Theoretical Foundations in Nursing

Module #6 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Lesson title:
§ DOROTHEA OREM’S SELF-CARE DEFICIT MODEL
§ IMOGENE KING’S INTERACTING SYSTEMS
FRAMEWORK AND GOAL ATTAINMENT THEORY Materials: Book, pen and notebook
Learning Targets:
At the end of the module, students will be able to:
1. Acknowledge the background and credentials of these
nursing theorists;
2. Identify the major concepts with their definitions as utilized in
their respective theory;
3. List down their specific theoretical assertions or assumptions;
4. Highlight their major contributions in the nursing field;
5. Enumerate the major assumptions enclosed within their
theory;
6. Describe each of these theories in view of the four
metaparadigms;
7. Apply the significance of these theories in the nursing References:
education, research, and practice; and, Alligood, M. (2018). Nursing theories and their
8. Recognize the application of these theories in nursing today work (9th ed.). Singapore: Elsevier.
and in the clinical setting.

A. LESSON REVIEW/PREVIEW
Let us have a review of what you have learned from the previous lesson. Kindly answer the following questions on the space
provided. You may use the back page of this sheet, if necessary. Have fun!

The students must have read the theory specifically the theorist view of a person "as the whole being greater than the sum
of its parts". Through this, they must provide an explanation and site example of situations where this view is being applied
in at least 5 sentences.
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 Theoretical Foundations in Nursing
Module #6 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

B. MAIN LESSON
You will study and read their book, if available, about this lesson.

DOROTHEA OREM’S SELF-CARE DEFICIT MODEL

“Nursing is a helping profession of assisting patients overcome or compensate for their
health-associated limitations and engaging in actions to regulate their own functioning and
development or that of their dependents.”

✔ The model is a collection of three interrelated theories.

✔ These are nursing systems, self-care, and self-care deficit.
✔ The focus of Orem’s model is to enhance the person’s ability for self-care and this
also extends to the care of dependents.
✔ A person’s self-care deficits are the result of environmental situations.
✔ Theoretical sources – philosophical system of moderate realism.
There are three systems that exist within this professional nursing practice model:
1. Wholly Compensatory System – nurse provides total care
2. Partially Compensatory System – nurse & patient share responsibility for care
3. Supportive-Educative System – client has primary responsibility for personal health, with nurse acting as a
consultant

Wholly Compensatory System Partially Compensatory System Supportive-Educative System

✔ Accomplishes patient’s
therapeutic self-care
✔ Compensates for the patient’s
inability to engage in self-care
✔ Supports and protects the
patient
Nurse Actions: ✔ Accomplishes self-care
✔ Performs some self-care measures for the ✔ Regulates the exercise and
patient development of self-care
✔ Compensates for self-care limitations of agency
the patient
✔ Assists the patient as required
Nurse-Patient Actions:
✔ Performs some self-care measures
✔ Regulates self-care agency
✔ Accepts care and assistance from nurse

▪ The basic premise of the model is that individuals can take responsibility for their health and the health of others.
▪ In a general sense, individuals have the capacity to care for themselves or their dependents.
▪ It is based upon the philosophy that all “patients wish to care for themselves”.
▪ When an individual is unable to meet his own self-care requisites, a self-care deficit occurs.
▪ It is the duty and obligation of the professional nurse to recognize and identify these deficits in order to define a
support modality or intervention.

Major Concepts & Definitions:

▪ Self-care
→ It is composed of the practice of activities that maturing and mature individuals initiate and perform, within
time periods, on their behalf. This is to ensure maintaining life, healthful functioning, continuing personal
development, and well-being.

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 Theoretical Foundations in Nursing
Module #6 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

→ Self-care requisites are formulated and expressed insights about actions to be performed which are
known to be relevant and vital to human functioning.
1. Universal self-care requisites – those needs that all people have; include air, water, food,
elimination, activity and rest, solitude and social interaction, hazard prevention, and promotion of
normal functioning
2. Developmental self-care requisites – those needs that relate to the development of the
individual; include conditions that promote development, engagement in self-development, and
prevention of or overcoming effects of human conditions and life situations that can adversely
affect human development
3. Health deviation requisites – those needs that arise as a result of a patient’s condition; include
all pathologic conditions or disorders which include defects, deformities, and disabilities. These
require medical intervention and management.

