Running head: DOROTHEA OREM’S SELF CARE THEORY Dorothea Orem’s Self Care Theory Carmen Sigley West Virginia University Abstract When a patient needs to decrease the potential problem that prevents him from reaching his optimal health, nurses can use Orem’s Self-care Model as a tool to identify when and how much they can influence the patient care. This theory is the key of nursing care if it is used optimal and in a period of time when patient’s development can be discover and manipulated.
The purpose of this paper is to prove that Orem’s Theory can be used efficiently if is done in an ongoing manner and using actions of individuals directed to self care. The environment is an important aspect and regulates the factors or conditions in the interest of the individual’s life, health, and well-being. Dorothea Orem’s Self Care Theory This paper argue in favor of Dorothea Orem’s Self Care Model because is one of the most essential tools that a nurse can use in eliminating the distance between patient well-being and patient’s health status.
The purpose of this theory is to allow individuals and their families to maintain control of their healthcare and is ongoing throughout the continuum of life, forever evolving. Even Orem’s Self Care Model is a complex process and require more time than others models it can be used when a patient require hospitalization for long period of time. The model is based on four concepts that constitute nursing’s metaparadigm, as proposed by Fawcett: human beings, environment, health, and nursing (Fawcett, 2005).
In 1971, Orem described a human being (humanity) as “…an integrated whole composed of an internal physical, psychological, and social nature with varying degrees of self-care ability” (Chinn & Kramer, 2004). Using this Theory a nurse can discover the patient’s developmental level and can predict the path of care that guides both the client and family to an increase health care self level. The Self Care Model scales down the actual nursing care requirements for the patient, and differs from other health-care models by creating autonomy for nursing as a profession through a continuous use of the evidence based practice in decision making.
Orem suggest that the domain and boundaries of nursing as a field of practice and a field of knowledge is placed along the Self Care Model and the conditions that exists when judgments are made to build the patient’s plan of care. A human being has the capacity to reflect, symbolize, and use symbols. When referring to humans, Orem uses the terms individual, patient, multiperson unit, self-care agent, dependent-care agent (Fawcett, 2005). In a 1996 newsletter to the International Orem Society she states: “What do nurses encounter in their worlds as they design and produce nursing for others?
What meaning can and should nurses attach to persons, things, events, conditions, and circumstances they encounter? ” Orem’s Nursing Theory reflects her own nursing experiences, and the model came to her as a “flash of insight, an understanding that the reason why individuals could benefit from nursing was the existence of…self care limitations” (Orem, 1978, cited in Fawcett, 2005, p. 230). Orem defines a human being as “a substantial or real unity whose parts are formed and attain perfection through the differentiation of the whole during the process of development. (Orem, 1985, cited in Meleis, 1997). The patient needs to use self care in order to maintain optimal health and wellness, and possessing the ability and responsibility to care for himself and dependants. The model guides health care providers to do a primary evaluation of patient’s health status and then help nurses to understand the developmental stage of the client. Adaptation to the new activity level and potential comes after a prolonged period of time, and it is a work team between all the health care providers participating to the plan of care.
Using Orem’s Self Care Theory a patient adjusts to the changes in his health status passing through all stages, regaining his previous activity level. For example a patient with left side paralysis is at present he is to be discharged with minimal injury. At the admission he was in compensatory system in which the nurse provides total care for the patient. The patient at that time was incapable to do anything for himself, including but not limited activities of daily living and ambulation, being totally dependent of the nurse for survival.
After several months of care the client entered in the second of Orem’s systems, the Partial Compensatory system and nurses assisted in the care of the patient, but the patient and family could assist as well. He regained the previous activity level in his right hands due to treatments and physical therapy and started to do some of the easy activity himself. The patient is able to resume his own care but the nurse needs to monitor his vital signs, oxygen saturations, assist in ADL’s and ambulation, and education of a nurse.
The third Orem’s systems is the Educative-developmental system and the patient has primary control over his health while health care providers assist with education and promoting safe health practices. In this example the client has cholesterol and he can fit into this category because needs compliance with diet, exercise regimen and medications. The nurse has an important role at this moment because she needs to educate how the patient can be compliant with the regime and to educate him how to properly maintain good health practices.
Dorothea Orem’s Self-care Theory use patient-nurse relationships as a central unit of the care and the goals are to restore, promote, and maintain health. The theory looks at the patient as a whole and his interaction with the environment. Self-care in Orem’s Theory is an ever changing process throughout the continuum of life and requires constant reassessment of the patient. After establishing a plan of care that is a comprehensive assessment process health care provider make decisions using evidence based practice in order to achieve the goal.
Using this theory nurses are able to discuss every aspect of the patient well-being, character traits, social situation, environmental living, head to toe physical assessment using self-care requisites, behavioral characteristics and past medical history. Orem focuses on the patient’s needs for nursing care established by the patients self-care deficits found during the assessment process. The time consuming of the process for the nurse and staffing ratios do not allow for such an extensive initial plan of care in cases of a short term patient care.
