Orem’s Self-care model By: Tiffany fick & Amy Undercoffer James Madison University NSG 563– professional role transition - 2 Instructor –Kimberly Brown, DNP, RN, NEA-BC October 10, 2016

Who is Dorothea orem? Theorist : Dorothea Orem (1915-2007) was born in Baltimore, Maryland.2 She earned her diploma in nursing in 1935 at Providence Hospital in Washington, DC.2 She earned her BSN in nursing education in 1939 at the Catholic University of America.2 She earned her MSN in nursing education in 1955 at the Catholic University of America.2 Picture Received from https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=imgres&cd=&cad=rja&uact=8&ved=0ahUKEwjsqOSfp9HPAhVL5WMKHU_AAi8QjRwIBw&url=https%3A%2F%2Fen.wikipedia.org%2Fwiki%2FDorothea_Orem&psig=AFQjCNGzUy8X6k57Ts_hUqD58oMUAGEGGg&ust=1576225650035338 on October 10, 2016

Continued History on Dorothea orem… She worked within many roles of nursing including: staff nurse, private duty nurse, nurse educator, administrator and nursing consultant.2 In 1976 she Received her honorary Doctorate of Science degree.2 She first published her concept of self care in 1959.1 Her Theory was first published in Nursing: Concepts of Practice in 1971.2 her Theory published for the sixth time in Nursing: Concepts of Practice in 2001.1

Dorothea orem’s Mission To help the patient gain independence as quickly as possible.1 Promotion of self care activities that individuals need to be able to perform in order to maintain life, health and well-being.5 Focuses on health promotion and maintenance.5 Retrieved from https://www.google.com/search?q=mission&biw=1517&bih=708&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjhnKjZttvPAhUrl1QKHY3ADtAQ_AUIBygC&dpr=0.9#imgrc=1Yo0o8BfvwOfdM%3A on October 15, 2016

The self-care Model Considered a Grand Theory1 Most complex1 Broadest in scope1 Offers an abstract framework under which the key perceptions and principles of the nursing discipline can be identified.3 Pertains to nonspecific and relatively abstract perceptions.3 Can be used in a variety of populations and settings.3 Not directly adaptable to testing.3

Construction of the Self-Care Model Combination of three interrelated theories Theory of Self-Care Theory of Self-Care Deficit Theory of Nursing System1 Retrieved from https://www.google.com/search?q=orem+self+care+model&biw=1517&bih=708&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjd27rouNvPAhWLxlQKHd5MB_UQ_AUIBygC&dpr=0.9#imgrc=dV--1_v1BQM0fM%3A On October 15, 2016

Theory of Self-care Self-care - activities performed throughout life to maintain well-being.5 A human regulatory function that is essential for life.4 refers to all self-care approaches learned or acquired to sustain one’s equilibrium, function, and Balance.4 Self-care agency- ones ability to engage in self care. You must Understand the patient’s capacity or ability of self-care.1 Factors such as age, gender, and developmental status are considered.1 sociocultural and environmental factors are considered as well.1 While determining the patient’s ability to provide self-care, a nurse patient relationship develops. The nurse explores the patient’s ability to provide adequate self- care.1

Theory of Self-care deficit Self-care deficit describes the insufficiencies in a person’s ability to care for oneself, necessitating degree of assistance.4 What deficits does the patient have in providing his or her own self-care?1 the nurse confirms with the patient the nurse’s assessment of the patient’s needs. This allowing for all participating parties to be in agreement of what is needed or not required. Thus a plan of care develops.1

Theory of Nursing System The nurse performs their duties based upon the patient’s self-care deficit, which is determined by assessing a patient’s inability to provide effective self-care1. nursing actions are designed to meet the patient’s self-care needs1. The Range of care can be: highly involved requiring total or near total care (wholly compensatory system).1 less involved requiring only Support and education. This means the patient can provide effective self-care, but needs to work with the nurse to develop and maximize these abilities (supportive-educative system).1 In between requiring more care after an event such as a patient on 24 hour bedrest after surgery, but they can be more independent thereafter (partially compensatory system).1

Relevance and contributions to practice Nursing has evolved due to advancement in technology, an aging population, and an increase in patient care acuity. The nurse is expected and required to maximize His/her ability to care for her patients. Putting orem’s theory to practice allows the nurse to utilize the patient’s own self-care abilities to their entirety. In doing so, the nurse can maximize his/her skills for the needs of the patient from an individualized plan of care. Using Orem’s theory promotes patient autonomy and independence. Without truly assessing a patients capacity and willingness to care for themselves, the nurse has the potential to waste his/her efforts on something the patient could have done for themselves or is not willing to do.