▪ Therapeutic self-care demand

→ This is composed of the totality of nursing care measures important at certain times or over a period of
time for meeting all of the individual’s known self-care requisites.
→ It uses methods appropriate for managing the factors identified in the requisites and fulfilling the activity
element of the requisite.

▪ Nursing agency
→ It refers to the developed capabilities of nurses that empower them to meet the therapeutic self-care
demands of the patient.

▪ Self-care agency
→ This is a complex acquired ability of mature & maturing individuals to know & meet their continuing
requirements for deliberate & purposive action to regulate their own human functioning and development.
▪ Dependent-care agent
→ This is a maturing adolescent who accepts and fulfills the responsibility to know and meet the therapeutic
self-care demand of significant others who are socially dependent on them.

▪ Nursing systems
→ These are series and sequences of deliberate practical actions of nurses performed at times.

Theoretical Assertions:
✔ Nursing systems are action systems formed by nurses through the exercise of their nursing agency for persons with
health-derived or health-associated limitations in self-care or dependent care.
✔ It includes deliberate action, intentionality, diagnosis, prescription, and regulation.
✔ “Self-care is a regulatory function by man. It is deliberate and is performed by the person himself or have them
performed by another person or them in order to maintain life, health, development, and well-being.”

Theory in View of Metaparadigms:

Nursing is an art through which the practitioner of nursing gives specialized assistance to persons with
Nursing disabilities, making more than ordinary assistance necessary to meet self-care needs. The nurse also
intelligently participates in the medical care the individual receives from the physician.
Humans are defined as “men, women, and children cared for either singly or as social units” and are
Person
the “material object” of nurses and others who provide direct care.

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 Theoretical Foundations in Nursing
Module #6 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Health is “being structurally and functionally whole or sound”. Also, health is a state that encompasses
Health both the health of individuals and groups, and human health is the ability to reflect on oneself, symbolize
experience, and communicate with others.
The environment has physical, chemical, and biological features. It includes the family, culture, and
Environment community.

Application to Nursing Community:

▪ What is clear in the model of Orem is the emphasis on education and supportive measures. It becomes clear that
nurses today should not move away from this very important aspect of clinical nursing – health teachings.

IMOGENE KING’S INTERACTING SYSTEMS FRAMEWORK AND GOAL ATTAINMENT

THEORY
“Nursing is an observable behavior found in the health care systems in society that aims to
help individuals maintain their health so they can function in their roles.”

Interacting System Framework

✔ This theory emphasizes the importance of the interaction between the nurse and
patients.
✔ It views this interaction as an open system which is in constant interaction with a
variety of environmental factors.
✔ There are three interrelated systems that represent the domain of nursing:
1. Personal systems – composed of body image, growth and development,
perception, self, space, and time.
▪ When two or more persons interact, they form an interpersonal system.
2. Interpersonal system – composed of the concepts of communication, interaction, role, stress, and
transaction.
▪ A comprehensive interacting system is composed of groups that make up a society. This results in
the social system.
3. Social system – composed of the concepts of authority, decision-making, organization power, and status.

Goal Attainment Theory

✔ This is a middle-range theory that is the product of developments from her first Interacting Systems Framework.
✔ The theory stated that mutual goal-setting between a nurse and a client is based on:
o nurse’s assessment of a client’s concerns, problems, and disturbances in health
o nurse’s & client’s perceptions of the interference
o nurse’s & client’s sharing of information wherein each functions to help the client attain the goals identified
✔ The theory also maintained that nurses interact with family members when clients cannot verbally participate in the
goal-setting.
✔ As such, this theory is focused on the interpersonal system and the interactions that take place between individuals,
more specifically in the nurse-client relationship.
✔ The system is an open one in that it allows feedback because each phase of the nurse-patient activity has the
potential to influence perception.