When nurses receive several admissions per twelve hour shifts; to scrutinize a patient thoroughly Orem’s Self Care theory is almost impossible if nurses are not familiarized with the steps of the theory. Takes several days to know a patient as well as Orem suggests and when the patient is admitted short length of stay the luxury of time does not exist. Complexity, a very long and detailed plan, the wording difficult to understand require a vey in depth study of the model by a health care provider before to be used.
Nurses needs to recognizing how all the components fit together can only be accomplished after actually studying the patient long time and the assessments must be done in direct contact between nurse- client- family. The patient is “an individual with physical and emotional requirements for development of self and maintenance of their well-being”, the environment in which he lives is the “client’s surroundings which may affect their ability to perform their self-care activities” and a “structural and functional soundness and wholeness of the individual” is his health that gives contour to unique and individualized plan of care. Orem 1991). In Orem’s theory self care patient is the part that has the ability to perform activities and meet personal needs with the goal of maintaining health and wellness of mind, body and spirit. The model states that self care is a learned behavior influenced by the metaparadigm of person, environment, health and nursing. There are three components that can be influenced during the hospitalization: universal self care needs, developmental self care needs, and health deviation.
Orem’s theory of self-care applies all these components to patients that are in at least 3 months recovery time, and the nursing care plan is one essential tool used to manage the balance between illness and self-care. The area of self-care deficit applies to the diagnosis area of the nursing care process and is an concept that does provides a guideline for the selection of methods when nurses helps and understand the patient roles in self-care. The supportive-educative role indicates that the client is participating in most of their self-care, and the nurse’s role is simply to monitor and regulate the client’s self-care.
In the case of newly diagnosed diabetic patient receiving diabetic care teaching while in hospital the model can be used to recognize the individual plan of care and to help patient to adapt the regimen to his needs. When patient has visits module and reports highly variable BS/chemstrip readings health care provider suspects that patient may be performing procedure incorrectly. The model suggests using the assessment tool as a method of discovering the reason behind the problem.
Then the 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. The Universal self care requisites are the air, water, food, elimination, activity and rest, solitude and social interaction, hazard prevention, and promotion of normality.
Developmental self care requisites are maturational which is the progress towards higher level of maturation and situational when prevention of deleterious effects related to development. Health deviation requisites are those needs that arise as a result of a patient’s condition (Fawcett, 2005). The last stage of this model suggests that nurses needs to offer a supportive-educative role to clients and help them to participate in most of their self-care. After regaining part of their past health level health care provider needs to monitor and regulate the client’s self-care.
This model argues in favor of being used by nurse to determine every aspect of the patient well-being, character traits, social situation, environmental living, head to toe physical assessment using self-care requisites, behavioral characteristics, and past medical history. The benefits of this Model is that can be used without any restriction by nurses in any long term patients with terminal illnesses or bedridden, but same time can become a key tool in short term patients with condition of a follow up care after discharge from hospital.
It is important to understand the stages and apply them in time manner. The health goals for a patient require the knowledge of the patient’s life history, life style and are organized regarding the needs and self care the patient can achieve. Nurse needs to assist clients and their family in self care matters to improve or to maintain the health level identified and described at the beginning of the assessment. The Model is very competent when an ongoing process that collects evidence in evaluating the results achieves and specifies the nursing system design.
I conclude that Self Care Model understand clients’ beliefs and keeps boundaries in our professional relationship to a level that can improve the trust between health care provider and patient. Following Orem’s Self Care Theory guidelines to adjust the changes in patient health status and to encourage the compliance with the regimen nurses can improve health care quality. Self Care Theory is associated with life processes helping to maintain the integrity of human structure and functioning of the patients.
Nurses can to maximize the level of performing the ADLs, maintenance of sufficient intake of air, water, and food when use Orem’s Self care Theory. The balance between activity and rest, solitude and social interaction, prevention of hazards to human life well being, and promotion of human functioning is the concept of this theory and the goal is to keep the patient health status at the present level if not improved.
Because the focus of Orem’s theory of nursing is to enhance the patient’s ability for self-care, nurses can use this theory for patients to determine the sensations, perceptions, appraisal and motivation that every patient have in order to develop foundation of self-care capabilities. References Chinn, P. L. , & Kramer, M. K. (2004). Integrated knowledge development in nursing (6th ed. ). St. Louis: Mosby. Fawcett, J. (2005). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories (2nd ed. . Philadelphia: F. A. Davis. Gomez, J. , & Walks, L. Dorothea Orem’s self-care deficit theory. Retrieved September 30, 2005, from Northern Arizona University Web site: http://dana. ucc. nau. edu/~jmg8/image_of_nursing. htm. Hartweg, D. L. (1991). Dorothea Orem self-care deficit theory: Notes on nursing theories (pp. 1- 63). London: Sage. Hartweg, D. L. (1995). Dorothea Orem self care deficit theory. In C. M. McQuiston & A. A. Webb (Eds. ), Foundations of nursing theory. Thousand Oaks, CA: Sage. [pic]
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