Question

Orem’s self- care

Answer 1

Dorothea Orem's Self-Care Theory

          The self-care theory in nursing was introduced by Dorothea Orem (1914-2007). She developed the theory from her experience as a staff nurse, the private duty nurse, nurse educator and administrator and nurse consultant, the theory was first published in Nursing: Concepts of Practice in 1971.

Major Assumptions Of The Theory

• All individuals are distinct.
• People in need of care should be self-reliant and responsible for their own care and others in their family needing care.
• The form of action – an interaction between two or more persons is the base of nursing care.
• The important component of primary care prevention and ill health are successfully meeting universal and development self-care requisites.
• People’s knowledge of potential health problems is important for promoting self-care behaviours
• The concepts of self-care and dependent care are behaviours learned within a socio-cultural life.

DOMAIN CONCEPTS

Nursing:

Nursing is considered as an art, a helping service by nurses, and a technology which involves the actions deliberately selected and performed to help individuals or groups under their care to maintain or change conditions in themselves or their environments.

Nursing encompasses the patient’s perspective of the health condition, the physician’s perspective, and the nursing perspective. The ultimate goal of nursing is to render the patient or members of his family capable of meeting the patient’s self-care needs.

Maintain a state of health:

Maintain a state of health is to regain the normal or near normal state of health in the event of disease or injury and to stabilize, control, or minimize the effects of chronic poor health or disability

Health:

When a living thing is structurally and functionally whole or sound includes that which makes a person human which operates in collaboration with physiological and psychophysiological mechanisms and a material structure and in relation to and interacting with other human beings.

Environment:

Environment components are the factors, elements, conditions, and developed environment.

Human being:

The concept of human being as a total being with universal needs, developmental needs and are capable of continuous self-care. The human being can be a unity that can function biologically, symbolically and socially.

Nursing client:

A human being who is incapable of continuous self-care or dependent care or limitations that result in ineffective/incomplete care due to health-related /health derived limitations. A human being becomes nursing client only when the self –care requisites exceeds self-care capabilities.

Nursing problem:

Any deficit in universal, developmental, and health derived or health-related conditions which needs care.

Nursing process:

Orem’s theory considers the nursing process as a system to determine (1)why a person is under care (2)a plan for care, (3)the implementation of care.

Nursing therapeutics:

Nursing therapeutics are the deliberate, systematic and purposeful action for caring nursing client.

OREM’S GENERAL THEORY OF NURSING

Orem’s general theory of nursing in three related parts such as:

A. Theory of Self Care

This theory Includes:

•        Self-care – any practice of activities that individual initiates and perform by themselves in maintaining life, health and well being

•        Self-care agency – can be any human ability for engaging in self-care, conditioned by age developmental state, life experience sociocultural orientation health and available resources.

•        Therapeutic self-care demand – self care requisites are met using valid methods and related sets of operations and actions

•        Self care requisites – action which renders provision of self care.

3 categories of self care requisites are-

o       Universal self care requisites: associated with universal needs, common to all like ADL , basic needs

o       Developmental self care requisites : developmental process needs like job and new place adjustment.

o       Health deviation self care requisites: care required in disease or illness or in any deviation from illness.

B. Theory of self-care deficit

It explains when nursing is needed or must be rendered like when an adult or dependent child is incapable or limited in the provision of continuous effective self-care.

Orem identifies 5 methods of rendering care

1. doing

2. guiding

3.supporting

4. providing developmental demands.

5.teaching

C. Theory of Nursing Systems

The theory of nursing systems explains how the patient’s self-care needs will be met by the nurse, the patient, or both

•        Orem’s theory identifies 3 classifications of a nursing system to meet the self-care requisites of the patient:-

•        Wholly compensatory system

•        Partly compensatory system

•        Supportive – educative system

•Orem recognizes the elements of the nursing system as

•        The scope of nursing responsibility in healthcare situations

•        General and specific roles of nurses and patients

•        Reasons for nurses’ relationship with patients and

According to her, the specialized technologies are usually developed by members of the health profession and it can be any systematized information about a process or a method for affecting some desired result through deliberate practical endeavour, with or without the use of materials or instruments.

Categories of technologies are:

1. social or interpersonal technology like communication adjusted to age, health status, relationships - interpersonal, intragroup or intergroup relations for coordination of efforts, maintaining the therapeutic relationship in light of psychosocial modes of functioning in health and disease, provision of human assistance adapted to human needs, acting abilities and limitations

2. regulatory technologies

•        supporting and maintaining life processes, modulating the psychophysiological modes of functioning in health and disease, supporting human growth and development and coordinating position and movement in space.

OREM’S THEORY AND NURSING PROCESS

In Orem’s theory, the nursing process determines the self-care deficits and then to identify the roles of person or nurse to meet the self-care demands. The steps of a nursing process are considered to be the technical component of the nursing process. In her theory, Orem emphasizes that the technological component must be coordinated with interpersonal and social processes within nursing situations.