In her early experiences, she worked in operating room nursing, private duty nursing, pediatric and adult medical and surgical units, evening supervisor in the emergency room, and biological science technician. Other than that, from 1940 to 1949, Orem has taken the position as director in both nursing school and the department of nursing at Providence Hospital in Detroit.
From 1949 to1957, Orem had worked for the Division of Hospital and Institutional Services of the Indiana State Board of Health to upgrade the quality of nursing in general hospitals throughout the state. While working, she had noted that nurses had difficulty articulating needs to hospital administrators in the face of demands made upon them regarding such issues as length of stay, scheduling admissions and discharges, etc. (McLaughlin-Renpenning and Taylor, 2002). Thus, she started to develop her definition of nursing practices. After reflecting upon her own nursing experiences, Orem says "an understanding that the reason why individuals could benefit from nursing was the existence ofâ€¦self care limitations" (Orem, 1978, cited in Fawcett, 2005, p.230).
Orem then moved to Washington D.C. in 1957 and become a consultant in the Office of Education. She was working to improve the nursing component of a vocational nursing curriculum. After that, she realized that the curriculum couldn't be determined until there was an understanding of the subject matter of nursing in general.
In 1959, she took the position as an assistant professor at The Catholic University of America, where she continued to develop her concept of nursing and self-care. Orem's ideas were further formalized after she joined the Nursing Development Conference Group (NDCG). This group, who came together in 1968, was "committed to the development of structured nursing knowledge and to nursing as a practice discipline" (Hartweg, 1995). Orem says her ideas are primarily the result of reflecting upon her experiences and she was not influenced by any one person, but she states that formal logic and metaphysics were among other disciplines that influenced her work. (Hartweg, 1991)
In 1970's, she has first published her book, titled Nursing: Concepts of Practice. It was the conceptual framework's original publication. Orem's work characterized as "a time for changes within the nursing profession, being a time for planning, researching and expanding nursing roles." (Chinn & Kramer, 2004)
Orem defined nursing as an act of assisting others in the provision and management of self-care to maintain or improve human functioning at home level of effectiveness. In general, nursing is an act of proving of self-care for person who needed in order to maintain the optimal health and wellness. Everyone possesses the ability and responsibility to care for themselves and dependents. Nursing is a service to people, not a derivative of medicine. Nursing promotes the goal of patient self-care.
According to Orem's theory, it is divided into three parts, which are theory of self-care, self-care deficit and nursing system.
Theory of self care
Orem's self-care theory is based on the concepts of self-care, self-care agency, self-care requisites and therapeutic self-care demand. Self-care consists of those activities performed individually by a person to promote and maintain personal well-being throughout life.
Self care agency is the ability of a person to perform their self-care activities. Self-care agency consists of two agents, self-care agent and dependent care agent. Self-care agent is a person who provides the self-care and dependent care agent is a person other than the individual who provides the care, for example, the patients.
Therapeutic self care demand is the totality of self care actions to be performed for some duration in order to meet self care requisites by using valid methods and related sets of operations and actions.
Self-care requisites also called as self-care needs. It is an action directed towards provision of self care. There are three categories of self care requisites, which are universal, developmental and health deviation. Universal self-care requisites are defined as the needs that are common to all individuals' activities of daily living. Moreover, the universal self-care requisites are identified by eight elements, which are air, water, food, elimination, activity and rest, solitude and social interactions, prevention of harm, and promotion of normality. Developmental self-care requisites are the needs resulting from the interventions and teachings designed to return a person to or sustain a level of optimal health and well being. For example, educate the child on toilet using and eat healthy diet. Health deviation self-care requisites are the needs resulting from illness, injury and disease or its treatment.
Theory of Self-Care Deficit
Theory of self-care deficit is the self-care needed by a person when their ability has achieved certain limitation. In another meaning is that a person benefits from nursing intervention when a health situation inhibits their ability to perform self-care or creates a situation where their abilities are not sufficient to maintain own health and wellness. The nursing action will be focuses on identification of limitation and implementing appropriate interventions to meet the needs of person. Nursing is required when an adult is incapable in the provision of continuous effective self-care. In addition, there are five methods of helping identified by Orem, which are acting (or doing for another), guiding, supporting (physically or psychologically), teaching and providing an environment to promote the patient's ability to meet current or future demands. The nurse can use any of these to help the individual.
Theory of Nursing Systems
Theory of nursing system is defined as the nursing interventions needed when individual are unable to perform the necessary self-care activities. In other way of meaning, this theory also defined as a series of actions a nurse takes to meet a patient's self-care needs. It describes the nursing responsibilities, roles of the nurse and patient, rationales for the nurse-patient relationship, and the types of actions needed to meet the patient's demands.
Nursing system composed of three systems, which are wholly compensatory, partial compensatory and supportive-educative. Wholly compensatory is a nurse need to provide full self-care for the patient, because the patient's self-care agency has exceeded the limitation that he or she must depends on others (nurse) for well-being. For examples, the coma patient paralysed patient or mental retardation patient.
Partial compensatory is some self-care requisites that need the assistant from nurse to meet, but some can be done by patient. For example, give assistance in ambulation for the patient who is following on surgery.
Supportive-educative is a nurse's action of using knowledge, support and encouragement to develop the self-care abilities of patient in terms of decision making or behavior control. For example, advising the teenagers on effects of smoking or taking drugs.
The reason why I choose to write Dorothea Orem is because I feel curious to know more about her after Madam Jaya taught us about the nursing theorists. During in that class, I heard that Madam Jaya said she likes Orem's theory. So, when I read the theory, I started to feel like to know more about her and how she comes out with such theory.
After I did some research on Dorothea Orem, I found that I started to like her theory. It's true that when an individual has exceeded their limitation of abilities, the self-care deficits occur. Thus, provision of self-care is needed to assist the individual to cope up the activities in daily living.