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G ATHERING I NFORMATION Nurse gathers basic conditioning factors through review of the chart, report from ED and interaction with the patient. Basic Conditioning Factors Mr. Smith is a 38 year old male, married with two children ages 12 and 10. Wife, children and extended family are all supportive. Occupation is a builder and he owns his own company. Enjoys hunting and fishing as hobbies and is a self proclaimed workaholic. Physically in good shape but has not seen a doctor in over 5 years. Admits to being frustrated because he is unable to work.

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S ELF -C ARE R EQUISITES Using the self care requisites Universal, Developmental and Health Deviation the nurse determines where there is a deficit and then is able to focus her/his care. The mode of helping chosen by the nurse is the partly compensatory nursing system.

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S ELF -C ARE D EFICITS The nurse identifies the following self care deficits: Breathing is shallow due to pain Bed Rest required due to pain and injuries Needs assistance with ambulation Needs assistance with ADLs Needs support due to Mr. Smith having difficulty coping with limitations Needs education about injuries and medication regimen

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N URSING S YSTEMS To address these deficits the nurse: Assesses Mr. Smiths pain level regularly and medicates prn Helps Mr. Smith with frequent position changes to promote comfort level in bed Provides support with ambulation Provides assistance with ADLs Encourages verbalization of feelings and provides therapeutic listening. Provide education about injuries and explain medications and possible side effects

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I NDEPENDENCE The nurse also identifies areas of self care that Mr. Smith can perform on his own: Nurse to keep items for ADLs in easy reach for Mr. Smith Encourage him to help set goals for the day and also encourage his input with the plan of care Enlist help of Mr. Smiths wife to bring items from home to promote feeling of productivity in Mr. Smith. Examples: magazines, lap top, paperwork from business

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C ONCEPTS U NIQUE TO O REM S M ODEL Depth of Content Orem clearly labeled nursing participants. She rejected the term client and preferred the term patient. Orem clearly described the environment by environmental features Orem described the health state as a factor that may impose new or different demands for self- care on the person (Fawcett, 2005, p. 250).

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U NIQUE C ONCEPTS Orem distinguished nursing from physicians by stating that physicians focus on what has been interrupted by the injury or illness where nurses focus what the patient needs for continuing care The nurses focus goes beyond the physicians focus to encompass: the patients perspective of his or her own health situation (Fawcett, 2005, p. 242) the physicians perspective of the patients health situation (Fawcett, p. 242) the patients state of health (Fawcett, p. 242) the health results sought for the patient, which may be life, normal or near normal functioning, or effective living despite disability (Fawcett, p. 242) the therapeutic self-care demand emanating from universal, developmental, and health-deviation self-care requites (Fawcett, p. 242) the patients present abilities to engage in self-care and his or her health-related disabilities in giving self-care (Fawcett, p. 242)

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U NIQUE C ONCEPTS Orems theories can interrelate to provide a view in nursing that is unique Orems theory follows a logical thought process (George, 1995, p. 118) Orems theory is used in nursing education and nursing practice. It is easily understood and can be applied to all individuals, patients or be applied to multiple patients Orems theory has been used to generate testable hypotheses in a variety of settings (George, p. 118) Orems theory is used by many nurse researchers, and it focuses on the art of helping Orems theory is used by many nurses in a multitude of settings Orems theory is consistent with role theory, need theory, field theory, and health promotion concepts (George, p. 118)

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S TRENGTHS OF O REM S T HEORY Orems Self Care Framework has made a great contribution to nursing knowledge Orem defines the person wholly as it is related to nursing Very clear on who receives nursing care legitimately Deductive reasoning is used throughout her work Provides a focus from nursing actions that is different from other health care professionals (Fawcett, 2005, p.293) Its explicit focus on what matters to nurses and how that focus helps nurses to retain a nursing perspective in the multidisciplinary milieu of health care (Fawcett, p. 293).

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S TRENGTHS Orems theory defines exactly when nursing is needed: Nursing is needed when the individual cannot maintain continuously that amount and quality of self-care necessary to sustain life and health, recover from disease or injury, or cope with their effects (George, 1995, p. 120).

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O REM S THEORY COMES FROM A CLINICAL BASE. Orem states that, in working on the components of [her] theory [she] needs to work with other people utilizing data from clinicians (Trench, Wallace, & Coberg, 1988). Provides a comprehensive base for nursing practice It can be used by many different areas of nursing such as education, administration, research clinical practice and nursing information systems (George, 1995, p. 120).

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O REM S THEORY COMES FROM A CLINICAL BASE. It can be applicable for the beginning practitioner all the way to the advanced clinician The terms self-care, nursing systems, and self-care deficit are understood by the new nursing student, and can be explored in greater detail as the nurse becomes more experienced. (George, 1995, p. 120).

