The Nursing Theory of Dorothea Orem - Research Paper Example

? The Nursing Theory of Dorothea Orem Dorothea Orem was a prominent nursing theorist who significantly contributed to the nursing professionby developing a theory of nursing known as Orem Model of Nursing. Orem got the idea to develop her theory through her work as a nursing consultant. When she observed nurses in various hospitals, she found that while they generally were able to perform their job functions, they could not articulate the true purpose of nursing. Orem’s intention was to determine an appropriate focus for the profession that centered on individual patients. This theory was significant in the sense that it provided nurses with a clearer focus on what the profession entailed: helping those who were unable to help themselves due to their health conditions. This paper will give a biographical account of Dorothea Orem’s life and provide a complete description of the Orem Model of Nursing including the Self-Care Deficit Theory. The paper will include examples of how the theory can be applied in various medical settings. It will also discuss the contributions, value and relevancy of her theory. The Nursing Theory of Dorothea Orem Dorothea Orem was a nursing theorist who developed the Orem Model of Nursing also known as the Self-Care Nursing Theory. Orem's nursing theory states that caring for oneself is a basic human need. The duty of nurses is to design interventions to provide or manage self-care actions for individuals to recover or maintain health (Taylor, p. 74). Orem was one of the first theorists to realize that nursing is needed when humans are unable to care for themselves. She felt that “nursing is distinguished from other forms of care by the way it focuses on human beings” (Fawcett, 2001, p. 35). Through this theory Orem made a profound contribution to the development of professional nursing by establishing the philosophical basis for collaborative nursing care that integrates the strengths and disabilities of patients as well as knowledge of the nursing process. The Orem Model of Nursing is currently in use throughout various medical settings. Dorothea Orem was born in 1914 in Baltimore Maryland. Orem graduated from Seton High School in Baltimore in 1931. She then graduated from the Providence Hospital School of Nursing in Washington, D.C. in 1934 and went on to the Catholic University of America to earn a Bachelor of Science in Nursing Education in 1939 and a Master of Science in Nursing Education in 1945 (“Dorothea Orem,” n.d.). Orem’s first jobs were at Providence Hospital, Washington, D.C. and St. John's Hospital in Lowell, Massachusetts. Some of the positions she held included operating room nurse, private nursing, hospital staff nursing in pediatric and adult medical –surgical units and evening emergency room supervisor. In 1945 she began to focus her career on nursing education. She worked as the director of Providence Hospital School of Nursing in Detroit and continued this phase of her career at the Catholic University of America where she worked as an Assistant Professor, Associate Professor, and Dean of Nursing. In 1949 she left Detroit and moved to Indiana where she found a position as a consultant in the Division of Hospital and Institutional Services of the Indiana State Board of Health. During her tenure there she intended to raise the standard of nursing in hospitals throughout the state (“Biography of Dorothea Orem,” n.d.). Between 1949 and 1957 Orem was able to closely observe nurses and their work as a result of her position with the Indiana State Board of Health. As a result of her observations she began to realize that nursing required a certain way of thinking as well as a certain way of communicating (Fawcett, 2001). In attempting to develop nursing as a meaningful profession, Orem asked herself three questions: “(1) What do nurses do and what should nurses do as practitioners of nursing? (2) Why do nurses do what they do? and (3) What results from what nurses do as practitioners of nursing?” (Fawcett, 2001, p. 34) She concluded that nursing was needed when people can no longer be independent due to a specific health condition. “The nurse’s role was to assist the client with self-care practices and maximize self-care abilities” (Clark, 1986, p. 127). These conclusions would result in the eventual development of the Self-Care Deficit Theory of Nursing. In 1957 Orem accepted a position as curriculum consultant at the Office of Education and Welfare in Washington D.C. While she was there she worked on a project to help improve training for nurses (“Biography of Dororthea Orem,” n.d.). In 1959 she began working on the Self-Care Deficit Theory while beginning work as an assistant