8 propositions related to the Goal Attainment Theory:

1. If perceptual accuracy is present in the nurse-client interactions, then transactions will occur.
2. If a nurse and client make transactions, then goals will be attained.

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 Theoretical Foundations in Nursing
Module #6 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

3. If goals are attained, then satisfaction will occur.

4. If goals are attained, then effective nursing care will occur.
5. If transactions are made in nurse-client interactions, then growth and development will be enhanced.
6. If role expectations and role performance as perceived by nurse and client are congruent, then transactions will
result.
7. If role conflict is experienced by nurse and client or both, then stress in nurse-relationship interactions will occur.
8. If nurses with special knowledge and skills communicate appropriate information to clients, then mutual goal setting
and goal attainment will occur.

Major Concepts & Definitions:

▪ Perception
→ a process in which data obtained through the senses and from memory are organized, interpreted, and
transformed

▪ Stress
→ an ever changing condition in which an individual, through environmental interaction, seeks to keep
equilibrium to support growth and development and activity
→ an organization is made up of individuals who have prescribed roles and positions and who make use of
resources to meet goals-both personal and organizational.

▪ The self
→ made up of thoughts and feelings related to one’s awareness of being a person separate from others and
influencing one’s view of who and what he or she is

▪ Growth and development

→ processes in people’s lives through which they move from potential for achievement to actualization of self

▪ Body image
→ includes both the way one perceives one’s body and others’ reactions to one’s appearance

▪ Space
→ the physical area known as territory and by the behaviors of those who occupy it

▪ Interactions
→ observable behaviors of two or more persons in mutual presence

▪ Communication
→ verbal and non-verbal situational, perceptual, transactional, irreversible, or moving forward in time, personal,
and dynamic
→ Transactions are a series of exchanges between human beings and the environment that include
observable behaviors that seek to reach goals of worth to the participants

▪ Role
→ characterized by reciprocity in that a person may be a giver at one time and a taker at another time, with
the relationship between two or more individuals who are functioning in two or more roles that are learned
social, complex, and situational
▪ Authority

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 Theoretical Foundations in Nursing
Module #6 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

→ refers to the active, reciprocal process of transaction in which the actors’ experience, understanding, and
values influence the meaning, legitimacy and acceptance of those in organizational positions associated
with authority

▪ Status
→ the relationship of one’s place in a group to others in the group or of a group to other groups

▪ Decision-making
→ a changing and orderly process through which choices related to goals are made among toward the goal

▪ Time
→ an interval between the two events that is experienced differently by each person

Theory Assumptions:
✔ The focus of nursing is the care of the human being (patient).
✔ The goal of nursing is the health care of both individuals and groups.
✔ Human beings are open systems interacting with their environments constantly.
✔ The nurse and patient communicate information, set goals mutually, and then act to achieve those goals. This is
also the basic assumption of the nursing process.
✔ Patients perceive the world as a complete person making transactions with individuals and things in the
environment.
✔ The transaction represents a life situation in which the perceiver and the thing being perceived are encountered. It
also represents a life situation in which a person enters the situation as an active participant. Each is changed in
the process of these experiences.

Theory in View of Metaparadigms:

Nursing is a process of action, reaction, and interaction whereby nurse and client share information
Nursing about their perceptions in the nursing situation. The nurse and client share specific goals, problems,
and concerns and explore how to achieve a goal.
Individuals are social beings who are rational and sentient. Humans communicate their thoughts,
actions, customs, and beliefs through language. Persons exhibit common characteristics such as the
Person
ability to perceive, think, feel, choose between alternative courses of action, set goals, select the means
to achieve goals, and make decisions.
Health is a dynamic life experience of a human being, which implies continuous adjustment to stressors
Health in the internal and external environment through optimum use of one’s resources to achieve maximum
daily living potential.
The environment is the background for human interactions. It is both external to, and internal to, the
Environment
individual.

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 Theoretical Foundations in Nursing
Module #6 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

CHECK FOR UNDERSTANDING

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to the correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in your answer/ratio is not allowed.

