MA.ESTRELLA LENA M. PUSAG R.N.

1
MA.ESTRELLA LENA M. PUSAG R.N. 2
 1914- Baltimore, Maryland
 Early 1930’s – Providence School of Nursing,
washington, D.C.
 1939- BSN completed
 1945- MS in nursing education
 1958- consultant to the Office of Education
where she began working on her Self-Care
Theory

MA.ESTRELLA LENA M. PUSAG R.N. 3

 1959- first published her theory in “Guides for
Developing Curricula for the Education of
Practical Nurses” (a government publication)
 1976- honorary Doctorate of Science from
Georgetown University
 1999- last edition of her theory was published

MA.ESTRELLA LENA M. PUSAG R.N. 4

 Is the provision of self-care which is therapeutic
in sustaining life and health, in recovering from
disease or injury, or coping with their effects
 Is a service to people, not a derivative of
medicine
 Is to promote the goal of patient self-care.

MA.ESTRELLA LENA M. PUSAG R.N. 5

 human beings
 environment
 health
 nursing

MA.ESTRELLA LENA M. PUSAG R.N. 6

› Person: An individual with physical and emotional
requirements for development of self and
maintenance of their well-being.
› Environment: Client’s surroundings which may
affect their ability to perform their self-care
activities.
› Health: “Structural and functional soundness and
wholeness of the individual” (Orem 1991).
› Nursing: The acts of a specially trained and able
individual to help a person or multiple people deal
with their actual or potential self-care deficits.

MA.ESTRELLA LENA M. PUSAG R.N. 7

is the ability to perform activities and meet personal
needs with the goal of maintaining health and
wellness of mind, body and spirit.
is a learned behaviour influenced by the
metaparadigm of person, environment, health and
nursing.
Three components:
universal self care needs
developmental self care needs
health deviation

MA.ESTRELLA LENA M. PUSAG R.N. 8

› This includes activities which are essential to
health and vitality.
› Eight elements include:
air, water, food, elimination, activity and rest,
solitude and social interactions, prevention of
harm, and promotion of normality.

MA.ESTRELLA LENA M. PUSAG R.N. 9

› These include the interventions and teachings
designed to return a person to or sustain a level of
optimal health and well being.
› Examples can include such things as toilet training
a child or learning healthy eating.

MA.ESTRELLA LENA M. PUSAG R.N. 10

› This encompasses the variations in self care which
may occur as a result of disability, illness, or
injury.
› In other words the person with a variation is
meeting self care and maintaining health and
wellness in a more individualize meaning.

MA.ESTRELLA LENA M. PUSAG R.N. 11

› Every mature person has the ability to meet self care needs,
but a self care deficit exists when a person experiences the
inability to do so due to limitations.

› A person benefits from nursing intervention when a health

situation inhibits their ability to perform self care or creates
a situation where their abilities are not sufficient to maintain
own health and wellness.

› Nursing action focuses on identification of limitation/deficit

and implementing appropriate interventions to meet the
needs of person.

MA.ESTRELLA LENA M. PUSAG R.N. 12

 Persons who take action to provide their own self-
care or care for dependents have specialized
capabilities for action.

 The individual’s abilities to engage in self-care or

dependent care are conditioned by age,
developmental state, life experience, sociocultural
orientation, health, and available resources.

 The relationship of individual’s abilities for self-care

or dependent care to the qualitative and quantitative
self-care or dependent-care demand can be
determined when the value of each is known.

MA.ESTRELLA LENA M. PUSAG R.N. 13

 The relationship between care abilities and care demand
can be defined in terms of equal to, less than, more than.
 Nursing is a legitimate service wherein:
› (a) care abilities are less than those required for meeting a
known self-care demand [a deficit relationship]
› (b) self -care or dependent-care abilities exceed or are equal to
those required for meeting the current self-care demand, but a
future deficit relationship can be foreseen because of predictable
decreases in care abilities, qualitative or quantitative increases
in the care demand, or both.
 Persons with existing or projected care deficits are in, or
can expect to be in, states of social dependency that
legitimate a nursing relationship.