professor of Nursing Education. Also in 1959 Orem published the book “Guidelines for Developing Curricula for Education of Practical Nurses “In 1970 she began a consulting company. The following year Orem published “Nursing: Concepts of Practice” where she first wrote about her theory. This book would be revised several more times until 2001 as she revised her ideas. In 1976 Orem was presented with an Honorary Doctorate of Science from Georgetown University. Four years later Incarnate Wood College would also give her an Honorary Doctorate of Science. Two other universities would present Orem with honorary doctorates. Orem died in 2007 (“Biography of Dorothea Orem,” n.d.). One major assumption of the Orem Model of Nursing is that people learn to become self-reliant at a young age and as they go through life they teach others self- reliance. “Orem’s theory is based on the premise that people have the innate ability, right, and responsibility to care for them. It reflects a concept of human development that maturation is accompanied by self-reliance, a desire to be self-directing and encourage others to be so” (Clark, 1986, p. 127). The Orem Model of Nursing consists of the theory of self-care, the theory of self-care deficit and the theory of nursing systems. Orem’s Self-Care Deficit Theory is the main component of the Orem model. It determines the situations when nurses need to care for patients. A nurse may become an absolute caretaker for patients by performing tasks that they are incapable of accomplishing themselves. She may also support the patient and/or the patient’s family members by helping the patient and other caregivers meet self-care needs. A nurse would also teach the caregivers of the patient to foster an environment that would enable the patient to regain greater independence (Keefe, n.d.). The theory of self-care provides general guidelines for patients to attain perfect health. The theory of nursing systems explains how patients would be able to care for themselves with or without the assistance of the nurse (Keefe, n.d). “Three systems exist within the Orem model of nursing: the compensatory system, in which the nurse provides complete care; the partial compensatory system, in which the nurse and patient each take responsibility for care and the educative development system in which the patient has the primary responsibility for personal health with the nurse acting as a consultant” (Denara, 2010, p. 29). According to the Self-Care Deficit Nursing theory individuals want to become and remain self-sufficient throughout their lives. They have a “continuing demand for engagement in self-care, in care of self; the constituent action components of the demand together are named for therapeutic self-care demand” (Fawcett, 2001, p. 35). The theory of self-care explains this demand. Generally individuals are believed to have the ability to know how and when they need to take care of themselves. Nurses are needed when individuals are completely or partially unable to care for themselves due to specific health issues (Denara, 2010). This theory of nursing proposed by Orem views nursing as an interpersonal process meant to help people that need it. In this instance the term deficit does not refer to a limitation but a relationship between an individual’s abilities and a need for action. The nurse determines the deficit and provides the appropriate support for his/her caregivers. Other assumptions of the theory are: “Successfully meeting universal and developmental self-care requisites is an important part of primary care prevention and ill health; a person’s knowledge of potential problems is needed for promoting self-care behaviors; self-care and dependent care are behaviors learned within a socio-cultural context” (“Self-Care Deficit Theory,” n.d.). Nurses need to be aware of patient’s needs for self-care, of the extent to which individual patients are capable of taking care of themselves and determine whether or not the patient will be capable of taking care of him/herself. The results of nursing care relates to the reasons why patients need it and contribute to the well-being, health and life of patients (Denara, 2010). Orem’s theory of self-care includes activities or practices that are initiated by individuals to maintain their own wellbeing, health and life. It is influenced by life’s experience in socio-cultural conditions with the state in age development and available resources in health orientation (Taylor, 2011). When people are able to take care of themselves well they are able to maintain human and structural functioning and contribute to further development. It also includes the Therapeutic self-care demand is the “"totality of self care actions to be performed for