Dorothea Orem Why do people need nursing?

•Jennifer Ames•Charles Dietrich•Holly Leveille

Dorothea Orem’s motivation for developing her self care theory

What if every individual adult has the capacity for self-care; however, when a health problem arises it is possible that this capacity is insufficient to confront the situation, making it then necessary to receive help from other persons who compensate for this deficit

The theory begins to take shape

In 1957 while working for the US Department of Health, Education and Welfare as curriculum consultant, Dorothea attempted to plan a nursing curriculum for licensed practical nurses. She was searching for a pragmatic framework to organize nursing knowledge. Her focus was on the questions “What is nursing?” and “When do people need nursing care?” and from this she theorized that people need nursing when they are unable to care for themselves.

Shape into a bookIn 1971, she presented the Self-

Care Deficit Theory of Nursing (S-CDTN) in the book Nursing Concepts of Practice

She incorporates the medical model rather than rejects it, centers on the individual, is problem oriented, and is easily adaptable in varied clinical situations.

Orem’s Theory of Nursing

Theory of self care

Theory of self care deficit

Theory of nursing system

Theory in depth

Theory of self care- Health deviation self-care is required in conditions of illness, injury, or disease

Theory of self care deficit- nursing is required when an adult is incapable or limited in the provision of continuous, effective self-care.

Theory of nursing system- is how the patient's self-care needs will be met by the nurse, the patient, or by both

“It is the existence of a self-care deficit that indicates the need for nursing.” (Banfield, 2001)

Orem defines nursingNursing is a service to people, not a

derivative of medicine.Nursing has responsibilitiesRoles of nurse and the patientRational of nurse/patient relationshipType of actions needed to meet the

patients demands

Her theory helps make nursing a legitimate science

Global Concepts

1.The human being2.Environment3.Health 4.Nursing

Human being

A person is composed of physical, psychological, interpersonal, and social aspects.

They have the potential for learning and develop a way to meet self care needs

Symbolize what they experience

Environment

Is anything outside of or external to the person.

Can positively or negatively effect a persons ability to function

Nursing

Promotes the health of self and that of service of helping others.

It is actions by the nurse to overcome or prevent self care limitations.

A nurse may have to provide service that is wholly compensatory or partly compensatory and also educate the client.

Nursing cont:wholly compensatory nursing system-

the nurse supports and protects the client, compensates for the client’s inability to care for self, and attempts to provide care for the client.

partly compensatory nursing system- both the nurse and client perform care measures.

supportive-educative nursing system- the nurse’s actions are to help clients develop their own self-care abilities through knowledge, support, and encouragement

HealthIs the internal and external

conditions that permit self-care needs to be met

The person as a wholeIt is a team effort by the nurse

and patient for the promotion of self care

Interpretation & InferencesGoal of self care is to promote health and well

being.A human being is the focus of nursing only

when self care demand surpasses self care capabilities.

Actions are deliberate, systematic, and purposeful.

“Deliberate action refers to actions performed by individual human beings who have intentions and are conscious of their intentions to bring about, through their actions, conditions or states of affairs that do not at present exist” (Orem, 2001, pp 62-63).

Interpretation & InferencesA person needs to engage in behaviors that

will regulate self & the environment (Banfield, 2011).

The environment can positively or negatively affect the health and well being of individuals (Orem, 2001).

A nurse within the healthcare environment will help patients develop their capabilities to meet self care requisites.

Patient and nurse variables are not determinants of health rather can influence under various circumstances at various points in time.

Implications & ConsequencesThe Institute of Medicine (IOM)

called for a redesign of the country’s healthcare system.

Shift from acute care to management of chronic health problems.

Six goals of healthcare identified: ◦Safe, effective, patient centered,

efficient, timely, & equitable.

Implications & ConsequencesThese change will continue to

influence a patient’s self care demand and agency.

Patients manage their health conditions, not healthcare providers.

Nurses influence will increase to assist patients in developing their abilities to meet their self care demand.