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L IMITATIONS OF O REM S T HEORY Orems theory is clouded by ancillary descriptions The term self-care is used many different ways Self-care agency, self-care demand, self-care premise, self- care deficit, self-care requisites, and universal self-care Orems discussion on health is very limited Her model suggests three static conditions of health Orems suggest that physical movement is a major determining factor in placement of her system Discusses very little about the patients emotional needs (George, 1995, p.120-121)

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R ESEARCH Orems first publication was in 1971. Working with colleagues, her final edition was released in 2001. Orem Study Group was created from 2000-2004 which focused on learning the complexity of nursing diagnoses based on the Self-Care Deficit Nursing Theory (Bekel, Renpenning, Banfield, Flues, & Hohdorf, 2004).

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C URRENT R ESEARCH In 1993 the International Orem Society for Nursing Science and Scholarship (IOS) was created. The purpose of the IOS is to advance nursing science and scholarship through the use of Dorothea E. Orems nursing conceptualizations in nursing education, practice, and research (Alligood, 2010, p. 276) The 11th World Congress Self-Care Deficit Nursing Theory will be held from November 5-7, 2010 in Bangkok, Thailand (www.scdnt.com)

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C URRENT R ESEARCH Orems framework can be used as a guide for nursing research Some researchers base their research on her beliefs or definitions in the model Others will use her concepts, but grow with others theorist ideas (Hartweg, 1991, p. 39).

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C URRENT R ESEARCH Currently many employers are focused on disease prevention and health promotion (Healthy People 2010). Orems self-care deficit nursing theory is particularly valuable for examining disease prevention and health promotion because of its emphasis on individual responsibility for both activities and on nursing assistance when deficits in self-care occur (Moore & Pichler, 2000, p. 137)

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E DUCATION Orems theory has been a guide to nursing curricula at the associate degree and baccalaureate degree level. Many schools utilize Orems nursing process in clinical practice, developing extensive assessment tools, teaching packets, and evaluation models (Hartweg, 1991, p.38). The University of Tennessee-Chattanoogas School of Nursing organized its philosophy and structure within Dorothea Orems Self-Care Deficit Nursing Theory (UTC, 2010). The Universitys definition of person, environment, health, and nursing is based on Orems terminology.

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A NALYSIS OF O VERALL M ODEL Orem focuses on nursing as a helping art that assists an individual to meet self-care needs. It is within this model that helps a nurse determine the deficits and actions needed (by the nurse) in order to restore the patients independence. Orems theory can also be used by nurses in a variety of settings. Her work related nursing as a practical science and identified three practice sciences and three nursing sciences. These sciences that Orem identified offer a structure for the organization of existing nursing knowledge, and new knowledge(Alligood, 2010, p. 278).

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N EW I NSIGHTS Considering the limitations in Dorothea Orems model, an emotional/mental deficit should also be added which would further treat the patient as a whole. Orems theory could also be enhanced by the incorporation of ancillary staff (Dietitian, Occupational Therapy, Social Worker) to help the patient achieve maximal independence.

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On June 22, 2007, Dorothea Orem passed away at her residence on Skidaway Island, Georgia (Alligood, 2010, p. 266).

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R EFERENCES Alligood, M. R., & Tomey, A. M. (2010). Nursing theorists and their work. Maryland Heights, Missouri: Mosby Elsevier. Bekel, G, Renpenning, K, Banfield, B, Flues, I, & Hohdorf, M. (2004). Learning the complexity of nursing diagnosis based on scdnt through a computer-based training program. Retrieved from http://docs.google.com/viewer?a=v&q=cache:SYbgZxIem8EJ :www.scdnt- conferences.com/download/day3/Plenary_9_Bekel.pdf Current Nursing (2010, February 14). Nursing theories. Retrieved from http://currentnursing.com/nursing_theory/ DeLane, S. C., & Ladner P. K., (2002) Fundamentals of nursing: standards & practice, Albany, NY: Thompson Delmar Learning.

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R EFERENCES Fawcett, J. (2005). Contemporary Nursing Knowledge: Analysis and Evaluation of Nursing Models and Theories (2 nd ed.). Philadelphia, PA: F. A. Davis Company. George, J. B. (1995). Nursing Theories: The Base for Professional Nursing Practice (4 th ed.). East Norwalk, CT: Appleton & Lange. Hartweg, D. L. (1991). Dorothea Orem: Self-Care Deficit Theory. Newbury Park, Ca: Sage Publications. Moore, J, & Pichler, V. (2000). Measurement of orem's basic conditioning factors: A review of published research. Nursing Science Quarterly, 2 (13), 137-142. doi: 10.1177/08943180022107573 Santrock, J. W., (2009). Child Development. (12 th ed.). New York, NY: McGraw-Hill University of Tennessee (2010). University of Tennessee Chattanooga School of Nursing Philosophy, Retrieved from http://www.utc.edu/Academic/Nursing/philosophy.php