DOROTHEA OREM’S THEORY

APPLICATION OF THEORY IN NURSING PROCESS

Introduction

Theories are a set of interrelated concepts that give a systematic view of a phenomenon (an observable
fact or event) that is explanatory & predictive in nature. Theories are composed of concepts,
definitions, models, propositions & are based on assumptions. They are derived through two principal
methods; deductive reasoning and inductive reasoning.

Objectives

• to assess the patient condition by the various methods explained by the nursing theory
• to identify the needs of the patient
• to demonstrate an effective communication and interaction with the patient.
• to select a theory for the application according to the need of the patient
• to apply the theory to solve the identified problems of the patient
• to evaluate the extent to which the process was fruitful.

Definition:

Nursing theory is an organized and systematic articulation of a set of statements related to questions in
the discipline of nursing. A nursing theory is a set of concepts, definitions, relationships, and
assumptions or propositions derived from nursing models or from other disciplines and project a
purposive, systematic view of phenomena by designing specific inter-relationships among concepts for
the purposes of describing, explaining, predicting, and /or prescribing..

Importance of nursing theories:

• Nursing theory aims to describe, predict and explain the phenomenon of nursing
• It should provide the foundations of nursing practice, help to generate further
knowledge and indicate in which direction nursing should develop in the future
• Theory is important because it helps us to decide what we know and what we
need to know
• It helps to distinguish what should form the basis of practice by explicitly
describing nursing
• The benefits of having a defined body of theory in nursing include better patient
care, enhanced professional status for nurses, improved communication between nurses,
and guidance for research and education
• The main exponent of nursing – caring – cannot be measured, it is vital to have
the theory to analyze and explain what nurses do
• As medicine tries to make a move towards adopting a more multidisciplinary
approach to health care, nursing continues to strive to establish a unique body of
 knowledge
• This can be seen as an attempt by the nursing profession to maintain its
professional boundaries.

Purposes of theory in practice:

• Assist nurses to describe, explain, and predict everyday experiences.

• Serve to guide assessment, intervention, and evaluation of nursing care.
• Provide a rationale for collecting reliable and valid data about the health status of
clients, which are essential for effective decision making and implementation.
• Help to establish criteria to measure the quality of nursing care
• Help build a common nursing terminology to use in communicating with other
health professionals. Ideas are developed and words defined.
• Enhance autonomy (independence and self-governance) of nursing by defining
its own independent functions.

If theory is expected to benefit practice, it must be developed co- operatively with people who practice
nursing. People who do research and develop theories think differently about theory when they
perceive the reality of practice. Theories do not provide the same type of procedural guidelines for
practice as do situation- specific principles and procedures or rules. Procedural rules or principles help
to standardise nursing practice and can also be useful in achieving minimum goals of quality of care.
Theory is ought to improve the nursing practice. One of the most common ways theory has been
organized in practice is in the nursing process of analyzing assessment data

INTRODUCTION OF DOROTHEA OREM

Dorothea Orem’s self-care deficit theory, a general theory of nursing, is one of the most
widely used models in nursing today. In 1914, Dorothea Orem was born in Baltimore,
Maryland. She received her nursing diploma in the early 1930’s from Providence Hospital
School of Nursing, Washington D.C. In addition to earning a BSN Ed. (1939) and MSN Ed.
(1945), she has received three honorary doctorates and an Alumni Achievement Award for
Nursing Theory in 1980 from Catholic University of America (Hartweg, 1995).
Early in her career, Orem gained experienced as a staff nurse in a variety of hospital
clinical settings. While serving as director of nursing service at a Detroit hospital, she recalls
that she was asked a substantive question and didn’t have an answer because she “had no
conceptualization of nursing” (McLaughlin-Renpenning & Taylor, 2002, ).
Orem goes on to say while working at Indiana University where her goal was to upgrade
the quality of nursing in general hospitals throughout the state, she 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)

EXPERIENCE
 • Early nursing experience included operating room nursing, private duty nursing (in home and
hospital), pediatric and adult medical and surgical units, evening supervisor in the emergency
room, and biological science technician.
• 1940-1949 Orem held directorship of both nursing school and the department of nursing at
Providence Hospital in Detroit

ACHIEVEMENTS

• 1976 and 1980 Honorary degree of Doctor of Science.

• 1980 CUA Alumni Association Award for Nursing Theory.
• 1988 Doctor of Humane Letters from Illinois Wesleyan University
• 1988 Linda Richards Award
• 1991 National League for Nursing
• 1992 Honorary Fellow of the American Academy of Nursing.
• 1998 Doctor of Nursing Honoris Causae from the University of Missouri.
Development of Theory

• 1949-1957 Orem worked for the Division of Hospital and Institutional Services of the Indiana
State Board of Health. Her goal was to upgrade the quality of nursing in general hospitals
throughout the state. During this time she developed her definition of nursing practice.
• 1958-1960 US Department of Health, Education and Welfare where she help publish
"Guidelines for Developing Curricula for the Education of Practical Nurses" in 1959.
• 1959 Orem subsequently served as acting dean of the school of Nursing and as an assistant
professor of nursing education at CUA. She continued to develop her concept of nursing and
self care during this time.
• Orem’s Nursing: Concept of Practice was first published in 1971 and subsequently in 1980,
1985, 1991, 1995, and 2001.
• Continues to develop her theory after her retirement in 1984

DEFINITIONS OF DOMAIN CONCEPTS

1. Nursing – is art, a helping service, and a technology

• A service geared towards helping the self and others

• Is required when self-care demands exceed a patient’s self-care ability (agency)
• Promotes the patient as a self-care agent
• Has several components

 Nursing art: the theoretical base of nursing and other disciplines such as sciences, art,
humanities
 Nursing prudence: the quality that enables the nurse to seek advice in new or difficult
situations, to make correct judgements, to decide to act in a particular manner, and/or to act
 Nursing service: a helping service
 Nursing agency: the ability of the RN

• ROLE THEORY: the role of the nurse & patient are complementary as they work together to
achieve self-care
• SPECIAL TECHNOLOGIES:

– Social & Interpersonal technologies - communicating, coordinating, establishing &

maintaining therapeutic relations, rendering assistance
– Regulatory technologies - maintaining and promoting life processes,
growth/development, and psycho-physiologic modes of functioning

2. Health – health and healthy are terms used to describe living things …