Orem Model of Nursing James Madison University Susan Foltz, Adrian Fredman, Darlene Pettit, & Jennifer Watson NSG463 Professional Role Transition

Dorothea Orem Born 1914, in Baltimore Maryland In 1930, received diploma in nursing (Black, 2014) In 1939, received BS nursing education (Black, 2014) In 1946, received MS in nursing education (Black, 2014) During her professional career, Orem worked as a staff nurse, private duty nurse, nurse educator, administrator and nurse consultant Developed the Self-Care Deficit Theory as a result of working toward “improving the quality of nursing in general hospitals in her state” (“Self Care Deficit”, n.d.) First published Self-care theory in 1959. However, Orem “continued to develop her conceptual model over several decades” (Black, 2014)

Developing the Self-Care Theory One must first determine the patients’ ability to provide self-care. This determination is initiated by the nurse and involves the development of a nurse-patient relationship. Many factors are considered such as the patients gender, age, environment, developmental status and health related necessities for the patient. (Black, 2014)

Theory Of Self-Care Self-Care: the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health and well-being. Self-Care Agency: is considered the human’s ability or power to engage in self-care and is affected by basic conditioning factors. Therapeutic Self-Care Demand: is the totality of “self-care actions to be performed for some duration in order to meet known self-care requisites by using valid methods and related sets of actions and operations.” (Gonzalo, 2011).

Theory Of Self-Care deficit Self-Care Deficit delineates when nursing is needed. Nursing is required when an adult (or in the case of a dependent, the parent or guardian) is incapable of or limited in the provision of continuous effective self-care. (Wayne, 2014)  

Theory Of Self-Care deficit Specifies when nursing is needed Nursing is required when an adult (or in the case of a dependent, the parent) is incapable or limited in the provision of continuous effective self care. Orem identifies 5 methods of helping: Acting for and doing for others Guiding others Supporting another Providing an environment promoting personal development in relation to meet future demands Involves teaching another  

Theory Of Self-Care deficit Assessment – collect data in six areas (health status, physician’s perspective of health status, person’s perspective of health, health goals, person’s requirements for self care, and person’s capacity to perform self care.) Nursing diagnosis/plans with scientific rationale – Nurse designs a system that is wholly or partly compensatory or supportive-educative, bringing out a good organization of the components of patients’ therapeutic self care demands, selection of combination of ways of helping that will be effective and efficient in compensating for/ overcoming patient’s self care deficit Implementation/evaluation - Nurse assists the patient or family in self care matters to achieve identified and described health and health related results. Collecting evidence in evaluating results achieved against results specified in the nursing system design, actions are directed by etiology component of nursing diagnosis, evaluation. 3 Steps to the Nursing Process

Theory of Nursing System Three types of nursing systems: Wholly compensatory Necessary when one cannot engage in self-care actions (Gonzalo, 2011) Patient is dependent on the nurse to accomplish patient’s therapeutic self-care (Gonzalo, 2011) Partly compensatory Necessary when one is unable to engage in some but not all self-care activities (Gonzalo, 2011) Nurse and patient work together to meet patient’s self-care needs (Gonzalo, 2011) Supportive-educative Necessary when one needs to learn to perform self-care activities but needs assistance to do so (Gonzalo, 2011) Patient provides essential self-care and the nurse supports/educates patient in development of self-care (Gonzalo, 2011)

How does this theory relate to nursing practice?? Self-Care Deficit Theory is a grand nursing theory, therefore “covers a broad scope with general concepts that can be applied to all instances of nursing” (“Dorothea Orem”, n.d.). This theory can easily be utilized in Emergency Nursing by applying the categories of basic conditioning factors to improve patient outcomes after discharge. Basic conditioning factors include: Age/developmental state (“Self care deficit”, n.d.) Families of origin or marriage (Green, 2013) Locate individuals in their worlds and relate to conditions and circumstances of living (Green, 2013) Socio-cultural orientation Available resources

How does this theory Relate to Nursing Practice?? This theory has great correlation when exploring nursing and patient relationships in a chronic health care setting. When nurses are in a long term care situation they develop and can successfully make an assessment on what that patient is capable of physically and cognitively. It is important to remember that taking the time to encourage the patient to become proactive in their care will have great benefits and promote: A sense of health and well-being Ownership of self-care Independence and responsibility Empowering the patient to call in their own refills on medications and requesting prescriptions when needed gives the patient a sense of importance and control of a sometimes uncertain situation.

How does this theory Relate to Nursing Practice?? Orem’s Theory in an Outpatient Setting Applying Orem’s Theory in the Outpatient setting can be done in several steps, for example: Placement of a mediport/portacath Assessment patients’ understanding of procedure Develop a plan of education and include additional assistance if required. Implement teaching and assistance if needed and establish that the education has been properly received Dorothea Orem's self care theory relates to practice in outpatient hemodialysis clinics because we provide care to End Stage Renal Disease patients. These patients must make considerable lifestyle changes which include dietary, fluid restrictions, medication regimen, and vascular access care. As a dialysis nurse, we assist these patients by providing education and strategies to encourage their self-care. When we receive a patient who is new to dialysis a self-deficit occurs because they lack the knowledge for proper self-care.

references Black, B. (2014). Professional Nursing: Concepts & Challenges (7th ed). St. Louis, MI: Elsevier Inc. Dorothea Orem's Self-Care Theory. (n.d.). Retrieved October 12, 2016, from http://currentnursing.com/nursing_theory/self_care_deficit_theory.html Dorothea Orem - Nursing Theorist. (n.d.). Retrieved October 09, 2016, from http://www.nursing-theory.org/nursing-theorists/Dorothea-E-Orem.php  Gonzalo, A. (2011). The Self-Care Deficit Nursing Theory. Retrieved from: http://nursingtheories.weebly.com/dorothea-e-orem.html.

References Green, R., (2013). Application of the self care deficit nursing theory: The community context. Self-Care, Dependent-Care, & Nursing 20(1), 5-15. Self Care Deficit Theory. (n.d.). Retrieved October 09, 2016, from http://www.nursing-theory.org/theories-and-models/orem-self-care-deficit- theory.php Wayne, G. (2014). Dorothea Orem - Self Care Nursing Theory - Nurseslabs. Retrieved October 13, 2016, from http://nurseslabs.com/dorothea-orems-self-care- theory