Nursing Theory Paper 1n196q

Running head: DOROTHEA OREM’S SELF-CARE THEORY

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Dorothea Orem’s Self-Care Theory Courtney Queener 11/07/2014 NUR 500 Theoretical Foundation of Nursing Practice State University of New York Polytechnic Institute

“Dorothea Orem’s Self-Care Theory” One well-known nursing theorist who has been greatly influential in the world of nursing is Dorothea Orem, who is recognized for her self-care deficit model. Orem was born in Baltimore, Maryland in 1914. She received her nursing diploma from Washington D.C.’s Providence Hospital School of Nursing in the early 1930s. She went on to further her education by completing her Bachelor of Science in Nursing degree in 1939 and her Master’s degree in 1945; both of these degrees were received from the Catholic University of America in Washington D.C. After receiving her graduate degree, Orem focused primarily on teaching, research and istration. During her nursing career, Orem received several honorary doctorate degrees from prestigious universities such as Georgetown, Incarnate Word College, Illinois Wesleyan University and the University of Columbia. She also awarded multiple recognitions during her career including the Catholic University of America Alumni

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Achievement Award for Nursing Theory, the Linda Richards Award from the National League for Nursing and she was named an honorary fellow of the American Academy of Nursing (“Dorothea Orem: Nursing Theorist”, 2013). Orem began to develop her self-care deficit theory during her time as Director of Nursing Service and Director of Nursing Education at Providence Hospital in Detroit in 1945. She began forming her theory in reaction to “issues regarding the lack of a substantive and structured body of nursing knowledge” (Dorothea Orem: Self-Care Deficit Theory, 2012). During this time she also defined nursing practice with “clear statements of the inherent distinction between the practice of nursing and medicine” (Dorothea Orem: Self-Care Deficit Theory, 2012). Orem eventually returned to Washington D.C. to become the acting dean of the Catholic University of America School of Nursing in 1959. During this time she continued developing her theory. In 1971, she published Nursing Concepts of Practice, which is the book that outlined her self-care theory. The second edition of this book was published in 1980. After retiring in 1984, Orem published a third edition in 1985 and a fourth in 1991 (Dorothea Orem: Self-Care Deficit Theory, 2012). Dorothea Orem’s Self-Care model “posits that nursing care is required when an adult is unable to perform self-care sufficiently to sustain life, maintain health, recover from disease or injury, or cope with the effects of disease or injury” (Friedman, Bowden & Jones, 2003, p. 67). The central philosophy behind this theory is that “all patients want to care for themselves, and they are able to recover more quickly and holistically by performing their own self-care as much as they are able to do” (“Dorothea Orem: Nursing Theorist”, 2013). This theory can be applied to people of all ages and in all stages of their life because people who require nursing care are those who are “incapable of self-care related to an illness or injury, individuals who may require partial nursing care as they recover from an illness or injury, and those who are self-care sufficient but

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need ongoing and education” (Simmons, 2009, p.419). This model is not only directed towards the ill patient receiving the care and their self-care deficit, it may also be directed towards the caregiver such as a parent or guardian caring for an ill child, which would be dependent-care (Friedman, Bowden & Jones, 2003, p. 67). Adult patients should be encouraged to perform all aspects of their care that they are mentally and physically able to do. This participation in care gives patients a sense of control over their current situation and also benefits patient outcomes. Caregivers will also require education regarding care practices that need to be performed for the patient and what to do if complications arise. Caregivers may also require and information about coping mechanisms due to the stress of providing care for a loved one. Because of the grand nature of this theory, it can be applied to all areas of nursing and related to all nursing interventions. Nurses work with their patients on a daily basis to help promote self-care and to educate the individual on any accommodations that need to be made in order for the individual to maintain life and health. There are six central concepts in Orem’s Self-Care Model which include self-care, selfcare agency, therapeutic self-care demand, self-care deficit, nursing agency and nursing systems (Friedman, Bowden & Jones, 2003, p. 67). Self-care is defined as “practice of activities that an individual initiates and performs on their own behalf in maintaining life, health and well-being” (“Dorothea Orem’s Self-Care Theory”, 2012). Self-care agency is “a human ability which is the ability for engaging in self-care conditioned by age, development state, life experience, sociocultural orientation, health and available resources” (“Dorothea Orem’s Self-Care Theory”, 2012). Therapeutic self-care demand is a “totality of self-care actions to be performed for some duration in order to meet self-care requisites by using valid methods and related sets of operations and actions” (“Dorothea Orem’s Self-Care Theory”, 2012). Self-care deficit exists “when an adult (or in the case of a dependent, the parent) is incapable or limited in the provision

