Analysis Of Orem 's Self Care Theory

In essence, the role played by the nurse is to increase and facilitate the self-care abilities and level of the individual patient (Smith & Parker, 2015). As such, self-care is neither reflexive nor instinctive. Instead, it is either performed rationally or intentionally in response to an already known need. Based on this Orem's theory, rational response is learned through communication and interpersonal relations. Orem asserts that self-care agency can also be defined as the power to take action (Caruso, Cisar & Pipe, 2008). It is a complex capability developed to enable maturing adolescents and adults to recognize, identify, and understand various factors to be managed or controlled so as to decide about, develop, and perform realistic care measures. The capability discussed above is strongly dependent on culture-related values and lifelong experiences.

According to Taylor (2011), Self- care can be viewed as work, which is needed for personal maintenance of health, wellness and psychological development. When someone has a disability and is incapable of providing self-care for himself/herself, further assistance is required. If family or community members are unable to assist someone with his/her self-care, trained and equipped caregivers a vital tool. The level of care provided by the caregiver depends on the specialization of services provided. Orem’s self-care theory focuses on self-care deficits and potential self-care deficits. Since 1956, the correlation between self-care and nursing have led Orem to guide and lead the self-care theory into the nursing practice, by explaining the structure, knowledge, process, and sciences behind this theory

In addition to teaching and administrative responsibilities, she conducts research funded by National Institutes of Nursing Research, publishes, mentors faculty and students and serves as a consultant at national and international levels. Swanson was inducted as a fellow in the American Academy of Nursing and received Distinguished Alumni Award from the University of Rhode Island.

Orem’s theory has been used in educational programs and healthcare institutions to improve nursing care and make a difference in patient’s lives. Dorothea Orem held many roles throughout her career in patient care and as faculty and dean of Catholic University, the same place where she obtained her bachelor’s and master’s degree in nursing. Her self-care deficit theory is categorized as a systems theory and grand nursing theory. Orem’s theory has stood the test of time, yet has adapted to fit current nursing concerns. She is known as one of the pioneers of nursing theory.

Dorthea Elizabeth Orem modeled her theory on the belief that people have the innate ability, right and responsibility to care for themselves and that nurses should focus on affecting that ability (Orem, 1995). According Orems self-care theory individuals whose needs for self care outweigh their ability to engage in self care are said to be in a self care deficit (Isenberg, 2006). The theory of self-care deficit is the core of Orem's general theory of nursing because it defines when nursing is needed. Nursing is required when an adult is incapable of or limited in the provision of continuous effective self-care. Nursing can be provided if the abilities to perform self-care for a particular demand are not met (Graham, 2006).

Dorothea Orem’s self-care deficit theory is based upon the idea that individual’s require a set of actions to maintain self-care and independence. When an individual is unable to perform an action required for daily care then that individual has a deficit. In order for the person to regain or acquire the skills needed to overcome this deficit they must first be willing to seek help and take the steps and measure needed (Orem, 1991). Nurse’s play a key role is this process by evaluating what the deficit is, formulating the steps needed, implementing the process and evaluating the results. Some of the concepts to this theory are that of, dependency, nursing, health, person, environment,

Dorothea Orem’s self-care theory of nursing is one of the major nursing theories. It pays particular attention to the role of the patient in their own rehabilitation, as it expounds the benefits of self-care. Orem’s theory is well documented and has been used by several researchers as a basis for their research. This particular theory of nursing is broad and can be applied to the primary, secondary and tertiary levels of prevention. Many nursing schools have used this theory as a benchmark or guide in their curriculum development.

As I researched geriatric nursing, I found that Dorothea Orem’s Self-Care Deficit Theory is the best support evidence based theory when it comes to geriatrics. The self-care deficit theory proposed by Orem in 1971 is a combination of three theories: theory of self-care, theory of self-care deficit and the theory of nursing systems. The self-care deficit nursing theory, also known as the Orem model nursing, was developed by Dorothea Orem between 1959 and 2001. It is considered a grand nursing theory, which means it covers a broad scope with general concept that can be applied to all instances of nursing. (Nursing Theory, 2011.) The self-care model states that nursing facilitates client self-care by measuring the client's deficit relative to self-care needs, the nurse implements appropriate measures to assist the client in meeting these needs by matching them to an appropriate supportive intervention. (Cherry, 2013.)

