Dorothea Elizabeth Orem: Self-Care Deficit Nursing Theory Dorothea E. Orem was known as a pioneer in the development of distinctive nursing knowledge and as one of foremost America’s nursing theorist (Alligood & Tomey, 2010, Fawcett, 2000). Her self-care deficit theory which is a general theory of nursing, is used widely in nursing today (Hartweg, 1995). Orem’s contributions played significant role in shifting nursing away from a medical model of practice and to gain recognition as a legitimate science (Chinn & Kramer, 2004).
The Four Metaparadigm Human Orem used multiple terms while referring to humans such as individual, patient, multiperson unit, self-care agent, dependent-care agent (Fawcett, 2005). Health Her definition of health directly contradicts, as experiences of some of the patient’s needs and requirements are varied and different (George, 1995). Nursing Orem viewed Nursing as an art, community services and a technology.
Nurses in order to help individuals or groups under their care, deliberately selected and performed their nursing actions (Meleis, 1997). Environment Orem stated that it was the total environment and not any single aspect of it that made it developmental, hence it is argued that she undescored the possible contribution of environment to a person’s development (Fawcett, 2005). It is significant to mention the steps she specifically identified for the nursing process and involvement to intellectual and practical phases (Balabagno, et al, 2006).
Has six basic concepts out of which self care,self-care agency, therapeutic self-care demand, and self care deficit are associated with patient, whereas nursing agency and nursing system are associated with the nurses and their actions (Berbiglia & Banfield, 2006). Definition of theoretical terms are precise and congruent throughout and its language is consistent with 21st century (Berbiglia & Banfield, 2006). However, Mendoza, et al (2004) stated that majority of the students are perplexed and uncertain by the multiple terminologies with similar eanings used in her theory. Also added that at a deeper level students had difficulty to define and differentiate her numerous terminologies and hypothesis. Her theory applies to all aspect of nursing as it serves nurses involved in nursing practice, in development and validation of nursing knowledge and in teaching and learning nursing. It not only provides a foundation for organizing existing nursing knowledge but also for the development of new knowledge. (Berbiglia & Banfield, 2006).
Her model is applied in various forms as it serves as a philosophical guide and framework to clinical practice and nursing research (Hartweg, 1991). Applying a grand theory like Orem`s in a study alone will pose extreme difficulty to prove due to its complexity and the broadness of the theory it consists of numerous variables to focus on, especially in a healthcare setting (Dela Cruz, et al, 1991). Orem`s theory placed more emphasis on the physiological and sociological aspects of the individuals and undermined the importance of mental health (Moustafa, 1999).
Her theory applies to different specialties related to nursing such as education, research, administration, clinical setting. It is applicable to nurse`s who are at the beginning stage as well as the advanced stage of their practice(George, 1995). Some essential areas concerned with patient care were unclear and weak like definition of family, the nurse-society relationship and public education (Balabagno, et al, 2006). Orem`s theory has been used for research which includes quantitative and qualitative methods.
Theoretical entities were well described but its value was not constant across the population. Still her theory is useful in developing and guiding practice and research (Tomey & Alligood, 2002). During my first assessment with Susan in the ward I observed the following she was socially withdrawn, not forthcoming when approached. She appeared unkempt with her body odour, dirty outfit and messy hair. She appeared guarded and was uncooperative with nursing staff, which made it difficult for the nursing team to orientate her to the ward staff and environment, as well as carry out nursing care.
In order to provide a conceptual framework to assess, plan, implement and evaluate Susan’s self care deficit and the nursing process, Orem’s theory is used in this case study. Nursing system form when nurses prescribe, design and provide nursing that regulates the individual’s self-care capabilities and meet self-care requirements as suggested by nursing system theory (Kozier, Erb & Blais, 1997, pg. 38) The aim of this framework is to guide and help Susan to acquire her self-management requirements. The five methods of helping that nurses could utilize to aid the client towards self-management were identified by Orem (2001).
Which are health status, the doctor’s perspective of the person’s health, the perspective of her health, the health goals within the context of life history, lifestyle and health status, the person requirement of self care, and the person capacity to perform self-care (George, 2011). Orem (2001) mentioned that a nurse performing activities linked with diagnostic, prescriptive, regulatory and treatment operations, and inducts evaluation as an aspect of control is a representation of nursing process and when used systematically can very well fabricate the application of the theory .
The 3-steps in Orem’s self-care deficit theory and nursing process are diagnosing and prescribing phase, designing nursing system, and planning for delivery of nursing. Step 1: Nursing Diagnosing and Prescribing. Nursing requires the nurse to obtain data regarding the patient’s self-care agency and the therapeutic self-care demand, as well as to recognize current and predicted future bond between agency and demand (Orem, 2011).
During this phase, the nurse obtains the data in six areas: health status, the doctor’s perspective of the person’s health, the perspective of her health, the health goals within the context of life history, lifestyle and health status, the person requirement of self care, and the person capacity to perform self-care (George, 2011). Basic Conditioning Factors Susan, 30 years old Chinese lady, married with one 6 year old son. She puts up with her mother in law who is homemaker, husband who is a taxi driver and school going son in a 3 room flat.
Susan is a free thinker and has been unemployed for the past 3 years. She used to work as an Administrative Officer and was terminated due to her poor performance at work. She had Body Mass Index (BMI) of 14. 8. Universal Self-Care Need Susan showed a deficit in adequate air, water and food intake due to her smoking habit of 18 cigarettes per day and insufficient eating pattern resulting in low BMI of 14. 8. Her activities of daily living were affected as she refused oral intake, showed minimal interest in personal hygiene by not combing her hair and changing her attire daily and bathing only once a week.
There was clear evidence of imbalance between her activity and rest, due to decreased involvement in exercise regime and more involvement in online computer activities inside her room, depriving herself from adequate sleep pattern. Another clear evidence of imbalance was between her solitude and social interaction, as she showed less interest in exercise routine of jogging or walking which she used to do three to four times in a week instead segregate herself from social touch by minimising her regular contacts with her friends.
After performing investigations her blood results showed abnormalities in her bone mineral density and kidney function test which posed a hazard to her life, functioning and well-being and the possible reason may be because of reduced oral intake. The doctor’s order for Susan was a high calorie diet so that she would gain at least 4. 8 kg to acquire BMI which will fall under a healthy range. But Susan had restricted knowledge and insight for her potential health threat and her illness.
After analysing the data possible threat to her health related to her altered mental state was identified. Based on Orem’s framework the following nursing diagnosis were identified which are the nursing diagnosis identified are low BMI related to poor oral intake, self-care deficit related to altered mental state and potential for non-compliance in treatment related to deficit in nutritional knowledge and lack of insight towards her illness. There is a need for increased therapeutic self-care