Statement of the Problem

SELF-CARE DEFICIT THEORY OF NURSINGBY DOROTHEA ELIZABETH OREM

Born: 1914Died: June 22, 2007

Dorothea Orems self-care deficit theory, a general theory of nursing, isone of the mostwidely used models in nursing today. It addresses the clients self-care needs. It is defined as goal oriented activities that are set towards generating interest in the part of the client to maintain life and health development. This theory is aimed towards making the clients perform self-care activities in order to live independently.

In her theory, Orem defines the four concepts that constitute nursings metaparadigm, ashuman beings, environment, health, and nursing.

Person: An individual with physical and emotional requirements for development of self and maintenance of their well-being.

Environment: Clients surroundings which may affect their ability to perform their self-care activities.

Health: Structural and functional soundness and wholeness of the individual

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.

Orems Self-Care Deficit Theory

A Conceptual Framework for Nursing

Dorothea Orems Self-Care Deficit Theory: Each person has a need for self care in order to maintain optimal health and wellness and each possesses the ability and responsibility to care for themselves anddependants.The model is separated into three conceptual theories which include: self care, self caredeficit and nursing system.

Self-Care

Self care is the ability to perform activities and meet personal needs with the goal of maintaining health andwellness of mind, body and spirit. It is a learned behaviour influenced by the metaparadigm of person, environment, health and nursing. It is a human regulatory function that is based on individuals capabilities of performing their own care.Nurses candraw from their own experiences that there is a relationship among self-care, self-care agency and therapeutic demand and when a client is unable to perform his own self-care, a self- care deficit exists and the nurse performs the tasks the patient is unable to do for him/herself.

Self-Care Agency

Self-Care Agency refers to: (1) power inherent in human capabilities essential fordeliberate action, (2) a self-care action repertoire, and (3) relationship between 1 and 2. The theory of self-care expressesthe purpose of taking care of self, referred to as the self-carerequisites;the how of taking care of self,referred to as the self-care agency; and theoutcome of these , known as the self-care practices for self-care system.Self-Care Limitationincludes the following: (1) actual, defined as absences of an essential action or system of action from the repertoire; (2) predicted, of the human absence or restriction of one or more human capabilities for engagement in deliberate action; and (3) positive/negative, the temporary or permanent or relatively permanent effect of the value of a capability on an individual action repertoire.

Self-Care Demand

Therapeutic self-care demand represents the totality of action required to meet a set ofself-care requirements using a set of technologies. These include the interventions and teachings designed to return a person to orsustain a level of optimal health and well being. Examples can include such things as toilet training a child or learning healthy eating.

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

Developmental Self - Care Needs - 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.

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 benefitsfrom 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. There are two different terms relating to self-care deficit. The first isactual self-care deficit, definedas a descriptive statement of the relationship between the therapeutic self-care demand and self-care system in which the actions specified by the therapeutic self-care demand and present or absent from the self-care system. Secondly, there is thepotential self-caredeficit, a descriptive statement of the relationship between the therapeutic self-care demand and predicted self-care limitations.

Nursing agencyis the name for the human power and action repertoire associated withnursing practice. Nursingsystems theory suggests that nursing systems form when nurses prescribe, design, and provide nursing that regulates the individuals self-care capabilities and meets therapeutic self-care requirements

Nursing Systemsrefers to the ability of the nurse toaid the person in meeting current and potential self care demands.This focuses on the person.There are three support modalities identified in this theory and the clients ability for self care involvement will determine under which support modality theywould be considered.

Three support modalities of the nursing systems:

(1)Wholly compensatory systems- required for individuals who are unable to controland monitor their environment and process information;(2)Partly compensatory systems- designed for individuals who are unable to perform some (but not all) self-care activities; and3)Supportive-educative (developmental) systems- designed for persons who need to learn toperform self-care activities (Kozier et al, 1998, p.39).

Orem's Self-Care Deficit Theory: Theoretical AssertionsBy Rachelle Dogao

Dorothea Orem's Self Care Deficit Theory encompasses all aspect relating to the patient's health, nursing and all the factors that affect which.

The concepts discussed revolve mainly around self care. It is the patient's ability to care for himself and his dependents as well as others as dictated by the environment he lives in that determines health or the need for assistance in maintaining health. On the other hand, the society plays the major role into regulating the nursing care process as to when nursing care is needed and when and how the nursing system is implemented. It is also the environment andthe society that directly affect the nurse-patient relationship and self care agency, which are all interconnected into achieving, restoring, and maintaining health.

As shown in the figure below, health can be achieved if the person has knowledge and resources to perform self care activities to meet self care deficits. On the other side, self care deficit results when self care agency (ability to perform self-care) is not adequate to meet the known self care demand and/or the failure to meet the health care requisites (Kozier et.al, 2002) This then warrants the need for nursing intervention through the nursing system, which in turn is empowered by the nurse-patient relationship. The end result of all of this is the maintenance, restoration, or preservationof health.

Five major assumptions of Orems general theory of nursing are as follows:

(1) Human beings require continuous deliberate inputs to themselves and their environments to remain alive and functions in accord with natural human endowments.

(2) Human agency, the power to act deliberately, is exercised in the form of care of self and others in identifying needs for and in making needed inputs.

(3) Mature human beings experience privations in the form of limitations or action in care of self and others involving and making of life sustaining and functioning- regulating inputs.