Relevance and contributions to Practice continued… Nurses focuses on self-care much more than any other discipline in healthcare. 4 Nursing interventions related to the Self-Care Model include: Education regrading one’s illness or lack of ability to perform self-care, identification of symptoms, adherence to follow-up appointments, physical and occupational therapy, medication management, pain management, and nutritional counsling.4 Orem’s Self-care model has been used to promote and build the structure for much research in nursing over the years. It has also been used in the development and modification of nursing programs.4

Further Direction for Practice Orem’s theory can help nurses choose what nursing interventions are appropriate based on the needs of the patient. Orem’s theory of nursing systems are concepts that can help a nurse define his/her practice. The wholly compensatory system can be utilized In the case of ventilated patients after respiratory arrest that require management of ventilation, hemodynamics, nutrition, elimination, and even hygiene. The partially compensatory system can be applied to Patients who had a surgical procedure and are not allowed to ambulate 24 hours after the procedure. Supportive-educative nursing system can be applied to patients who have had a stent placed after a heart attack. they should be taught to correct their diet and lifestyle to prevent further events.

Limitations One limitation is that orem’s theory is dependent upon the understanding that each individual has the desire to be in control of their own lives.1 Orem presents nursing systems as fixed and constant, implying that there are three static conditions of health, when we know that healthcare and nursing practice is ever changing.

Origin of interest Working in the cardiac cath lab and the intensive care unit (ICU), we put Orem’s theory into practice each day. we care for patients throughout a broad spectrum of practice. Patients can range from needing less involvement from the nurse requiring only education to improve and promote self-care, to needing more involvement necessitating total care from the nurse. It is imperative that our patients maximize their self-care abilities while under our care. we may have one or two patients that can do the majority of their own care and another patient that requires total care assistance. We must promote self-care for the first two patients and not spend unnecessary time doing things for them that should/could do themselves. This would be a disservice to these patients as they could become more dependent on further assistance. It would also take away from the needs of the total care patient since their self-care abilities require more attention.

Summary Dorothea orem was a nursing theorist who believed nurses should deliver their plan of care based on the needs of their patient. The construction of her self care model is based upon three interrelated theories: The Theory of Self-Care, the Theory of Self-Care Deficit, and the Theory of Nursing System1 Self-care are the activities performed throughout life to maintain well-being.5 Self-care deficit describes the insufficiencies in a person’s ability to care for oneself, necessitating a degree of assistance.4 nursing systems are the nursing actions and range of care designed to meet the patient’s self-care needs.1

Summary continued… Orem delivers a unique approach to the nursing process in which she offers a method of determining the self-care needs and deficits of a patient and Then offers specific roles for the nurse and/or the patient to ensure that the self-care demands are achieved.5 This theory explains how patients typically want to care for themselves. when patients are allowed to care for themselves, care is not only patient centered, but recovery is shorter.5 Picture received from https://www.google.com/search?q=self+care&biw=1517&bih=708&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjcsZ-6rN3PAhVP1GMKHTUUDuMQ_AUIBigB&dpr=0.9#imgrc=71CLae0tPzi3LM%3A on October 15, 2016

References 1 Black, B. (2015). Professional Nursing: Concepts & Challenges 7th edition. (p. 273, 276). St. Louis, MI: Elsevier Inc. 2 Carver, R., & Miers, M. (2015). Dorothea Orem collection. Retrieved from http://www.medicalarchives.jhmi.edu/papers/orem.html 3 Lee, S. (2013). Overview of nursing theory. Retrieved from http://www.oita-nhs.ac.jp/journal/PDF/12_2/12_2_3.pdf 4 Pajarillo, E. (2012). Editor’s perspective: Towards self-care. Journal of Nursing Practice Applications and Reviews of Research. doi 10.13178/jnparr.2013.0302.0516 5 Texas Woman’s University (2016). Nursing theorist: Orem. Retrieved from http://libguides.twu.edu/c.php?g=270175&p=1803595 6 Wayne, G. (2014). Dorothea Orem’s self-care theory. Retrieved from http://nurseslabs.com/dorothea-orems-self-care- theory/#limitations