Dorothea Orem Theory [PDF]

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Dorothea Orem’s Theory of Self Care



Dorothea Orem Born in Baltimore, Maryland. One of America’s foremost nursing theorists. Father was a construction worker Mother was a homemaker. Youngest of two daughters.



Education Studied at Providence Hospital school of Nursing in Washington D.C. in 1930’s Got her B.S.N.E. in 1939 and her M.S.N.E in 1946 both from the Catholic University of America Got her M.S.N.E. at Catholic University of America in 1946 1958-1960 upgraded practical nursing training at Department of Health, Education and Welfare Was editor to several texts including Concepts Formalization in Nursing: Process and Production, revised in 1980, 1985, 1991, 1995, 2001



Nursing Experience Early nursing experience included operating room nursing, private duty nursing (in home and hospital), pediatric and adult medical and surgical units, evening supervisor in the emergency room, and biological science technician. 1940-1949 Orem held directorship of both nursing school and the department of nursing at Providence Hospital in Detroit.



Development of Theory 1949-1957 Orem worked for the Division of Hospital and Institutional Services of the Indiana State Board of Health. Her goal was to upgrade the quality of nursing in general hospitals throughout the state. During this time she developed her definition of nursing practice. 1958-1960 U.S Department of Health, Education and Welfare where she help publish “Guidelines for Developing Curricula for the Education of Practical Nurses” in 1959.



Development of Theory 1959 Orem subsequently served as acting dean of the school of Nursing and as an assistant professor of nursing education at CUA. She continued to develop her concept of nursing and self care during this time. Orem’s Nursing: Concept of Practice was first published in 1971 and subsequently in 1980,1985, 1991, 1995, and 2001. Continues to develop her theory after her retirement in 1984



Achievement



1976 and 1980 Honorary degree of Doctor of Science. 1980 CUA Alumni Association Award for Nursing Theory. 1988 Doctor of Humane Letters from Illinois Wesleyan University 1988 Linda Richards Award 1991 National League for Nursing 1992 Honorary Fellow of the American Academy of Nursing. 1998 Doctor of Nursing Honoris Causae from the University of Missouri.



Image of Nursing Orem began her theory development in the 1960’s, and her first publication was in 1971. During that time the mass media played a small role in portraying nursing as a respected profession but unfortunately played a much larger role in the destruction of that image.



Image of Nursing In the early 1960’s Nurses were depicted as subordinate to Physicians in films and on television. For example, in TV shows such as Dr. Kildare and Ben Casey, nurses were shown delivering messages to the doctors, carrying trays and doing minimal skill level tasks. Throughout the show, the doctors were condescending towards the nurses, and constantly portrayed as superior. In 1962 a revolutionary TV show came about, and for the first time nurses were depicted in a positive realistic light.



“The Nurses”1962-1964 This TV show was the first of medical drama’s to focus on the nurse instead of the physician, and showed the nurses in their true profession. They were depicted as: -objective -articulate -disciplined -concerned with professional development of herself and colleagues -demonstrated the existence of nursing standards and organization



“The Nurses”1962-1964 For the first time in TV history, when problems arose, instead of waiting for the physician to arrive and give orders, the nurses identified the problem themselves and found solutions. In the short time that it was on the air it did a great deal for the propagation of a positive nursing image.



Image of Nursing In the mid 1960’s the positive image of nursing took a plunge. In the media, the obsession with nurse’s sex lives dominated over all other thematic elements. Films, books and television shows depicted the nurse as a tall, thin, well endowed blonde whom every man craved. Nurses would often fall in love with their patients, and the physicians would woe them.



Image of Nursing



This ushered in an era of sexually suggestive material which included nurses as promiscuous women, having sex with patients, physicians and other male characters without any attachment, such as in “Carry on Nurse”. Soon the context had completely left the screen and all that was left was outright pornography. Including such titles as “Night Call Nurses”, “I, A Woman” and “Deep Throat”. Fortunately, although this portrayal hindered the progress nurses were making, this was not the image the majority of society assumed when thinking about what nurses do.



