Transcript Orem Model of Nursing - James Madison University

OREM MODEL OF NURSING
James Madison University
Susan Foltz, Adrian Fredman,
Darlene Pettit, & Jennifer Watson
NSG463 Professional Role Transition
DOROTHEA OREM
Born 1914, in Baltimore Maryland
 In 1930, received diploma in nursing (Black, 2014)
 In 1939, received BS nursing education (Black, 2014)
 In 1946, received MS in nursing education (Black, 2014)
 During her professional career, Orem worked as a staff
nurse, private duty nurse, nurse educator, administrator and
nurse consultant
 Developed the Self-Care Deficit Theory as a result of
working toward “improving the quality of nursing in
general hospitals in her state” (“Self Care Deficit”, n.d.)
 First published Self-care theory in 1959. However, Orem
“continued to develop her conceptual model over several
decades” (Black, 2014)
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DEVELOPING THE SELF-CARE THEORY
One must first determine the patients’ ability to provide
self-care. This determination is initiated by the nurse
and involves the development of a nurse-patient
relationship. Many factors are considered such as the
patients gender, age, environment, developmental status
and health related necessities for the patient.
 (Black, 2014)
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THEORY OF SELF-CARE
 Self-Care: the performance or practice of activities that individuals initiate and perform on their
own behalf to maintain life, health and well-being.
 Self-Care Agency: is considered the human’s ability or power to engage in self-care and is
affected by basic conditioning factors.
 Therapeutic Self-Care Demand: is the totality of “self-care actions to be performed for some
duration in order to meet known self-care requisites by using valid methods and related sets of
actions and operations.” (Gonzalo, 2011).
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THEORY OF SELF-CARE DEFICIT
Self-Care Deficit delineates when nursing is needed.
Nursing is required when an adult (or in the case of
a dependent, the parent or guardian) is incapable
of or limited in the provision of continuous effective
self-care. (Wayne, 2014)
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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. Orem identifies 5 methods of helping:
 Acting for and doing for others
 Guiding others
 Supporting another
 Providing an environment promoting personal development in relation to meet future demands
 Involves teaching another
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THEORY OF SELF-CARE DEFICIT
3 Steps to the Nursing Process
Assessment – collect data in
six areas (health status,
physician’s perspective of
health status, person’s
perspective of health, health
goals, person’s requirements
for self care, and person’s
capacity to perform self
care.)
Nursing diagnosis/plans with
scientific rationale – Nurse
designs a system that is wholly or
partly compensatory or
supportive-educative, bringing out
a good organization of the
components of patients’
therapeutic self care demands,
selection of combination of ways
of helping that will be effective
and efficient in compensating for/
overcoming patient’s self care
deficit
Implementation/evaluation Nurse assists the patient or
family in self care matters to
achieve identified and
described health and health
related results. Collecting
evidence in evaluating results
achieved against results
specified in the nursing system
design, actions are directed by
etiology component of nursing
diagnosis, evaluation.
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THEORY OF NURSING SYSTEM
Three types of nursing systems:
Wholly compensatory
 Necessary when one cannot engage in self-care actions (Gonzalo,
2011)
 Patient is dependent on the nurse to accomplish patient’s therapeutic
self-care (Gonzalo, 2011)
Partly compensatory
 Necessary when one is unable to engage in some but not all self-care
activities (Gonzalo, 2011)
 Nurse and patient work together to meet patient’s self-care needs
(Gonzalo, 2011)
Supportive-educative
 Necessary when one needs to learn to perform self-care activities but
needs assistance to do so (Gonzalo, 2011)
 Patient provides essential self-care and the nurse supports/educates
patient in development of self-care (Gonzalo, 2011)
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HOW DOES THIS THEORY RELATE TO NURSING
PRACTICE??
Self-Care Deficit Theory is a grand nursing theory, therefore “covers a broad scope with general
concepts that can be applied to all instances of nursing” (“Dorothea Orem”, n.d.).
This theory can easily be utilized in Emergency Nursing by applying the categories of basic
conditioning factors to improve patient outcomes after discharge.
Basic conditioning factors include:
 Age/developmental state (“Self care deficit”, n.d.)
 Families of origin or marriage (Green, 2013)
 Locate individuals in their worlds and relate to conditions and circumstances of living (Green, 2013)
 Socio-cultural orientation
 Available resources
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HOW DOES THIS THEORY RELATE TO NURSING
PRACTICE??
 This theory has great correlation when exploring nursing and patient relationships in a chronic health
care setting. When nurses are in a long term care situation they develop and can successfully make an
assessment on what that patient is capable of physically and cognitively.
 It is important to remember that taking the time to encourage the patient to become proactive in their care
will have great benefits and promote:

A sense of health and well-being
 Ownership of self-care
 Independence and responsibility
 Empowering the patient to call in their own refills on medications and requesting prescriptions when
needed gives the patient a sense of importance and control of a sometimes uncertain situation.
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HOW DOES THIS THEORY RELATE TO NURSING
PRACTICE??
Orem’s Theory in an Outpatient Setting
Applying Orem’s Theory in the Outpatient setting can be done in several steps, for example:
Placement of a mediport/portacath
 Assessment patients’ understanding of procedure
 Develop a plan of education and include additional assistance if required.
 Implement teaching and assistance if needed and establish that the education has been properly received
Dorothea Orem's self care theory relates to practice in outpatient hemodialysis clinics because we provide care to
End Stage Renal Disease patients. These patients must make considerable lifestyle changes which include dietary,
fluid restrictions, medication regimen, and vascular access care. As a dialysis nurse, we assist these patients by
providing education and strategies to encourage their self-care. When we receive a patient who is new to dialysis
a self-deficit occurs because they lack the knowledge for proper self-care.
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REFERENCES
Black, B. (2014). Professional Nursing: Concepts & Challenges (7th ed). St. Louis, MI:
Elsevier Inc.
Dorothea Orem's Self-Care Theory. (n.d.). Retrieved October 12, 2016, from
http://currentnursing.com/nursing_theory/self_care_deficit_theory.html
Dorothea Orem - Nursing Theorist. (n.d.). Retrieved October 09, 2016, from
http://www.nursing-theory.org/nursing-theorists/Dorothea-E-Orem.php
Gonzalo, A. (2011). The Self-Care Deficit Nursing Theory. Retrieved from:
http://nursingtheories.weebly.com/dorothea-e-orem.html.
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REFERENCES
Green, R., (2013). Application of the self care deficit nursing theory: The community
context. Self-Care, Dependent-Care, & Nursing 20(1), 5-15.
Self Care Deficit Theory. (n.d.). Retrieved October 09, 2016, from
http://www.nursing-theory.org/theories-and-models/orem-self-care-deficittheory.php
Wayne, G. (2014). Dorothea Orem - Self Care Nursing Theory - Nurseslabs.
Retrieved October 13, 2016, from http://nurseslabs.com/dorothea-orems-self-caretheory
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