Dorothea Orem's Conceptual Framework of Nursing

The nursing profession has experienced a mushrooming of theory development over the past three decades. One of the more significant of the nursing theories to emerge from this activity is Dorothea Orem's conceptual framework of nursing, which is most often referred to as the selfcare nursing model. I am going to review the development, structure, application, and evaluation of the selfcare model.

As nursing consultant to the Indiana State Board of Health from 1949to1957, Orem was exposed to the broad range of nursing activities and responsibilities. This exposure provided her with the experiences and observations which, in turn, led to the development of the initial ideas which were eventually synthesized into her selfcare nursing model.

As early as 1956, Orem recognized that patients are often limited in their capacity to provide selfcare, or to participate intelligently in their own care, and that the process of nursing, to a great extent, involves dealing with problems stemming from these conditions. Thus, in the persuit of solutions to these problems, she sought answers to such questions what do nurses do? why do nurses do what they do? what should nurses do? what are the outcomes of what nurses do?

In 1959, Orem introduced the elements of her selfcare conceptual framework. At that time, she stated that nursing involved both a mode of thinking and a mode of communication, and that nursing requirements are modified a

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fcare requisites are those which are associated with life processes, and with the maintenance of the integrity of human structure and function. Universal selfcare requisites are common to all human beings during all stages of the life cycle, adjusted to age, developmental state, and environmental and other factors. Developmental selfcare requisities are those which are associated with the human developmental processes, with the conditions and events which occur during the various stages of the human life cycle, and with the events which may adversely affect human development. Healthdeviation selfcare requisites are those which are associated with genetic and constitutional defects, and with human structural and functional deviations, and with the effects of these defects and deviations, as well as with medical diagnostic and treatment measures designed to deal with these defects and deviations. Healthdeviation selfcare requisites exist for persons who are ill, are injured, have specific forms of pathology, including defects and disabilities, and who are under medical diagnosis and treatment. Within the context of person, therapeutic selfcare demand refers to those selfcare actions which are required to meet the vario

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