Images of Nursing Media Portrayal



Image of Nursing Realistic Portrayal



Metaparadigm Concept Person: An individual with physical and



Person: An individual with physical and emotional requirements for development of self and maintenance of their well-being. Environment: Client’s surroundings which may affect their ability to perform their self-care activities. Health: “Structural and functional soundness and wholeness of the individual” (Orem 1991). Nursing: The acts of a specially trained and able individual to help a person or multiple people deal with their actual or potential self-care deficits.



Orem’s Theory of Self Care



Each person has a need for self care in order to maintain optimal health and wellness. Each person possesses the ability and responsibility to care for themselves and dependants. Theory is seperated into three conceptual theories which include: self care, self care deficit and nursing system.



Theory of Self Care Self care is the ability to perform activities and meet personal needs with the goal of maintaining health and wellness of mind, body and spirit. Self care is a learned behaviour influenced by the metaparadigm of person, environment, health and nursing. Three components: universal self care needs, developmental self care needs, and health deviation.



Universal Self Care This includes activities which are essential to health and vitality. Eight elements identified these include: air, water, food, elimination, activity and rest, solitude and social interactions, prevention of harm, and promotion of normality.



Developmental Self Care Need These include the interventions and teachings designed to return a person to or sustain a level of optimal health and well being. Examples can include such things as toilet training a child or learning healthy eating.



Health Deviation Self Care This encompasses the variations in self care which may occur as a result of disability, illness, or injury. In other words the person with a variation is meeting self care and maintaining health and wellness in a more individualize meaning.



Theory of Self Care Deficit Every mature person has the ability to meet self



care needs, but when a person experiences the inability to do so due to limitations, thus exists a self care deficit. A person benefits from nursing intervention when a health situation inhibits their ability to perform self care or creates a situation where their abilities are not sufficient to maintain own health and wellness. Nursing action focuses on identification of limitation/deficit and implementing appropriate interventions to meet the needs of person.



Theory of Nursing Systems The ability of the nurse to aid the person in meeting current and potential self care demands. Focused on person Three support modalities identified in theory including: total compensatory, partial compensatory, and educative/supportive compensatory. The client’s ability for self care involvement will determine under which support modality they would be considered.



Support Modalities



Total compensatory support encompasses total nurse care- client unable to do for themselves. Partial compensatory support involves both the nurse and the client sharing in the self care requirements. Educative/supportive compensatory support elicits the help of the nurse solely as a consultant, teacher or resource person. Client is responsible for their own self care. A person can fluctuate between support modalities at any given time throughout life.



Nurse’s Role The nurse’s role in helping the client to achieve or maintain a level of optimal health and wellness is to act as an advocate, redirector, support person and teacher, and to provide an environment conducive to therapeutic development.



Application of Theory To Nursing Process Orem’s theory of self-care is applied to many undergraduate nursing curricula. The nursing care plan is one example of how her theory of self-care can be applied to nursing process



Nursing Care Plan The nursing care plan includes; assessment data pertaining to Gordon’s Functional Assessment, a NANDA nursing diagnosis, the identification of client expected outcomes, the nursing interventions and evaluation.



Nursing Theory in Practice The self-care aspect of Orem’s theory applies to the assessment and evaluation of the nursing process. Orem emphasizes the importance of how one’s own self-care is important for maintaining life, health development and wellbeing. The only restriction to this method is that the nurse can only make assessments where there is direct contact between the nurse and the client and or the family.



Nursing Theory in Practice The area of self-care deficit applies to the diagnosis area of the nursing care process. Although self-care deficit is an abstract concept, it does provide a guideline for the selection of methods for helping and understanding the patient roles in selfcare.