Long Term Impact on NursingNurse-patient relationship was refocused to

include a more intertwined connection. Nurses were given a sense of direction for

the development and management of the nursing practice.

Provided framework for nurses to focus on the individual’s self-care ability and ensuing plan of care, not the disease process.

Dorothea Orem delineated the why, what, and how of nursing especially in the notion of design in the nursing process (Clarke et al, 2009).

Evaluation of the nursing model

“Orem’s work is widely used in nursing education and practice” (Chitty & Black, 2011, pg 311). The self-care theory framework was formulated as Orem experienced a period of intensive exposure to nurses and their activities from 1949 to 1957(Fawcett, 1995).

Orem’s self-care model addresses the four global concepts of human being, environment, health, and nursing but also adds in the nursing process of problem identification and planning (why is the person under care, what is the plan of care, and implementation of care).

Evaluation of the nursing model

Orem’s self-care theory can be used in all settings because the theory starts with maintenance of sufficient intake of air, water, and food. The theory also focuses on elimination and balancing activity with rest. Because these the necessities of the basic life functions, this theory can be used in any department. The concepts are easily understood in which the nursing process is used to determine the self-care deficit.

The self-care theory would be used in dealing with illness, injury, or disease such as cancer, a heart attack, a stroke, or even adjusting to a different job because of a condition.

Case Study 54 year old male is admitted to the floor with the diagnosis of acute

myocardial infarction. He lives in a rural community and lives with his wife and two young children. He is a truck driver by trade who drives long hours cross country daily. He admits to drinking lots of caffeine and living mostly on fast food with little consumption of vegetables or fruit in his diet. The patient’s past medical history is only significant for hypertension while his surgical history is positive for total knee arthroplasty and cholecystectomy. His father has a history of cardiovascular disease and dies at the age of 62, while his mother has a history of breast cancer. The patient experienced onset of symptoms at home while shoveling snow after a large storm. Pt states he experienced chest tightness and shortness of breath. He stated he took a break and symptoms stopped. He continued then to finish shoveling and upon return to his home he became increasingly short of breath, diaphoretic, and felt a gripping and twisting in his chest. Upon arrival to the hospital the patient showed ST segment changes and troponin levels were elevated. Pt was immediately taken to the cath lab with successful surgical interventions. The patient is now staying overnight for recovery. The patient tells the nurse he is depressed and worries how he is going to manage his condition while on the road for his job.

Questions1. According to Orem’s theory nursing intervenes:

a) When the demands for self care are greater than the individual is able to achieve on their own.

b) To reduce the stressors interacting with an individual.c) To promote adaptation in the patient through modification.

2. In utilizing the self care theory in this situation, the nurse will provide interventions to improve the well-being of the patient by having the opportunity to teach the patient to help control the impact that cardiovascular disease can have on his life. (T/F)

3. According to Orem’s theory the patient will actively participate in their own care by demonstrating conscious actions to regulate his health and well-being. (T/F)

Questions4. In utilizing Orem’s theory of the nursing system, match the nursing

system with the action provided by the nurse. ___Supportive-educative _____wholly compensatory ____partly

compensatorya) Monitor the patient’s ability for independent care and providing assistance until

patient is fully able to resume activities of daily living.b) Reducing the patient’s pain post operatively through parenteral medications.c) The nurse’s assessment identified key areas of his health condition and the

adequacy of his current activity/rest patterns. The patient identifies what activity and rest mean to them and current exercise plan. Together they come up with an activity schedule and establish priorities.

5. The nurse working with the patient regarding meal planning and dietary restrictions while on the road is an example of a nursing intervention utilizing the theory to help patient achieve their self care requisites. (T/F)

6. The nurse, understand that environmental factors can positively or negatively affect the health of an individual, will focus on the patient’s ability to change environmental factors such as diet, exercise, and activity rather than focusing on the cardiovascular disease process when utilizing Orem’s theory. (T/F)

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Orem, D.E. (2001). Nursing concepts of practice (6th ed.) St. Louis, MO: Mosby.