1. A 56 years old and a diabetic patient was admitted in the hospital after an amputation of his left foot due to a non-healing
(gangrenous) wound. Because of his condition, his movements are limited thus he becomes unable to perform some
self-care needs. Nurse Pepper is tasked to provide him the necessary care. What kind of compensatory system does
this situation call for?
a. Wholly Compensatory System
b. Partially Compensatory System
c. Supportive-Educative System
d. Any of the three
ANSWER: ________
RATIO:___________________________________________________________________________________________
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2. The theory of Orem is founded on the philosophy that:

a. “Individuals are capable of caring for themselves or their dependents.”
b. “All patients may not be able to care for themselves.”
c. “All patients are caring.”
d. “All nurses are caring.”
ANSWER: ________
RATIO:___________________________________________________________________________________________
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3. Wholly Compensatory System means:

a. compensates for the patient’s inability to engage in self-care
b. compensates for self-care limitations of the patient
c. regulates self-care agency
d. patient accomplishes self-care
ANSWER: ________
RATIO:___________________________________________________________________________________________
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4. It uses methods appropriate for managing the factors identified in the requisites and fulfilling the activity element of the
requisite.
a. Developmental self-care requisites
b. Therapeutic self-care demand
c. Health deviation self-care requisites
d. Universal self-care requisites
ANSWER: ________
RATIO:___________________________________________________________________________________________
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 Theoretical Foundations in Nursing
Module #6 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

5. Series and sequences of deliberate practical actions of nurses performed at times:

a. Nursing systems
b. Wholly compensatory system
c. Partially compensatory system
d. Supportive-Educative system
ANSWER: ________
RATIO:___________________________________________________________________________________________
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_________________________________________________________________________________________________

6. This is characterized by reciprocity in that a person may be a giver at one time and a taker at another time:
a. Communication
b. Perception
c. Interaction
d. Role
ANSWER: ________
RATIO:___________________________________________________________________________________________
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7. General Systems Framework:

a. Allows feedback because each phase of the nurse-patient activity has the potential to influence perception
b. Focused on the interpersonal system
c. Emphasizes the importance of the interaction between the nurse and patients
d. Maintained that nurses interact with family members when client cannot verbally participate in goal-setting
ANSWER: ________
RATIO:___________________________________________________________________________________________
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_________________________________________________________________________________________________

8. Which of the following is false regarding Goal Attainment Theory?

a. If goals are attained, then satisfaction will occur
b. If perceptual accuracy isn’t present in the nurse-client interactions, then transactions will occur
c. If nurse and client make transactions, then goals will be attained
d. If goals are attained, then effective nursing care will occur
ANSWER: ________
RATIO:___________________________________________________________________________________________
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_________________________________________________________________________________________________

9. This theory maintained that nurses interact with family members when clients cannot verbally participate in the goal-
setting. This refers to:
a. Adaptation Model
b. Conservation Model
c. Goal Attainment Theory
d. Behavioral system Model
ANSWER: ________

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 Theoretical Foundations in Nursing
Module #6 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

RATIO:___________________________________________________________________________________________
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_________________________________________________________________________________________________

10. The Goal Attainment theory holds true to the following assertions, except?
a. Persons are non-spiritual beings.
b. People have the capacity to think, know, make choices, and select alternatives.
c. People have the ability to record their history and preserve their culture through language and other
symbols.
d. People are open systems in transaction with their environment.
ANSWER: ________
RATIO:___________________________________________________________________________________________
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C. LESSON WRAP-UP

AL Activity: GUIDED DISCOVERY

This strategy leads you through practices that will help you develop deeper understanding and mastery. By posing one
question, you have the free will to answer it based on your own understanding in the Main Lesson. The more you dig deeper,
the more comprehensive the information you will relay. Here’s the question and enjoy! You can use the back page of this
sheet.

▪ If you are already a nurse, how will you interact with your patient?
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▪ What do you think are the barriers when you are interacting (about the care to be provided) to your patients? Give
at least three.
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