Treating the Patient is Treating the Family: Using Orem's Theory of Self-Care in Family Nursing Practice

From a pediatric perspective, the family is an integral part of the healthcare team. Parents are the primary ally and resource in providing individualized care for their child. Even in adult patients, who they are is impacted by the relationships that they have. Serious or chronic illnesses and injuries affect the entire family. The family, then, becomes the patient, particularly when it is necessary to make lifestyle changes.

Many people have many different definitions of a family. Some include family as the people they live with, some include their entire extended family, and some include friends, neighbors, coaches, and teachers. According to the Vanier Institute (2013), a family is “a combination of two or more persons who are bound together over time by ties of mutual consent, birth, and/or adoption” (para. 2). Whichever way you look at it, families often play a major role in life. It only makes sense that when a person begins to go through a drastic change in life such as illness, the family will be involved. This is why it is important that nurses learn how to provide suitable client and family centered care. They can do this by following the four

Including the client as an expert member of the team creates an enhanced quality of care (Coad, Patel & Murray, 2014). In pediatrics, parents are often at the center of the child’s care. When asked to define what made the client care experience positive, parents stated that sensitivity, empathy and honesty were key factors (Coad, Patel & Murray, 2014). Working in healthcare, nurses can become desensitized to difficult experiences because they deal with them daily. Integrating the client and family as part of the healthcare team, allows the nurse to see the patient and family as a people first. By avoiding using illness as context, and instead using person as context, care will be more holistic (Coad, Patel & Murray, 2014). A family-focused approach helps to ensure that the whole family feels a part of the experience and is valued. In the case of bereavement, family centered care is particularly important. If the family is not included in the care from the start, it can provide barriers for grieving and impact how the family deals with loss (Jones, Contro & Koch, 2014). Nurses have an opportunity to help support the family through the grief process (Jones, Contro & Koch, 2014). Families have a significant impact on how the client heals, so by caring for the family’s needs, the nurse is indirectly caring for the patient. It is in the client’s best interest for the care to be holistic for the patient as well as the family (Jones, Contro & Koch, 2014). All

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.

Orem’s Self-Care Deficit Theory views every individual as practicing “self-care, a set of learned behaviors, to sustain life, maintain or restore functioning, and bring about a condition of well-being.” (Creasia & Friberg 2011) The nurse uses her/his abilities to assist the patient to overcome current self-care deficits and help the patient achieve her/his best level of self-care. As time passes many of the elderly need more assistance with the activities of daily living. Taking care of themselves physically becomes more difficult, sometimes there is decreased mental acuity, as well as a loss in social contact. In every one of these areas the nurse assists the patient to achieve her/his highest level of self-care. This includes diet, eating, elimination, activity, social interaction, education, awareness of obligations, and the promotion of health. Where possible the nurse will help the patient achieve self-care. Since there are no true cures to the aging process the nurse will be needed more and more

According to Erlingsson and Brysiewicz (2015), family is considered a core, social institution and is our first interaction with human beings. When viewing the family as a context, the nurse assesses the patient that is in need of care while in the background, there are the family members of the patient. According to Kaakinen, Coehlo, Steel, Tabacco & Hanson (2015), the source of support to the patient is his or her family members. Usually family members are in attendance with the patient. This approach is used when a mother is admitted to the intensive care unit after falling and sustaining head trauma. The patient is the mother. The nurse is focused on the mother and care was directed

For this assignment, I chose to study grand nursing theorist Dorothy Orem and the nursing concept she introduced, the self-care deficit theory (also known as the Orem model of nursing). I chose to study Dorothy Orem because she is well known in Indiana, the state in which I reside. Orem’s grand nursing theory “was developed between 1959 and 2001…[and] is particularly used in rehabilitation and primary care settings where the patient is encouraged to be as independent as possible” (Orem & Taylor, 2011).

The preceptor applied Dorothea Orem self-care deficit theory to the pediatric clinic and their families. In the future, I’ll ask to nurse in charge for me to assist in administering the

Moreover, the family understands the specifics about the individual's condition and their daily routines. This can help health care professionals to decide if the person is following the proper steps in their therapy. Once this takes place, is the point that health care professionals can make adjustments to reflect changing realities. Those patients, who have their families involved, will be able to receive better care by ensuring that nothing is overlooked. This is the point that physicians will have a more complete picture surrounding their underlying levels of health. (Saleeba, 2009)

One of my interventions in regards to my patient is that we use a family-centered approach of care. According to Maxwell, approximately one third of the time patients are not able to fully participate in the difficult decisions regarding their health goals and the treatments that are to be made or alerted (Maxwell, 2007, p. 368). Being that this is the case it is very important that the nurses and physicians have a good understanding of what the family members want for their loved ones. Although this is an area that most health care professionals are in agreement with and is practiced in all hospitals, this article goes into further detail in discussing certain interventions that are coordinated to specifically ensure that there is strong family to health professional relationship.

There are many characteristics that appeared in the concept of family support, however, the main one was the ability of the family to communicate with health care providers regarding the individual that they are taking care of so the patient can have better outcomes. If there was sufficient communication between the care providers and family members, there would be more positive outcomes in the patient care plan. Nurses should be educated in ways to communicate with family members, also to include them in the patient care plan “Education in a more family-oriented nursing approach seems essential to increase nurses’ awareness regarding the importance of family caregivers of older patients in the hospital." (Hagedoom et al.,

In addition, Schoen (2000) states that it is important for the nurse to spend time with the patient, family and significant others. In fact, the nurse uses this time to implement one of Orem’s nursing system; the nurse uses the supportive- educative compensatory system to educate and discuss with the client potential problem; he/she may encounter at home in meeting their activities of daily living. It is very important for family members to understand that the client may require some assistance in meeting their activity of daily living; such as preparing a meal, clothing self as well as their personal hygiene needs. However, the degree of assistance need depends on the extent of the client's self care deficit.

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.

Dorothea Orem developed The Self-Care Deficient Nursing between 1959-2001. It has also been known as the Orem Model of Nursing. This theory is considered a grand nursing theory. This means the theory covers a broad scope with concepts that can be applied to all areas of nursing. A benefit of this theory is that it can be applied to a variety of patients and nursing practices. Orem proposed that the purpose of nursing is to help people meet their self-care needs. Nurses do for others what they cannot do for themselves. Individual well-being affects health. Central philosophy of Orem’s theory is that all patients want to care for themselves and they can recover holistically and quicker when preforming their own care. Orem identified three self-care requisites. The first is universal self-care requisites. These include needs that all people have such as air, water, food, activity, rest, and hazard prevention. Developmental

When you have the privilege of being or becoming a nurse, the number one goal is to provide excellent care to your clients, and for that goal to take place most successfully, nurses must practice self-care. Self-care aids in keeping nurses healthy including providing the best quality of care to clients. “Care for yourself so you can care for others” is an old saying, that many in the health care profession have forgotten (Halm, 2017). For many nurses, self-care is an approach that seems to indulging, something that nurses do not have time for (Lombardo, 2011). However, it shouldn’t matter if you are a nursing student, a new graduate, or an acute care nurse, taking care of our needs and our own well-being is essential and will also help meet challenges that we all face whether it is at