MA.ESTRELLA LENA M. PUSAG R.N. 14

› The ability of the nurse to aid the person in meeting
current and potential self care demands.
› Focused on person
› Three support modalities identified in theory
including: total compensatory, partial compensatory,
and educative/supportive compensatory.
› The client’s ability for self care involvement will
determine under which support modality they would
be considered.

MA.ESTRELLA LENA M. PUSAG R.N. 15

 Nurses relate to and interact with persons who occupy
the status of nurse’s patient.

 Legitimate patients have existent and projected

continuous self-care requisites.

 Legitimate patients have existent and projected deficits

for meeting their own selfcare requisites.

 Nurses determine the current and changing values of

patient’s continuous self –care requisites, select valid and
reliable processes or technologies for meeting these
requisites, and formulate the courses of action necessary
for using selected processes or technologies that will
meet identified self-care requisites.

MA.ESTRELLA LENA M. PUSAG R.N. 16

 Nurses determine the current and changing values of patient’s
abilities to meet their self-care requisites using specific
processes or technologies.

 Nurses estimate the potential of patients to

› a) refrain from the engaging in self-care for therapeutic purposes or
› (b) develops or refine abilities to engage in care or in the future.

 Nurses and patients act together to allocate the roles of each in

the production of patients’ self-care and in the regulation of
patients’ self-care capabilities.

 The actions of nurses and the actions of patients that regulate

patients’ self-care capabilities and meet patients’ therapeutic
self-care needs constitute nursing systems.

MA.ESTRELLA LENA M. PUSAG R.N. 17

 Total
compensatory
support
encompasses total
nurse care- client
unable to do for
themselves.

MA.ESTRELLA LENA M. PUSAG R.N. 18

› Partial
compensatory
support involves
both the nurse and
the client sharing in
the self care
requirements.

MA.ESTRELLA LENA M. PUSAG R.N. 19

Educative/supportive
compensatory support
elicits the help of the
nurse solely as a
consultant, teacher or
resource person.
Client is responsible
for their own self care.

MA.ESTRELLA LENA M. PUSAG R.N. 20

› The nurse’s role in helping the client to achieve or
maintain a level of optimal health and wellness is
to act as an:
 Advocate
 Redirector
 support person and teacher

to provide an environment conducive to therapeutic

development

MA.ESTRELLA LENA M. PUSAG R.N. 21

In order to help explain this concept, Orem also
created three areas of how care can be administrated
to a client depending on the physical and mental
capabilities of the client.
Wholly compensatory, partly compensatory and
supportive-educative role
Bedridden oncology patient arrives via ambulance
for chemotherapy. Family insists upon keeping
patient at home; however, leaves patient alone with
nurse in chemo clinic for treatment. Patient requires
O2 at 2L/min, continuous tube feeding at 90cc hour,
foley catheter, bedpan. Nurse in clinic administers
chemo premeds and chemo; changes dressing around
g-tube due to leaking; administers O2 at 2L; empties
Foley at end of treatment; places patient on bed pan
one time.
Preterm labour patient regularly visits clinic for BP
monitoring, etc. Patient on bed rest (at home), except
for weekly visit to module. Nurse assists patient out
of wheel chair into bathroom, assists with urine
sample collection, and onto exam table. Nurse
administers injection of terbutaline and educates
patient regarding oral terbutaline.
Newly diagnosed diabetic patient received diabetic care
teaching while in hospital. Now, patient visits module and
reports highly variable BS/chemstrip readings. Nurse suspects
patient may be performing procedure incorrectly. Nurse
assesses that patient has been cutting some of his chemstrips
in half to save money. Nurse instructs patient that cutting
strips exposes chemicals and inaccurate readings may result.
Additionally, nurse assesses that patient's wife (who does
family cooking) did not receive any nutritional education
while patient was hospitalized. Nurse begins nutritional
counseling and provides wife with referral to nutritional
services department.
 It is believed that Orem’s theory portrays the
idea that nursing is the ability to care for
another, especially when they are unable to
care for themselves. This corresponds to our
philosophy of caring for person with the goal
of achieving optimal level of health and
wellness.

MA.ESTRELLA LENA M. PUSAG R.N. 26

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