Dorothea Orem's Self Care Model

According to Petiprin (2015), Dorothea Orem’s theory is used to encourage a person to become more independent. Petiprin (2015) further states that it is true of rehabilitation settings, (Such as,)for example HealthSouth Sunrise Rehabilitation Hospital in which patients are transitioning out of being cared for by physicians and nurses and to exclusive self-care at home. According to George (2011), Dorothea Orem has developed three connecting theories: the theory of self-care, the theory of self-care deficit and the theory of the nurse system. George defines the term metaparadigm as the core content of a discipline (2011). George further states that the metaparadigm of the discipline of nursing comprises of four major concepts: person, health, environment and nursing (2011). At HealthSouth Sunrise Rehabilitation Hospital, the mission of our operations is the delivery of quality healthcare in the most appropriate, safe, patient-centered environment (HealthSouth, 2015). The purpose of this paper is to discuss Dorothea Orem theory, metaparadigm and how it relates to nursing practice at HealthSouth Sunrise Rehabilitation Hospital.

The nursing process does not merely treat the patient as a physical body, but rather treats the patient holistically. The central philosophy of Dorothea Orem's self-care deficit nursing theory "is that all patients want to care for themselves, and they are able to recover more quickly and holistically by performing their own self-care as much as they're able" (Dorothea Orem, 2012, Nursing Theory). However, although self-care may be the core of Orem's theory, the decision to engage in self-care must be facilitated by the patient's social and physical environment, of which the family can play a critical role in shaping.

The profession of nursing requires a capacity and joy for caring and healing others both mentally and physically. Nurses spend their careers caring for patients and their families often in the worst and most frightening periods of their lives. Nursing responsibilities can be lengthy, stressful and physically and emotionally demanding. The demands of the nursing profession coupled with the nursing shortage and longer work hours put even more stress on nurses. Despite these extreme demands, many nurses do not fully appreciate the importance self-care. Yet without proper care for themselves, nurses are not able to provide the best care for their patients.

Dorothea Orem’s Self Care Model states, “Nursing care is required when an adult is unable to perform self-care sufficiently to sustain life, maintain health, recover from disease or injury, or cope with the effects of disease or injury” (Orem, 1991). Orem also takes into account that caregivers also need nursing care. Six concepts:

Dorothea Orem’s Self Care Model states, “Nursing care is required when an adult is unable to perform self-care sufficiently to sustain life, maintain health, recover from disease or injury, or cope with the effects of disease or injury” (Orem, 1991). Orem also takes into account that caregivers also need nursing care. Six concepts:

Intervention: MHP and MHS discuss several incidents in the home that Samantha displayed defiance and disrespect. MHP use role-play to process outcomes from reported behaviors and practice alternative ways to express herself. MHP, MHS and Samantha discuss the role-play and possible trigger for the behaviors. MHP provide Samantha examples of her behaviors that is consistent in all environments. MHP administer the circle of support to prepare for Samantha’s discharge. MHP offers Samantha to review coping skills to improve overall behaviors. MHP explain to Samantha adjusting to a family unit is important.

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.

some other health issues. As a result, Mrs. Gibb needs assistance with daily activities such as

The patient has a status post right great toe amputation and has sores on his buttocks and left residual limb. The patient 's daughter believes the sores are caused by poor hygiene, nutrition, and poisoning. Sean reports that he bathes and changes his clothes twice a week, and stays in his wheelchair all day, even sleeping in it on occasion. Following series of hospitalizations due to Sean not taking care of himself, he now lives in a nursing home.

As time passed, Marginee`’s symptoms continued to mount. For example; she did not cry when she was hungry or wet; she sat quietly or slept most of the time; she was slow to respond to stimuli; she was slow to respond to her name and finally; she made no attempts to use language. Her father stated that he felt her non-responsiveness generated a feeling of detachment. Her parents concern was heightened when she did not respond to verbal commands even when reinforced by the use of slight physical punishment. For example, at the age of two, she crawled or walked up the staircase and

Orem focuses on nursing as a deliberate human action and notes that all individuals can benefit from nursing when they have health-derived or health-related limitations for engaging in self-care or the care of dependent others (Gunther, 2016). The nurse chooses deliberate actions from nursing systems to bring about desirable conditions in persons. The goal of nursing is to move a patient toward responsible self care or to meet existing healthcare needs of those who have health care deficits (Gunther, 2016). Orem expects people to be responsible for themselves and to seek help when they cannot maintain therapeutic self-care or dependent-care (Fawcett, 2003).

Orem’s 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” (Current Nursing, 2010, para. 16). Orem’s created five methods of helping; which are acting for and doing for others, guiding others, supporting one another, providing an environment that promotes personal development, and teaching one another.

Dorothea Orem's self-care deficit theory was born while Dorothea Orem (1917-2007) was working in the Department of Health Education and Welfare (HEW) as a curriculum consultant. At this time in the history of the profession, nursing was just emerging as a unique academic discipline. Orem's theory was designed to answer the fundamental question: What is nursing? Orem defined nursing as a way of realizing every patient's desire to engage in self-care in a manner to "sustain life and health, recover from disease or injury and cope" with the consequences of major health events and daily life (El-Kader n.d.). Major assumptions of the theory include that "people should be self-reliant and responsible for their own care and others in their family needing care" (Dorothea Orem's self-care deficit theory, 2012, Current Nursing). Fundamentally, nursing and the nursing process is designed to enhance self-care and to address deficits in self-care.

Dorothea Orem created the self-care theory in 1959 and continued to build upon her theory until 2001. The purpose of Orem’s theory was to define nursing, discuss the relationship among the nurse and the patient, and to promote a clear understanding of the scope of nursing (Taylor, Self-Care Deficit Theory of Nursing, 2006). Today, Orem’s theory is widely known and is utilized in nursing curriculum, as well as continuing education topics for healthcare providers.

Dorothea E. Orem devoted her life to defining nursing and the nurse’s role in improving the patient’s overall health, which she coined the Self-Care Deficit Theory. Orem’s theory is quite a complex one, which can be simplified by identifying that it is three theories in one: self-care theory, self-care deficit theory and nursing systems theory. In 1959, as Orem first began the evolution of the Self-Care Deficit Theory, she defined the nurse’s role as another self. This nursing theory is the foundation for nursing as it actually defines the art of nursing, the actions that drive the nurse and the nurse’s provision of care through the nursing systems theory. To place in simplistic terms, Orem assumes that all humans desire to care for self. In the self-care theory, she states that individuals are meant to care for themselves and their basic needs by promoting life, health, development and well-being (Banfield, 2011). When something happens that does not allow the human to care for self, a deficit occurs. This deficit drives the need for specialized nursing care to restore the human’s health so they can resume self-care.