursing agency. (i.e. medication teaching, wound care)
- General Theory of Nursing Administration: nursing as a field of knowledge and practice
Middle Range Theory: Theory of Dependent Care (Taylor)
Related Diagrams
Additional Information & References
- An Outline by Current Nursing
- More Self-Care Theory Diagrams and Information by Nurse Labs