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of continuous effective self-care” (“Dorothea Orem’s Self-Care Theory”, 2012). Nursing agency is “viewed as a service focusing on the person’s need for self-care action on a continuous basis to sustain life” (James, 1992, p.42). Nursing systems “describe how the patient’s self-care needs will be met by the nurse, the patient or both” (“Dorothea Orem’s Self-Care Theory”, 2012). Orem spoke of three main nursing systems: wholly compensatory, partly compensatory and ive-educative. The type of nursing system utilized is dependent upon how much help the patient needs (James, 1992, p.42). In her theory, Orem also discusses three different self-care requisites. A self-care requisite is defined as an “action directed towards provision of self-care” (Dorothea Orem: Self-Care Theory, 2012). These include universal self-care requisites, developmental self-care requisites and health deviation self-care requisites. Universal self-care requisites are those applicable to all people. They include intake of air, water and nutrition; eliminative function; balance of activity and rest; balance of time alone and time with others; prevention of danger to self; and being ‘normal’ as determined by science, culture, and social values (James, 1992, p. 42). Developmental self-care requisites are associated with developmental processes or events and aimed toward “prevention of developmental disorders and promotion of development according to potential” (James, 1992, p. 42). Health deviation self-care requisites are those that are required during a time of illness or injury. They include “seeking and securing appropriate medical assistance; being aware of and attending to the effects and results of pathologic conditions; effectively carrying out medically prescribed measures; modifying self-concepts in accepting oneself as being in a particular state of health and in specific forms of healthcare; and learning to live with effects of pathologic conditions” (Dorothea Orem’s Self-Care Theory, 2012). The nurse must assess all of these areas for a patient in order to determine if a self-care deficit exists. If

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there is a self-care deficit, the nurse must determine which nursing system is appropriate for the patient: wholly compensatory, partially compensatory or ive-educative. The nursing metaparadigm consists of four concepts: person, health, environment and nurse. In Orem’s theory, person is described as “an integrated whole, a unity functioning biologically, symbolically and socially. Persons are viewed as having the capacity for selfknowledge and for engagement in deliberate action” (Hanucharurnkul, 1989, p. 367). Orem viewed the person as an open system which interacts with the environment in order to perform self-care. The person is an integrated whole, biopsychosocial being (Hanucharurnkul, 1989, p. 367). The second element, health, is defined as “a state of wholeness or integrity of human beings. Persons are said to be healthy when they are structurally and functionally sound or whole” (Hanucharurnkul, 1989, p. 367). Orem’s definition of health takes into mental, physical and emotional health simultaneously. She believed that all of these areas must be functioning properly in order for the patient to successfully provide self-care (Hanucharurnkul, 1989, p.367). Environment is discussed in relation to developmental environment, which is described as “a set of conditions that motivate a person to establish appropriate goals and adjust behavior to achieve the results specified by the goals” (Hanucharurnkul, 1989, p.367). In her definition, environment seems to be the external environment which consists of both physical and psychosocial elements (Hanucharurnkul, 1989, p.367). The fourth element of the nursing metaparadigm is that of nursing, which is defined in Orem’s theory as “a helping service, an art and technology. It is a creative effort of one human being to help another human being. Nursing focuses on individual’s abilities and requirements for self-care” (Hanucharurnkul, 1989, p. 367). According to Orem, nursing is differentiated from other professional services by its focus on self-care. Nurses work with the individual to get the individual functioning to a point where they

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are able to provide self-care in a manner that sustains life and health (Hanucharurnkul, 1989, p. 369). Orem’s self-care theory is applicable in all areas and levels of nursing. This theory “can be related to the body of nursing knowledge in that it uses assessment skills, builds a nursepatient relationship, plans how to meet the objective of self-care, implements interventions and evaluates how effective the interventions were to attaining health and self-care, with changes as needed” (Simmons, 2009, p. 420). The first step in the nursing process is that of assessment. The nurse must determine if there is a self-care deficit requiring nursing care. Once this is determined, “the nurse assesses the person for the reason he or she is unable to meet his or her needs. Some of the possible reasons for this deficit include a lack of knowledge, skill or motivation; a limited range of behaviors; or an overload of stimuli in relation to the person’s adaptation level” (James, 1992, p. 43). The next step in the process is planning. In this phase the nurse creates a plan of care based on patient-centered goals using input from the patient and family . It is in this step that the nurse determines which nursing system is necessary. In an example of a wholly compensatory nursing system “the nurse acts for the client by adjusting the lighting, the temperature of the room, the noise level or by coordinating activities that involve the client” (James, 1992, p. 43). Partially compensatory means that both the nurse and the patient are involved in the care. For example, “if a person can feed himself or herself, but is easily distracted, the nurse can turn off the television, draw the curtain or close the room door to enable to person to finish the meal” (James, 1992, p. 43). The final nursing system is iveeducative. In this system, “the person may be physically able to meet his or her needs, but may have a hard time adapting to new physical limitations, role conflicts, or an altered self-concept.

