Dorothea Orem's Self-Care Framework
(written by and reprinted with the kind permission of Jacqueline Fawcett, RN, PhD, FAAN)
THE CONCEPTUAL FRAMEWORK
Orem's work can be separated into a conceptual model and three theories. Orems conceptual model is constituted from six central or core concepts and one peripheral concept. The central concepts are self-care, self-care agency, therapeutic self-care demand, self-care deficit, nursing agency, and nursing system. The peripheral concept is basic conditioning factors.
SELF-CARE is defined as action directed by individuals to themselves or their environments to regulate their own functioning and development in the interest of sustaining life, maintaining or restoring integrated functioning under stable or changing environmental conditions, and maintaining or bringing about a condition of well-being.
SELF-CARE AGENCY is defined as a complex capability of maturing and mature individuals to: (1) determine the presence and characteristics of specific requirements for regulating their own functioning and development, (2) make judgments and decisions about what to do, and (3) perform care measures to meet specific self-care requisites.
THERAPEUTIC SELF-CARE DEMAND is defined as the action demand on individuals to meet some complex of universal, developmental, and health deviation self-care requisites. Universal self-care requisites are associated with life processes and maintenance of the integrity of human structure and function. Developmental self-care requisites are associated with human developmental processes and conditions and events that occur during various stages of the life-cycle, as well as with events that may adversely affect development. Health deviation self-care requisites are associated with genetic and constitutional defects and human structural and functional deviations and their effects, as well as with medical diagnostic and treatment measures prescribed or performed by physicians.
SELF-CARE DEFICIT is defined as the expression of a relationship of inadequacy between self-care agency and the therapeutic self-care demand.
NURSING AGENCY is defined as a complex property or attribute of nurses developed through specialized education and training in the theoretical and practical nursing sciences and through their development of the art of nursing in reality situations.
NURSING SYSTEMS is defined as a dynamic action system produced by nurses as they engage in the diagnostic, prescriptive, and regulatory operations of nursing practice. The wholly compensatory nursing system is selected when the patient cannot or should not perform any self-care actions. The partly compensatory nursing system is selected when the patient can perform some, but not all, self-care actions. The supportive-educative nursing system is selected when the patient can and should perform all self-care actions.
BASIC CONDITIONING FACTORS reflect features of individuals or their living situations, such as age, gender, health state, developmental age, sociocultural, health care system variables, family system elements, and patterns of living. Basic conditioning factors influence self-care and self-care agency.
THE THREE THEORIES
The three theories derived form Orem's conceptual model are the theory of self-care deficit, the theory of self-care, and the theory of nursing systems.
The central idea of the THEORY OF SELF-CARE DEFICIT is that individuals can benefit from nursing because they are subject to health-centered or health-derived limitations that render them incapable of continuous self-care or that result in ineffective or incomplete care.
The central idea of the THEORY OF SELF-CARE is that self-care is a learned behavior that purposely regulates human structural integrity, functioning, and development.
The central idea of the THEORY OF NURSING SYSTEMS is that nursing systems are formed when nurses use their abilities to prescribe, design, and provide nursing for legitimate patients by performing discrete actions and systems of actions that regulate the value of or the exercise of individuals' capabilities to engage in self-care and meet the self-care requisites of the individual therapeutically.
This page was last modified on 6/1/02