Case Study

Application of
Dorothea Orem ’ s
Nursing Theory
By: Miritza Iglesias, Nicole Toro, Nancy Pierre,
Taira Garcia, and Melissa Cruz
Objectives
Ability to identify and understand Orem’s
Theory
Ability to apply the theory of self care in a
nurse-patient environment
Ability to apply Orem’s theory in nursing
interventions and outcomes
Case Study :
 A home care nurse visits an elderly client who
lives alone and is restricted to bed because of
pain in his joints due to osteoarthritis. During
conversation, the nurse finds that the client
feels sad and inadequate due to his disability.
Orem’s Theory
Theory of Self-Care
Self care- practice of activities that individual
initiates and performs on their own behalf in
maintaining life, health, and well-being
Self care agency- is a human ability which is
“the ability for engaging in self care.”
 (Conditioned by age, developmental state, life
experience, socio-cultural orientation, health,
and available resources)
Therapeutic self care demand- “totality of self
care actions to be performed for some
duration in order to meet self care requisites
by using various methods and related sets of
operations and actions.”
Three Categories of Self-
Care
Universal self care- Associated with life
processes and maintenance of the integrity of
human structure and functioning; ADL’s .
Developmental self care- Associated with the
developmental processes; derived from a
condition or associated with an event (e.g.
adjusting to a new job).
Health Deviation self care- Required in
conditions of illness, injury, or disease;
includes seeking medical assistance, learning
to live with effects of condition, ect.
Theory of Self care deficit
Specifies when nursing is needed.
Nursing intervention is required when an adult
(or in the case of a dependent, the parent) is
incapable or limited in the provision of
continuous effective self care .
Theory of Self Care
deficit
Orem identifies 5 methods of helping:
Acting for and doing for others
Guiding others
Supporting another
Providing an environment promoting personal
development in relation to meet future
demands
Teaching another
What actions should the
nurse prioritize in this
client?
1.Pain- By reducing the pain, the client will then
be able to get involved in developing his
abilities and care for himself.
2. Developmental self care requisites- The client

would have to adjust to the changes of the

body due to his condition. Also, the client
would have to cope with the inability to move
due to the pain.
3. Universal self requisites- the client being able

to perform his daily living activities with

limited dependence.
Application of Theory
Which functional patterns should the nurse
assess during the assessment of activity
levels in the client?
Activities and exercise
Nutrition and metabolism
Sleep and rest
Elimination
Coping and stress tolerance
Functional Patterns
Activities and Exercise- aren’t being met by the
client due to fact that the client is elderly and
bed ridden.
Nutrition and metabolism- since client is
restricted to bed, he is not able to prepare
well balanced meals. Making sure that the
client eats correctly will help him maintain a
well balanced diet.
Sleep and Rest- Inability to sleep due to
continuous pain. Having a pain management
plan that includes providing adequate pain
medication.
Functional Patterns
Elimination- Constipation occurs after being
bed-ridden after long periods of time.
Coping and Stress Tolerance- Client shows
evidence of not being able to cope with his
disability.
Self- Awareness
Enhancement
Encourage patient to recognize and discuss
thoughts and feelings.
Confront patients ambivilent feelings .
Assist patient to accept dependency on
other’s, as appropriate.
Assist patient to change view of self as a victim
by defining own rights, as appropriate.

Adaptation to Physical
Disability
Identifies plan to meet ADL’s
Identifies plan to meet IADL’s
Accepts need for physical assistance
Identifies ways to cope with life changes
Uses strategies to reduce stress related to
disability
Reports decrease in negative feelings
Self-Care Assistance:
IADL’s
Consider the age/culture of the patient when
promoting self care activities
Monitor patient ability for independent care
Provide assistance until the patient is fully able
to assume self care
Provide for methods of contacting people for
support and assistance
Determine needs for home enhancements to
offset disabilities
InterventioSelf-Care Status:
0313
Bathes self
Dresses self
Feeds self
Maintaining personal cleanliness
Toilets self independently
Manages own non-parental medication
Pain Management
Consider cultural influences on pain response
Explore patient factors that improve/ worsen
pain
Assist patient and family to seek and provide
support
Consider type and source of pain when
selecting pain relief strategy
Encourage patient to monitor own pain and to
intervene appropriately
Teach the use of non-pharmacological
techniques
Pain Control: 1605
Recognizes pain onset
Describes causal factos
Uses non-analgesics relief measures
Reports uncontrolled symptoms to health care
professional
Recognizes associated symptoms of pain
Reports pain controlled
Bibliography
Orem, D.E. (1991). Nursing: Concepts of
practive (4th ed.). St. Louis, MO: Mosby-Year
Book Inc.
Taylor, S. G. (2006). Dorothea E. Orem: Self-
care deficit theory of nursing. In A.M.