Dorthea Orem NURSING CARE DEFICIT

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Nursing theories: Nursing Care Deficit

Melissa S. Kumm

NUR 410: Professional Roles, Ethical Issues, and Nursing Theories

Concordia University

Nursing theories: Nursing Care Deficit

Dorothea Orem was born in Baltimore, Maryland in 1914 (Masters, 2013). She earned her diploma in nursing in the 1930’s and a BSN in nursing education in 1946. She attended college at the Catholic University for America. She worked in many different fields of nursing including: pediatrics, adult medical and surgical units, emergency rooms, operating rooms and private duty nursing (Masters, 2013). Orem also worked in different levels of nursing in these fields, which included consultant, director, professor, theorist and author.

Orem worked on her nursing theory from the start of her nursing career and continued to refine it throughout the different stages of her nursing profession. Her theory was first introduced in 1956. In 1959 she introduced the basic ideas of the self-care theory. Orem’s first book was published in 1971. It was titled Nursing: Concepts of Practice. She introduced the three theories to her self-care deficit in 1985. In 1968 Dorothea retired from nursing and ultimately passed away in 2007 (Masters, 2013).

The Self-care deficit nursing theory that Orem developed is one of the most commonly used theories in the nursing field. Her theory originally began as a definition of nursing concern and goals as part of her teachings. This original definition included “man’s need for self-care action and the provision and management of it on a continuous basis in order to sustain life and health, recover from disease or injury, and cope with their effects (Masters, 2013, P. 180).”

Orem describes her theory as a general theory. There are three steps in Orem’s theory. First a nurse must determine why a patient needs care; next they must develop an approach as to how to provide that care and lastly implementing the plan of care. Her theory is compromised of three theories thatinclude the self-care deficit, nursing systems, and self care. Each theory focuses on the different relations we face in the nursing field. According to Masters the theory of self-care focuses on the patient, the self-care deficit theory focuses on the nurse to patient relations and the nursing system focuses on the people in the community. Each of these intertwines to make up her self-care deficit nursing theory.

The self-care theory is defined as how people care for themselves and states that nursing is required when a patient is unable to provide such care. As stated by Masters this theory is made up of three concepts including self-care agency, therapeutic self-care and basic conditioning factors.

The self-care agency is how a person grows and develops the basics needs to provide self-care to ones self. This is used to promote human functioning and development. This can be broken down into three different elements: Development, operability and adequacy. The first two can be described as a person’s ability to perform self-care tasks efficiently and consistently. Adequacy is the number and kinds of tasks one can perform to meet the self-care needs.

The therapeutic self-care demand is the care that is needed to meet an individual’s needs. Some examples of this would include: airway, water, nutrition etc. The basics of daily living needed to survive.

Basic conditioning factors are the things that affects ones ability to perform the self-care tasks. These would include: age, gender, developmental state, health state, pattern of living, healthcare system factors, family system factors, sociocultural factors, availability of resources, and external environmental factors (Masters, 2013).

There is the Universal self-care that is the basic needs of every individual. Such needs would include breathing, intake of water and food, elimination of waste etc. These are the basic needs of life. Developmental self-care requisites are the major life changes in one life that leads to ones development of self-care activities. A health-deviation self-care requisite is when people obtain the help that they need when they need it to maintain and gain the health they need (Masters, 2013).

Theory of self-care deficit is how an adult learns to care on one self and how thus person can be helped through the nursing process. As stated in Masters nurses use five methods to meet the self-care needs of patients. Including: acting for or doing for another, guiding and directing, providing physical and psychological support, providing and maintaining an environment that supports personal development and teaching.

Nursing systems theory is the relationships that a nurse must have to promote the end product of a patient as defined by the nurse and patient in the development of the plan of care. There are three different systems that a nurse can use to obtain this goal. The wholly compensatory system is when a patient is unable to perform any self-care activities and relies directly on the nurse. In the partially compensatory system is when a patient is able to perform some tasks of self-care and relies on the nurse for the remainder. This is until the patient has obtained the proficiency to be able to perform the task themselves and takes on more tasks. Supportive-educative system is when a patient is able to perform the tasks themselves but needs the education to do so as stated by Masters.

