Orem's Theory

The purpose of this paper will be to explain the components of Dorothea Orem’s self-care deficit theory, the current significance of the theory, and the application of this particular nursing theory. A nursing theory is an explanation of a division of nursing that “describes, explains, predicts, or prescribes” that particular division. (Perry, Potter, Stockert, & Hall, 2013, p. 41). Orem developed her personal theory, the self-care deficit theory, to assess a patient’s ability to perform vital daily tasks and how it affected the patient’s. (Hartweg & Pickens, 2016). This theory is a grand theory, which means it can be used in almost all areas of nursing. There are five components or methods that compose this theory that nurses will practice when working with a patient who needs to reach the self-care deficit. (Edney, Jaime, & Young, 2016). It is used today and has been included in several studies that have proven it to be effective in shortening hospital visits when used on critically ill patients. (Hohdorf, 2010). This particular theory has helped advance nursing practice since Orem’s first publication.

One article defined self-care as “the care of oneself without medical, professional or other assisntance or oversight.” (Godfey, CM et al, 2011). While reviewing different articles the conclusion was that the definition of self-care could

The theory focuses on the ability of a person to meet his or her own needs. Developed in the year 1970, Orem’s theory focused on the three various concepts, namely self-care, self-care deficit, and the nursing system. Self-care is a group of activities or processes that a person performs to maintain health, life, and wellbeing (Orem, 2001). For instance, self-care is being demonstrated when a chronic heart failure patient checks his or her weight daily, takes prescribes medications, and avoids salty foods. Self-care deficit happens when an individual is not able to provide effective self-care (Orem, 2011). Nurses are able to assist patients in this state by educating them with their disease condition and treatment compliance. A nursing

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.

Leventhal’s model of self-regulation is based on the idea that each person forms a cognitive representation of their illness, which allows them to make sense of their symptoms. This illness perception and the patient’s emotional response then guide behaviour towards managing the illness (Leventhal et al., 1984). An illness perception is made up of five major components. These are illness identity, potential cause, timeline, its consequences and how it may be controlled. Often patients with similar diseases can hold very different perceptions of their illness (Petrie and Weinman, 2012). Clinical severity of the condition does not necessarily predict how a patient will cope. This essay will outline strengths and weaknesses of whether the model can be used to explain health outcomes and coping strategies, implement successful interventions and predict or even improve adherence to treatment. Finally, the importance of constructs not included in the model, such as social support, will be discussed. The essay will evaluate the model using examples of illnesses such as stroke, cancer, diabetes and asthma.

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.

Self care is essential to the nursing profession because it is a reflection on the quality of health care nurses provide to their patients, it portrays an image to the patients on what’s necessary towards healthy living and can help nurses battle with stress and personal health. Self care can be expressed as taking care of ones self’s health and overall wellbeing. This can be shown through eating healthy, exercising daily, getting enough sleep and completing weekly activities to reduce stress. Improving your overall health can benefit nurses from overworking themselves and help minimize the affects certain stressors can have on them. By doing so, the overall atmosphere in the workplace and the quality of healthcare provided to the patients will be greatly improved.

Anne Gold is a nurse that works with children and adolescents diagnosed with Cystic Fibrosis. One of her reflective journals, published in Andre Picard’s book, “Critical Care, Canadian Nurses Speak For Change”, gives us a small but informative look into the nursing care provided towards her clients in their adolescent years. By identifying a theme and applying each of Barbara Carpers’ 4 ways of knowing to examples from Anne Gold’s journal, I am able to get a sample insight to the kind of nursing care Gold has developed over the course of her career based upon her experiences with working with adolescents. I can use these examples, as well, to delve in to her reasoning behind her approaches towards the adolescents she encounters and how she

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:

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.

For our smoking cessation community project, we will be using the Orem Self-Care Deficit Theory which was developed by Dorothea Orem to improve the quality of nursing in general. The goal is to guide and improve the practice of nursing which must be consistent with other validated theories, laws and principles. The theory of self-care is a practice of activities that an individual, like in our case the cigarette or tobacco smoker to initiate or perform in his or her own behalf to maintain a healthy well-being. This includes stopping smoking by using different available resources and a therapeutic self-care demand to be performed over a specific duration to meet the self-care

ENVIRONMENT Context where self-care occurs. Can hinder or support self-care activities. Includes the family, work, community, health care system. Person (client/patient) self-care deficits are the result of environmental situations. HEALTH Promoted by adequate self-care Major areas for "self-care" patient education Maintaining health Enhancing health Includes: exercise & physical fitness nutrition and weight control stress management maintenance of social support systems environmental control

The application of the Chinn and Kramer model to my selected theory, brought into view that even though this theory was developed in 1959, it will continue to remain a theory that will stand the test of time and of importance to the nursing profession. I feel that Orem’s self-care theory will stand the test of time, due to providing a clear understanding of the scope of nursing, and the theory helps define goals for

The Self-Care Deficit Theory of Nursing impacts modern health as well as nursing more than expected during the theory’s creation and evolution. The Institute of Medicine (IOM, 2001) demanded the need for health care to shift from acute care setting management of disease. Consequently,

Dorothea Orem’s self-care deficit theory’s nursing goal is to assist individuals to meet all their self-care needs by teaching them with skillful healthy habits (Hood, 2014, p. 137). In order for nurses to provide the support needed by an individual, they must assess all their patients’ self-care requisites. As explained by Moore (2015), “Orem uses the self-care requisites as a basis for assessment [in] the nursing process.” These self-requisites are universal needs that arise due to illness and/or changes in developmental stages (Hood, 2014). Dennis (1997) described in detail Orem’s basic conditioning factors that must be assessed to gather sufficient information about the individual and about their ongoing and emerging self-care requisites. Orem’s basic conditioning factors include: age, gender, developmental state, health state, health care system, sociocultural/spiritual orientation, family systems, patterns of living, environment, and available resources (Dennis, 1997).