some duration in order to meet self care requisites by using valid methods and related sets of operations and actions" (“Self-Care Theory”, n.d). They are measures, necessary at specific times or over a duration of time for meeting an individual’s self-care requisites by using appropriate methods and related sets of operations and actions. Therefore, the therapeutic self-care demand is based on what is done intentionally by members of society, which may benefit themselves or others (George, 2002). The fundamental purpose of Orem’s Model is to view the patient as a whole, use nursing expertise to help him/her get better and maintain optimal health. “Nursing is required when individual’s developed and operational powers and capabilities to meet their own therapeutic self-care demands in whole or in part are not adequate because of health state or health related conditions” (Fawcett, 2001, p. 35). When the Self-Care Deficit Theory is applied to nursing practice, it could identify what the patient would need to in order to learn to care for him/her. Through the application of this theory the patient is likely to receive the most inclusive nursing care. The way that this nursing theory is applied in patient management would show how a specific method of nursing assistance and the selected nursing system could be used to identify the patient’s self-care deficit (Denara, 2010). Nurses identify the self-care deficits of the patient through the process of patient assessment. “Once the deficit is identified the nurse needs to select the required nursing system in order to provide wholly compensatory care, partly compensatory care or supportive educative nursing system care” (Denara, 2010, p. 29). The type of care that would be provided would depend upon the patient’s condition and how capable the patient is of caring for him/herself. When a certain level of care is provided nursing tasks and use of certain nursing systems need to be evaluated to make sure that mutually planned goals are likely to be met (Denara, 2010). The following is an example of how the Self-Care Deficit Nursing theory may be applied: A 56 year female housewife (Mrs. C) seeks treatment from a hospital complaining of joint stiffness and pain that starts off severely and declines with continued activity. Previously she sought treatment from another hospital for the same symptoms but it failed. Mrs. C has been diagnosed with rheumatoid arthritis. She can function fairly well but has poor posture which may worsen symptoms. She is also malnourished. According to the Self-Care Deficit Theory, the woman’s basic conditioning factors would need to be first assessed. This information includes age, gender, health state, sociocultural status, education and marital status (Denara, 2010). Medical personnel would then assess self-care requisites which fall into three categories: 1. Universal – life processes and the maintenance of general structure and function of the human body. 2. Developmental-includes human growth and the different stages of the life cycle. 3. Health Deviation-when medical measures in the health care system are used to diagnose and correct a situation (“Self-Care Theory”). This would entail the identification of strengths and deficits that Mrs.C has in terms of determining a course of treatment. Some of her strengths are that she breathes normally, she is properly hydrated, regularly takes her medication, and she has positive family and social relationships. Mrs.C is likely to be encouraged by family and friends to continue to seek treatment. Some of her deficits include her malnourishment, her lack of awareness on how to prevent hazards and while she takes her medication when needed she is unaware of potential side effects. She is also unaware of the disease process. Mrs. C’s developmental self-care requisites include what she has adapted to her limited mobility and can feed herself, but she is not as able to groom and dress herself. She requires assistance for these things. Based on this information and Orem’s theory some areas that need to be addressed through treatment are: elimination, prevention of hazards, food and awareness of disease process (Denara, 2010). Orem’s self-care deficit theory is commonly used in home health nursing where the goal is to help patients become more self-sufficient in their homes. For example, “the self-care deficit of bathing/hygiene is used for a patient who is unable to bathe him/herself” (Keefe, n.d). In rehabilitation facilities patients are encouraged to be more independent because they are going from being treated by doctors and nurses for chronic illness or physical disability to relearning how to care for themselves in their homes. The Self-Care Deficit Nursing Theory can be