II. General Information
Dorothea Orem is one of America’s foremost nursing theorists. She was born on1914 in Baltimore, Maryland. She received a diploma of nursing at Providence Hospital in Washington, D.C. Later in 1939, she receive a BS in Nursing Education in Catholic University of America. In 1945, she received her Master’s Degree in Nursing Education in the same university. She worked as a staff nurse, private duty nurse, nurse educator and administrator and nurse consultant. In 1971, she published her first book Nursing: Concepts of Practice and subsequent editions were published in 1980, 1985, 1991, 1995 and 2001 (Currentnursing.com, 2012).
The central focus of Orem’s General theory of Nursing is the Self-care deficit theory which is composed of three interrelated theories: theory of self- care, theory of self-care deficit, theory of nursing systems. The theory of self-care deficit explains why a person needs nursing care. An assessment of the person establishes the need for nursing. This also provides how nursing can assist the person in order to meet the needs of the person. It focuses on the relationship of demands of self-care and the ability of the person to meet the self-care demands (Theory Based Nursing Practice: A working document, 2014).
The underlying assumptions in this theory are the following:
People should be independent and responsible for giving care to family members that need care.
Each person is distinctly unique.
Nursing is interaction between two or more entities.
For prevention of illness, it is essential to meet universal and self-care requisites
How a person perceives health threats plays a role in promoting self-care behaviours
The culture and society a person is in influences learning of self-care behaviours and dependent care (Currentnursing.com, 2012).
These are the major principles in Orem’s theory:
Metaparadigm in Nursing
A person is a system comprised of physical, psychological, interpersonal and social components. They have the capacity to develop and learn.
Health is being structurally or functionally whole. The aspects of health are inseparable. She believes in the promotion and maintenance of health, treatment of disease or injury and prevention of complications.
Environment is an external source of influence in the internal interaction of a person’s varied aspects.
Nursing is a human service geared towards helping persons with inabilities to establish or identify ways to perform self-care activities to promote independence.
Self-care is performed by the person that promotes the person’s well-being.
Self-care requisites are requirements that a person must be able to meet and perform in order to achieve well-being.
Universal Self-care requisites are the common self-care requisites among men, women and children which include some of the following: maintenance of a sufficient intake of air, food and water; proper elimination; balance in activity and rest and between solitude and social interaction; prevention of hazards; and promotion of human functioning and development
Health Deviation Requisites set standards to which the degree of self-care demand is needed.
Self-care agency is the ability of the person to perform self-care activities
Nursing agency is a set of established capabilities of a nurse trained and educated to perform and help people meet their therapeutic self-care demands
Nursing system occurs when the patient’s self-care demands exceed the available self-care agency (Octaviano & Balita, 2008).
An example of the application of the theory to nursing practice is on a case of a patient with a diagnosis of Cerebrovascular accident or CVA. CVA occurs when the brain cells die because of the lack of oxygen either from a blocked or ruptured blood vessel. The symptoms of stroke include paralysis, hemiplegia, slurring speech, loss of balance and loss of vision in one or both eyes. (Fientuch, 2014). One of the major problems in stroke is the loss of motor function which most likely leads to loss of independence. Keeping the Self-Care theory in mind, the nurse would carefully identify the needs and evaluate the potential for independence of the patient.
3 critical thinking questions: Diabetic patient
Give 5 essential self-care behaviours in diabetic patients that produce good health outcomes?
Self-care behaviours include having a healthy diet, regularly exercising, blood sugar monitoring, good medication compliance, effective coping skills and risk-reduction behaviours like good foot care (Shrivastava, Shrivastava & Ramasamy, 2013).
How does self-efficacy affect self-care in diabetic patients?
Self-care is essential in the control of diabetes. If a diabetic patient has high self efficacy, naturally he perceives himself as capable of performing self-care. The patient is able to care for themselves and manage the disease in a flexible and responsible way thus resulting to good metabolic control (Sigurðardóttir, 2005).
How should you as a nurse recommend self-care activities in order for the patient to comply successfully?
Patient education is important but in order to be successful, the learning must turn into self-care actions. First, the nurse must evaluate perceived patient barriers to self-care behaviours. If by any chances the patient is not comfortable or the response not favourable, the modifications should be altered. Involving the patient in the planning for self-care regimens is also vital. The self-care regimen should be realistic and patient-specific in order for the patient to follow it. As a health care provider, one should give more attention to those patients who are recognized as more prone to non-compliance. Changes should also be implemented step by step or individually and not done all together. The support given by the nurse should be based on the self-care agency of the patient towards his/her self-care regimen (Shrivastava, Shrivastava & Ramasamy, 2013).
Handout for Key Aspects of Orem’s Theory
The theory is aimed towards making the client perform self-care activities in order to maintain life and health development.
Metaparadigm in Nursing
A person is a system comprised of physical, psychological, interpersonal and social components. They have the capacity to develop and learn.
Health is being structurally or functionally whole. The aspects of health are inseparable. She believes in the promotion and maintenance of health, treatment of disease or injury and prevention of complications.
Environment is an external source of influence in the internal interaction of a person’s varied aspects.
Nursing is a human service geared towards helping persons with inabilities to establish or identify ways to perform self-care activities to promote independence.
Self-care is performed by the person that promotes the person’s well-being.
Self-care requisites are requirements that a person must be able to meet and perform in order to achieve well-being.
Universal Self-care requisites are the common self-care requisites among men, women and children which include some of the following: maintenance of a sufficient intake of air, food and water; provision of care associated with elimination; balance between activity and rest; balance between solitude and social interaction; prevention of hazards; and promotion of human functioning and development
Health Deviation Requisites set standards to which the degree of self-care demand is needed.
Self-care agency is the ability of the person to perform self-care activities
Nursing agency is a set of established capabilities of a nurse trained and educated to perform and help people meet their therapeutic self-care demands
Nursing system occurs when the patient’s self-care demands exceed the available self-care agency.
References
Currentnursing.com,. (2012). Dorothea Orem's Self-Care Theory. Retrieved 14 February 2016, from http://currentnursing.com/nursing_theory/self_care_deficit_theory.html
Fientuch, S. (2014). Signs of Stroke Everyone Should Know. Healthline. Retrieved 14 February 2016, from http://www.healthline.com/health/stroke
Gonzalo,. (2011). Dorothea E. Orem. Theoretical Foundations of Nursing. Retrieved 14 February 2016, from http://nursingtheories.weebly.com/dorothea-e-orem.html
Octaviano, E., & Balita, C. (2008). Theoretical Foundations of Nursing: The Philippine Perspective (pp. 122-126). Manila: Ultimate Learning Series.
Shrivastava, S., Shrivastava, P., & Ramasamy, J. (2013). Role of self-care in management of diabetes mellitus. Journal Of Diabetes & Metabolic Disorders, 12(1), 14. http://dx.doi.org/10.1186/2251-6581-12-14
Sigurðardóttir, Á. (2005). Self-care in diabetes: model of factors affecting self-care. Journal Of Clinical Nursing, 14(3), 301-314. http://dx.doi.org/10.1111/j.1365-2702.2004.01043.x
Theory Based Nursing Practice: A working document. (2014) (1st ed., p. 17). Chattanooga. Retrieved from http://www.utc.edu/nursing/pdfs/classes/orem-handbook.pdf