As a patient moves through the nursing theory the nurse must continually revise the plan of care for thus individual to help promote the level of care that they need. An example of this would be in the rehabilitation field. Initially out of surgery a patient requires many tasks to be performed by the nurse. These may include transferring if they are non-weight bearing. Educating on medications, dressing changes etc. As the patient progresses and heals they are able to perform more of these tasks themselves and at the end of their stay will need supportive-education to be able to return to their previous living conditions.

There are four metaparadigm described in Orem’s nursing theory. According to Masters these concepts are person, environment, health and nursing. Orem describes these as being interrelated to each other. These interrelate by what makes up the person. This would include a person’s environment and how it influences their beliefs on healthcare, health history, past experiences with nursing, education and much more.

Person as described by Orem is the individual under nursing care. The person is viewed biologically, symbolically and socially but still as a whole person (Masters, 2013). This person is considered to be able to provide self-care. Environment is the physical, chemical, biologic and social factors that make up who a person is. Also, included would be environmental factors, elements, conditions and development (Masters, 2013). This influences a patients needs as related to healthcare. Health as defined by Orem as “a state characterized by soundness or wholeness of developed human structures and of bodily and mental functioning (Masters, 2013, p. 185).” This is view is interrelated with a patients environment. Nursing is how a healthcare professional develops a plan of care to meet the patient’s self-care needs as described in Orem’s definitions of the wholly compensatory, partly compensatory and supportive-educative system as described earlier in this paper. All of these interrelate to how a nurse is going to develop a plan of care for the patient based on the patients background and a patients self-care needs and education needs (Masters, 2013).

Orem’s self-care is made up of both explicit and implicit assumptions. The explicit assumptions include: nursing is deliberate, purposeful helping service. A person must be willing to perform the self-care tasks themselves or for a dependent family member. Self-care is a life necessity for health, development and well being of an individual. The education and culture and how it influences a patient. Self-care is learned through interactions and communications.

Implicit assumptions states that people need to be self-reliant and responsible for their own health as well as anybody who is dependent upon them i.e. children. People are individuals who have developed from many different aspects in their life. Some examples of this would include environment, culture, education and much more (Masters, 2013).

For the structure of the model Dorothea describes how nurses must be able form a relationship with physicians, patients, family members as well as other healthcare providers as stated by Masters. This is why nurses must possess great communications skills. By building these relationships a nurse is able to incorporate others into the patient’s care as well as learn more background about the patient. This allows the nurse to better understand where the patient is coming from to better formulate a plan of care for thus patient.

Expanding upon the relationships that a nurse must have to provide care can further generate this nursing model. It could expand on how a nurse develops those relationships and maintains them. A nurse must be able to prove that they are knowledgeable enough to provide the care a patient needs and be able to prove that they are willing to help as starters to building a relationship.

The nursing theory is written simple and precisely to make it easy to understand. It is also described in depth to make it easier to use in the nursing field. It is useful in a wide variety of situations in the nursing practice. Orem’s theory allows for organization of previous knowledge and the generation of new knowledge (Masters, 2013).

The first stage in utilizing Orem’s nursing theory is for the nurse to develop a relationship with that of the patient. This is known as the diagnostic operations phase, or looking into what the patient needs to determine the social significance to the patient. From this relationship the two must work together towards social utilization by identifying current and potential self-care demands and developing a plan of care to achieve these goals to achieve social congruence. Known as the prescriptive operations phase. The regulatory operations phase is putting the plan that has been formulated into action. Last is the control operations phase, which is when the nurse evaluates the course of action for appropriate outcomes for the patient and adjusts plan as needed. During these phases is when the nurse and patient achieve social utilization or happiness between the two groups (Masters, 2013).

Orem’s nursing theory can be used in many different nursing fields. In the article Beginning the Recovery Journey in Acute Psychiatric care it describes how Orem’s self-care deficit nursing theory is used in psychiatric nursing. It discusses how when a patient is in the state of mental illness a nurse must step in and provide the activities of self-care for these patients due to them not being able to do so mentally. During a state of mental unstabability a patient may lack the insight or energy to perform the activities of self-care. This is where the nurse would step in to provide this care until the patient is up to doing so again. While doing this the nurse must build a trusting relationship with the patient to be able to help educate these patients and to eventually promote them to perform these self-care acts themselves.