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In this situation, the nurse may help the client expand his or her adaptation level through instruction, counseling or emotional ” (James, 1992, p. 43). The intervention phase is the third phase of the nursing process. This phase is when the plan that was created for the patient based on their goals is put into action. The interventions performed in this phase can vary greatly based on the nursing system that is most appropriate for the patient. These interventions can take several forms including “doing and acting for the person; guiding or directing the person; providing physical ; providing psychological ; providing an environment that s and promotes development; and teaching the person” (James, 1992, p. 43). The final phase of the nursing process is evaluation. In this time, the nurse must determine if the interventions have been successful in treating the patient’s needs. The ideal outcome “is for the client to meet successfully his or her own needs without nursing intervention” (James, 1992, p. 43). Reassessment may be necessary if a self-care deficit still exists and new goals and interventions will be planned. This process will continue until “the client has reached the maximum potential of independent self-care obtainable for that individual” (James, 1992, p. 43). This article “Dorthea Orem’s Self-Care Theory as Related to Nursing Practice in Hemodialysis” by Laurie Simmons discusses how Orem’s theory can be used in the treatment and education of patients on hemodialysis. Dialysis patients must make many lifestyle changes in order to manage their own care and health. These changes include “dietary and fluids restrictions, medication regime, recognizing signs and symptoms associated with potential complications and vascular access care” (Simmons, 2009, p. 420). A self-care deficit occurs when a new hemodialysis patient does not possess the knowledge for self-care. It is up to the nurse to work with the patient on learning to manage their disease. The nurse must first work to build a trusting relationship with the patient by providing and knowledge. Focus on the

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individual and patient-specific care are very important for the formation of this relationship. The patient should be included in the planning process which allows them to be more involved in their care and give them a sense of control over their situation (Simmons, 2009, p. 420). The nurse should also evaluate the patient for successful coping mechanisms and work with the patient to improve any deficits in this area. The article discusses the possibility of patients being non-compliant with their care as a way to exhibit control over their situation. Nurses working with these dialysis patients can “educate patients to help with the control of their disease and the impact it can have on life” (Simmons, 2009, p. 420). Patient education is vital in getting patients to a point where they are able to manage their own self-care. Education is continuous and “repeated over and over with a little different twist each time, it reinforces what has already been learned by the individual, keeping them self-care sufficient” (Simmons, 2009, p. 420). The article proposes that “knowledge helps patients on hemodialysis to regain a sense of control over their experience and environment and helps reduce feelings of vulnerability” (Simmons, 2009, p. 420). Encouragement of participation is the final way to promote self-care in patients on dialysis. Patients “may be given the opportunity to learn how to insert their own needles for treatment” and may “learn to prepare the dialysis machine prior to the initiation of therapy” (Simmons, 2009, p. 420). The application of self-care theory is appropriate in the treatment of hemodialysis patients because “the goal of nursing practice is to assist patients to become adequately prepared to engage in their own care, thereby improving patient outcomes and quality of life” (Simmons, 2009, p. 420). Dorothea Orem’s self-care deficit theory is universally recognized as one of the most influential theories in the world of nursing. This theory can be applied to all areas of nursing and to all patients that require some form of nursing care. Orem proposes that the goal of nursing is to get the patient functioning at a level in which they are able to manage their own care and that

DOROTHEA OREM’S SELF-CARE THEORY patient outcomes are improved when patients perform their own care. The nurse must use the concepts within this theory in her nursing practice in order to educate the patient on their condition and the interventions necessary to maintain life and health. The patient should be included in all steps of the nursing process to ensure that the patient feels in control of their situation. These steps are repeated and adjusted as necessary to ensure that the patient is functioning at the best of their ability.

References (2012). Dorothea Orem: Self-Care Deficit Theory. Retrieved from http://oremselfcaredeficittheory.blogspot.com/p/dorothea-orem.html (2013). Dorothea Orem: Nursing theorist. Retrieved from http://www.nursingtheory.org/nursing-theorists/Dorothea-E-Orem.php (2013). Dorothea Orem’s self-care theory. Retrieved from http://currentnursing.com/nursing_theory/self_care_deficit_theory.html

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Friedman, M.M., Bowden, V.R., & Jones, E.G. (2003). Family nursing: Research, theory and practice (5th ed.). Upper Saddle River, NJ: Prentice Hall. Hanucharurnkul, S. (1989). Comparative analysis of Orem's and King's theories. Journal of Advanced Nursing, 14(5), 365-372. doi:10.1111/1365-2648.ep8527085 James, L. (1992). Nursing theory made practical. Journal of Nursing Education, 31(1), 42-44. Simmons, L. (2009). Dorothea Orem's self-care theory as related to nursing practice in hemodialysis. Nephrology Nursing Journal: Journal of The American Nephrology Nurses' Association, 36(4), 419-421.