Nursing Theory In Practice The third area of her theory, nursing systems, applies to the interventions of the nursing care. In order to help explain this concept, Orem also created three areas of how care can be administrated to a client depending on the physical and mental capabilities of the client. Wholly compensatory, partly compensatory and supportive-educative role



Case Study



The wholly compensatory system accomplishes the client’s therapeutic self-care, compensates for the client’s inability to participate in their selfcare, provides support and protects the client. Bedridden oncology patient arrives via ambulance for chemotherapy. Family insists upon keeping patient at home; however, leaves patient alone with nurse in chemo clinic for treatment. Patient requires O2 at 2L/min, continuous tube feeding at 90cc hour, foley catheter, bedpan. Nurse in clinic administers chemo premeds and chemo; changes dressing around g-tube due to leaking; administers O2 at 2L; empties Foley at end of treatment; places patient on bed pan one time.



Case Study



The partly compensatory system has a give and take system in between the nurse and the client. The nurse performs, compensates for limitations, regulates and assists the client as needed. The client participates in some selfcare procedures, regulates and accepts care and assistance from the nurse. Preterm labour patient regularly visits clinic for BP monitoring, etc. Patient on bed rest (at home), except for weekly visit to module. Nurse assists patient out of wheel chair into bathroom, assists with urine sample collection, and onto exam table. Nurse administers injection of terbutaline and educates patient regarding oral terbutaline.



Case Study



The supportive-educative role indicates that the client is participating in most of their self-care, and the nurse’s role is simply to monitor and regulate the client’s self-care. Newly diagnosed diabetic patient received diabetic care teaching while in hospital. Now, patient visits module and reports highly variable BS/chemstrip readings. Nurse suspects patient may be performing procedure incorrectly. Nurse assesses that patient has been cutting some of his chemstrips in half to save money. Nurse instructs patient that cutting strips exposes chemicals and inaccurate readings may result. Additionally, nurse assesses that patient's wife (who does family cooking) did not receive any nutritional education while patient was hospitalized. Nurse begins nutritional counseling and provides wife with referral to nutritional services department.



Personal Philosophy of Nursing Nursing is the art of caring, nurturing and healing. Nursing goes beyond simply caring for illness, disease or ailment it is caring for the person. Part of the person is caring enough to aid them return to a state of optimal health and wellness in mind, body and spirit. These are believe to be the basic aspects essential to a fundament nursing philosophy.



Personal Nursing Philosophy Nursing is being able to intervene when the person is unable to care for themselves and teach them methods to help them move beyond their inability. This can include offering information, teaching and tools necessary for their well being.



Orem’s Philosophy It is believed that Orem’s theory portrays the idea that nursing is the ability to care for another, especially when they are unable to care for themselves. This corresponds to our philosophy of caring for person with the goal of achieving optimal level of health and wellness.



Game While watching the video clip, think of a self-care nursing diagnosis related to this situation. Come up with self-care deficit as a class Divide the class into two groups Each group is asked to come up with as many nursing interventions as they can related to this person and the self-care deficit.



Game 



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Flip a coin to find out which team gets to answer first. Then it will go back and forth. For every intervention that is appropriate, the team will receive a game piece. The object of the game is to connect four. Prizes at the end!! Good luck



References



Hartweg, D.L. (1995). Dorthea Orem: Self-care deficit theory. In C.M. Kalisch, P. A. & Kalisch, B.J. (1987). The Changing Image of the Nurse. Menlo Park, CA: AddisonWesley Publishing Company. Mayo, A. (1997). Professional nursing web site. Retrieved October 31, 2006 from http://members.aol.com/annmrn/nursing_portfolio_I_ind McQuiston & A.A. Webb (Eds.), Foundations of nursing theory: Contributions of 12 key theorists (pp. 139-202). USA: Sage Publications Inc.



References Orem, D.E. (1991). Nursing: Concepts of practice (4th ed.). St. Louis, MO: Mosby-Year Book Inc. Taylor, S.G. (2006). Dorthea E. Orem: Self-care deficit theory of nursing. In A.M. Tomey, A. & Alligood, M. (2002). Significance of theory for nursing as a discipline and profession. Nursing Theorists and their work. Mosby, St. Louis, Missouri, United States of America. Whelan, E. G. (1984). Analysis and application of dorothea orem’s self-care practuce model. Retrieved October 31, 2006 from http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=Pubmed&list_uids=6094754& dopt=Abstract