The Self-Care Deficit Theory of Nursing impacts modern health as well as nursing more so than expected during its creation and evolution. The Institute of Medicine (IOM, 2001) demanded the need for health care to shift from acute care setting to management of disease. Consequently, today’s health care is in the midst of a paradigm shift, as it redirects its attention towards patient centered care, disease prevention and wellness promotion. The Affordable Care Act implemented regulations, enforced by financial reimbursement to ensure that hospitals have shorter lengths of stay, lower readmission rates and strategies to enhance health promotion, disease prevention and improved quality of life (Taylor, 2012). The government has placed incredible demands on the health care system as baby boomers are aging and chronic diseases are becoming more complex requiring increased use of technology and nursing support. In order to meet the legislative requirements, administrators and educators must transition to the structure and concepts provided by the Self-Care Deficit Nursing Theory, for it is in this theory, nurses are empowered to better care for the patients as they present with complex self-care needs requiring specialized assistance from highly advanced, educated nurses who prepare these patients to return home better equipped for self-care despite their chronic conditions.

Orem’s theory of self-care is applied to many undergraduate and graduate nursing curricula. The nursing care plan is one example of how her theory of self-care be applied to nursing process [5]. Orem’s theory is extensively used in nursing literature and has improved quality and value of care based on results from different randomized controlled trails (RCTs) in the nursing profession. It is particularly used in rehabilitation and primary care setting, where the patient is encouraged to be as independent as possible [1].

Theory is the backbone to nursing as it gives nurses a framework and an idea of what they do and, most importantly, why they do it. Nursing theory means many different things to people and to only give credit to one definition would not be fair. Therefore, the definition of theory alone is, “the doctrine or principles underlying an art as distinguished from the practice of that particular art” (Theory, n.d). This definition is particularly useful because nursing is an art as well as a science. The art lies in the execution of nursing. Dorothea Orem developed the Self-Care Theory. First, this paper will explain the importance of nursing theory. Subsequently, this paper will attempt to summarize, analyze, discuss, and relate Orem’s theory to nursing today.

In Orem’s theory, nursing care is necessary when self-care deficit exists. The nurse can analyze the reason for the inability to meet self-care need, set a goal and implement necessary nursing intervention. Individuals have the ability to think, learn and function by themselves independently or through others. According to Orem, health is a state of physical, social well being, mental health and not only the lack of diseases. Individuals interact with their environment (George, 2011). The role of nursing in society is to allow individuals to mature and use their self-care capabilities to the extent that they can look after themselves.

According to Potter and Perry (2013), “Dorothea Orem defines self­care as a learned, goal­oriented activity directed toward the self in the interest of maintaining life, health, development, and well being” (p. 44). The theory is centered around the patient’s needs. The goal is to help the patient take care of themselves and take control over their health. The theory is not only used for the needs of patients, but also as a learning tool for nursing students. In most nursing schools, Orem’s theory is the bloodline of the program. Orem’s theory of nursing is made up of three other theories: the theory of self care, theory of self care deficit, and the theory of nursing systems, which is more specifically classified into wholly compensatory, partial compensatory, and supportive­educative.

According to Orem, a person is a functional, integrated whole with a motivation to achieve Self-Care (Aggleton and Chalmers 1990). However, when disease or infirmity affects an individual it unbalances this equation, thus making the ability to self-care debatable. Looking at the holistic concept of the human being together with individualistic, goal-directed nursing care through a process approach, allows the consideration of patient education in care planning (Carter 1990). It is important here to consider the fact that not only the patient, but the whole family needs educating. Price (1984) suggests that some individuals need to control their own situation during illness and resent being dependent on others. If education is provided the patient will have a balanced understanding of the situation and will be more motivated to learn to self-care with his/her disabilities.

In the latter half of the twentieth century, a movement within nursing began to define itself as a profession rather than an occupation. Nursing became a self-regulated profession throughout North America in the early 1960's through the establishment of Nursing Acts in provincial and state legislatures. Thus, nurses were given the legal authority to define, monitor and enforce education and competence standards, and define a code of ethics with the overall purpose of protecting the public interest. Further, a good deal of attention began to increasingly focus on nursing theory. Thus, it was upon the foundation of conceptualizing the professional nature of nursing as a field of medical practice that Orem’s theory was laid.