In the article Mitral valve prolapse and its effects. Orem’s nursing theory is used to help evaluate a patient’s current knowledge to the disease and their perspective of their health. It describes how a nurse must take both of these aspects into consideration and incorporate the patient into the development of the nursing care to help promote a relationship with thus patient. The nurse must develop a plan the helps to manage the patient’s symptoms to help to promote personal self-care by the patient. Much of Orem’s nursing theory is used in the communication/relationship between the nurse and patient to educate on ways to help manage symptoms to be able to care for oneself.

Orem’s theory of self-care is utilized in many different aspects of nursing. All patients go through stages where they need help performing the basic self-care needs. It is also very important for a patient to develop a trusting relationship with the nurse to be able to understand and accept the education that the nurse provides. Also, the relationship is important to the nurse to be able to understand where the patient is coming from such as their background or previous experiences. By having this relationship the nurse can develop a plan of care that is individualized to each patient.

In the rehabilitation field of nursing Orem’s theory of self-care is widely used. Nurses generally are only seeing their patients for a short period of time before they heal and move onto their future plans. During this time the nurse must be able to form a relationship with the patient, family, physician and other healthcare providers. Through each of these relationships they must be able to then formulate a plan of care based on a patients needs, their plans for the future, past history etc. When the patient is first out of surgery they rely on the nurse to perform more activities of self-care. In this process the patient may begin in the wholly compensatory system and progress through the partially compensatory system to eventually end in the supportive-educative system.

The wholly compensatory system is where the patient relies on the nurse to perform self-care activities as stated by Masters. In rehab this might include helping the patient to the bathroom, transferring. If they have just had shoulder surgery helping them brush their hair, dressing changes, etc.

In the partially compensatory system the patient is also participating in the self-care activities. The patient slowly takes on more and more tasks as they begin to heal. An example of this is when the patient begins to have more weight bearing status they begin to take some of the workload off of the nurse as they become stronger with their transfers as they strive for independence. Also, as their shoulder begins to heal after surgery they may begin to be able to brush their own hair etc.

With the supportive-educative system the patient is able to perform the self-care tasks they just need help with the decision-making process, and knowledge (Masters, 2013). This may include teaching a patient about dressing changes or about how to control blood glucose in a newly diagnosed diabetic. The goal is to educate the patient to be able to perform the self-care activities to be able to return to independence or move to long-term care as needed.

Even though the nurse may only work with a patient for a short period of time in rehab the relationship the nurse forms has to be a trusting one for the patient to be able to trust thus nurse and look to them for support. The nurse is often providing a great deal of education on how to perform self-care to these patients to help promote self-care. This may be how to provide self-care following a stroke with right-sided weakness. This patient must learn everything again especially if they were right-handed. Thus patient must learn how to perform these tasks with their left side. A trusting relationship will help the patient to better accept the teaching that the nurse is providing to them. This in turn helps the healing process occur faster.

When the patient is first admitted to the rehab setting the nurse must first go through the diagnostic operations phase and develop a relationship with the patient and other members of the team as well as the family. They must then proceed to assess the patient for what kind of care they require and how much care is required.

The nurse then moves onto the prescriptive operations phase and begins to develop a plan of care based upon the individual’s personal needs. Nurses need to include the patient in this plan of care to see what they feel is most important and where they eventually want to be in the end or what their goals are. The nurse then prioritizes the self-care needs of the patients.

Regulatory operations phase is the implementation of the plan of care as determined by the patient and nurse. This is the plan of care in action. With the nurse and patient working towards the final product as determined in the plan of care.

Control operations phase in rehab is when the plan of care is evaluated for its effectiveness as according the Masters. The nurse must adjust the plan of care based upon how the patient is performing self-care needs, and how they are progressing through the plan of care.

In conclusion This paper has described the nursing theorist Dorothea Orem’s background as well as how she developed her nursing theory, and continued to change and implement her nursing theory. The breakdown of her nursing theory is described and how they all intertwine to make up the self-care deficit nursing theory. This would include the steps to build a plan of care. The different stages a patient goes through as they progress towards their ultimate goal. It describes how a nurse builds a relationship with patients and other members of the team to develop a plan of care to promote the self-care for a patient. Examples of the self-care nursing theory are used to help show how this theory is used in the field of nursing. Also, how a patient progresses through the phases and how the nurse helps the patient through theses steps towards the goal that was laid out by the nurse patient relationship.