(4) Human agency is exercised in discovering, developing, and transmitting to others ways and means to identify needs for and make inputs to self and others.

(5) Groups of human beings with structures relationships cluster tasks and allocate responsibilities for providing care to group members who experience privation for making required deliberate input to self and others

Limitations

The ambiguity of applying theoryto nursing practice may lie in the fact that one theory does not always specifically support all aspects of nursing care. Orems self care deficit theory may not encompass all aspects of care and needs of a specific client. For instance, some dilemma withOrems theory include having an unclear definition of family, the nurse-society relationship and public education areas are weak. These issues are essential in the management and treatment plan in caring for patients. Although the family, community and environment are considered in self care action, the focus is primarily on the individual (Balabagno, et.al, 2006). Another limitation is the definition of health as being dynamic and ever changing with states ranging from health or non health, wellness or illness (Fitzpatrick JJ, 2005). This definition of health directly contradicts the experience of some patients with varying needs and levels of care requirements. One of the most obvious limitations of Orems theory is that throughout her work, it can be said that a limited recognition of an individuals emotional needs is present within the theory (George JB., 1995). It focuses more on physical care and gives lesser emphasis to psychological care. Other theories address this limitation quite adequately suchas Jean Watsons Theory of Caring.

Statement of the Problem

Specifically, this study sought answers to the following queries:

1. What is the clinical profile of the client in terms of self care requisites as classified into:

Universal self care

Developmental self care, and

Health deviation self care

2. What NANDA approved nursing diagnosis are formulated for the identified self care requisites.

3. What nursing interventions are instituted for the client in addressing the identified self carerequisites under the following basic nursing systems:

3.1 Wholly compensatory3.2 Partly compensatory3.3 Supportive-educative system

4. What are the clients rehabilitation system.

5. What theory based rehabilitation program can be proposed based on the finding?

Case study: Universal

The maintenance of balance between activity and rest

With poor cellular glucose utilization and the concurrent infectious process, the client had been experiencing fatigue and generalized body weakness. He has the capabilities of performing activities of daily living such as feeding, hygiene and grooming, and eliminating; however easily gets tired and fainted. In addition, his ambulation was affected by his inability to effectively bear weight on his affected foot, whichprompted assistance from staff and significant others.

Self Care Requisites Assessment in a Client with Poorly Controlled Type 2 DM and Left Diabetic Foot Ulcer

Dorothea Elizabeth OremsSelf Care Model

Universal

Developmental

HealthDeviation

Therapeutic Self Care Demands > Self Care Agency

Medical and Surgical Care

Self Care Deficits

Nursing Process- Nsg Dx (NANDA)- Planning of Nx system

Design- Wholly- Partly- Supportive Educative

Implementation

Evaluation

Independent performance of self care

Rehabilitation needs

Proposal Rehabilitation Program

Nursing Care Plan

Nursing Diagnosis

Activity Intolerance related to decrease energy resources versusincreased metabolic demands, and presence of left diabetic food ulcer.

Self limitations

Limitation of the knowing

Limitation for making judgment ad decision

Limitations for engagement in result achieving courses of action

Self-care Deficit

PartialCompleted

Planning

Goal: To demonstrate an increase tolerance to activity.

Objective: The client will be able to exhibit physiologic tolerance in performing activities of daily living such as feeding, hygiene and grooming, eliminating, positioning, moving and ambulating, and reporta reduced fatigue after 8 hours of direct nursing care.

Design of Nursing System

Partly compensatory nursing system

Implementation

Acting forMonitor Vital Signs, note responses to activity

Assess patients ability toperform normal tasks and note reports of dizziness, weakness, fatigue, and difficulty accomplishing tasks.

Maintain patency of IVF line and regulate to the prescribed rate.

Review laboratory figures, eg. Blood sugar, hemoglobin profile

GudingSupervise client in accomplishing self care activities eg. Feeding, grooming and hygiene.

Plan activities with client along with frequent rest periods to decrease energy demands.

Jointly establish good compliance to pharmocotherapeutic regimen eg. Insulin therapy to promote glucose uptake.

SupportiveAssist client in positioning, moving, eliminating as necessary, and especially in ambulating, allowing patient to do as much as possible.

Ascertain environmental safety in the performing of ADLs.

Encourage consumption ofcarbohydrates, fats and proteins based on the prescribed diet to maintain energy sources.

Providing a developmental environmentElicits clients active participation in planning energy-saving techniques, activity progression, including activities that heviews essential.

Praise clients accomplishments of simple task eg. Changing clothes independently.

Allow informed choices and decisions in compliance to therapeutic regimen.

Entertain and address clients concern honestly and realistically at his level ofmaturity.

TeachingDemonstrate to significant others techniques of assisting client in ambulating, moving positioning.

Discuss at patient and SOs level of understanding the need to refer such as shortness of breath, dizziness, increased fatigue andweakness.

Explain the purpose of the nursing care measures carried out.

Evaluation

The client exhibited an improved performance of ADL such as feeding, hygiene and grooming, eliminating, positioning, moving and ambulating, and reported a reduced level of fatigue. Even then, guidance and assistance most constantly be provided because he is unable to bear weight effectively in the affected foot.

He demonstrated improved cognitive effectively and psychomotor abilities to improve his activity of intolerance.

Hence, the partly compensatory nursing system was partially effective in meeting his self care need.

Bibliography:

http://upoun207tfn.blogspot.com/

http://www.slideshare.net/jben501/dorothea-orem-theory