used to prepare patients for greater independence once they are released from the facility. For example patients who are being treated for kidney disease are commonly encouraged to help themselves with regard to their own care. They participate in the decisions regarding their treatment, they are required to adhere to dialysis and medicines used to treat their kidney disease, and must stick to a strict diet and fluid consumption. This is likely to help patients cope with the disease and required treatments and nurses can help patients by encouraging them. “Because Orem’s theory describes self-care as a learned behavior and nurses believe self-care will improve patient’s well-being, nurses can help patients control the impact kidney disease has on their lives” (Graham, 2006). The first four categories of self-care requisites are relevant to the patients who are coping with and seeking treatment for kidney disease because they are likely to motivate patients to adhere to dietary and fluid consumption adjustments, compliance with medication and renal replacement therapies because patients know doing that will improve their health status. These categories are: “1. Seeking and securing medical help. 2) Being aware of and attending to effects of pathological conditions. 3) Effectively carrying out prescribed measures with respect to regulating or preventing pathological processes. 4) Compensating for disabilities and being aware or tending to discomfort” (Graham, 2006). Orem’s Model of Nursing is an all encompassing approach to the nursing profession that can easily be adapted to clinical practice, educational practice, and administrative and research settings. The theory may also be used in various aspects of patient care including assessment, nursing diagnosis, planning, implementation and evaluation (Keefe, n.d.). For example, surgical nurses may apply the theory when they provide therapeutic interventions by giving them proper assistance or guiding them to meet their needs as they recover from major surgery. The model enables nurses in all fields to determine the most effective way to help their patients recover from their specific ailment or injury. In conclusion, the Orem Model of Nursing made an impact on nursing in the sense that it integrated the doctor’s, nursing and the patients’ viewpoints in health condition with the main purpose of being able to help patient care for themselves in order for them to stay healthy or improve their health should they get injured or develop a disease. Orem was one of the first theorists to realize that the profession of nursing had as much to do with individuals as it does with medical processes. It was due to her dedication to the nursing profession that nurses can use her theory to care for patients and help them achieve optimum health and greater self-sufficiency. References Clark, M. (1986). Application of Orem's theory of self-care: A case study. Journal of Community Health Nursing, 3(3). Retrieved March 20, 2012 from http://www.jstor.org/discover/10.2307/3427521?uid=3739832&uid=2&uid=4&uid=3739256&sid=47698783645177 Delara, R. (2010). Dorothea Orem and her self-care theory. Test Print, 1(2). Retrieved March 20, 2012 from http://issuu.com/russeldelara/docs/testprint02_dorotheaorem/29#share Fawcett, J. (2001). The nurse theorists: 21st-century updates – Dorothea E. Orem. Nursing Science Quarterly, 14(1), 34-38. George, J.B. (2002). Nursing theories: The base for professional nursing practice. Upper Saddle River: Pearson Education Inc. Graham, J. (2006). Nursing theory & clinical practice: How 3 nursing models can be incorporated into the care of patients with end stage kidney disease. CANNT Journal, Volume 1. Retrieved March 21, 2012 from http://www.thefreelibrary.com/Nursing+theory+and+clinical+practice%3A+how+three+nursing+models+can+be...-a0156720128 Keefe, S. Orem's theory of nursing. (n.d). Retrieved March 19, 2012 from Ehow Web Site: www.ehow.com/about_5478995_orems-theory-nursing.html Taylor, C., Lillis, C., LeMone, P., & Lynn, P. (2011). Fundamentals of nursing (p. 74). Philadelphia: Wolters Kluwer Health Inc. Biography of Dorothea Orem. (n.d). Retrieved March 19, 2012 from Nursing Theories Web Site: www.nursingtheories.info/biography-of-dorothea-orem/ Dorthea Orem. (n.d.). Retrieved March 19, 2012 from Nursing Theory Web Site: http://nursing-theory.org/nursing-theorists/Dorothea-E-Orem.php Orem's self-care deficit theory. (n.d). Retrieved March 21, 2012 from Nursing Theory Web Site: http://nursing-theory.org/theories-and-models/orem-self-care-deficit-theory.php Dorothea Orem's self-care theory. (n.d). Retrieved March 23, 2012 from Nursing Theories Web Site: http://currentnursing.com/nursing_theory/self_care_deficit_theory.html Read More