Dorothea E Orem's Self-Care Deficit Nursing Theory The discipline of nursing uses theory in a variety of health care settings

to determine the quality of patients would receive to achieve a desired outcome. In this research paper, I will seek to present significant information about Orem's Self-Care Deficit Nursing Theory and its Application to nursing. The overall purpose of Orem's theory is not just to view the person as a whole, but to utilize nursing knowledge to restore and maintain the patient's optimal health. This research paper will present a basic background of the theorist and the key concepts that Orem used to establish the conceptual framework of Self-Care Deficit Theory. Dorothea E. Orem, MSNed, DSc. RM was born in 1914 in Baltimore, Maryland. She began her nursing education at Providence Hospital School of Nursing in Washington, DC. After receiving her diploma in the early 1930s, she earned her nursing education in 1945 from the Catholic University of America. According to Hartweg (1991), the original ideas for the model developed while Orem served as a nurse consultant with the Indiana State Board of Health between 1949 and 1957. As she traveled around the state, she became more aware of the ability of nurses to do nursing, but their inability to talk about nursing. After observation and questioning, she summarized her initial ideas about nursing in and Indiana State Board Health report (p.4). The concepts of the theory were further developed and in 1959, while Orem was a consultant to the office of Education, Department of Health, Education, and Welfare; she participated in a project to improve the practical (vocational) nursing program. During this time, Orem was searching for a pragmatic framework to organize nursing knowledge. She focused on the questions, "What is nursing?" and "When do people need nursing care? From these two questions, Orem conceptualized that people need nursing care when they are unable to care for themselves. In 1971, she presented the Self-Care Deficit Theory of Nursing

(SCDTN) in the book Nursing Concepts of Practice and has continually revised and updated her theory (DeLaune, Ladner 2002, p. 34). Orem's Self-Care Deficit Theory of Nursing is a grand theory, which is comprised of three interrelated theories: 1) the theory of self-care, (2) the self-care deficit theory, and (3) the theory of nursing systems. Incorporated within these three theories are six central concepts and one peripheral concept. Having a thorough understanding of these central concepts of self-care, self-care agency, therapeutic self-care demand, self-care deficit, nursing agency, and nursing system, as well as the peripheral concept of basic conditioning factors, is essential to understanding her general theory (George, 1995, p. 100) Orem's theory of self-care takes into consideration several other concepts, namely self-care, self-care agency, basic conditioning factors, and therapeutic self-care demand. According to George (1995), Orem defined self-care as the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health and well-being. When self-care is effectively performed, it helps to maintain structural integrity and human functioning, and it contributes to human development (p.101). To provide a more clear understanding to the self-care theory, Orem believed that human's has the ability or power to engage in self-care, this concept is know as Self-care agency. The individual's ability to engage in self-care is affected by basic conditioning factors namely age, gender, developmental state, health state, sociocultural orientation, family system factors,... resource adequacy and availability (George, 1995). According to Orem, basic conditioning factors are conditions or events in a time-place matrix that affect the value of person's ability to care for themselves. It is important to note that the influence of the basic conditioning factors on the self-care agency is not assumed to be operative at all times (Parker, 2005, p.150).

Within the theory of self-care, Orem identified three categories of self-care requisites: universal self-care requisites, developmental self-care requisites, and health-deviation self-care requisites. Universal self-care requisites are common to all human beings and include physiological and social interaction needs. For example, the sufficient intake of water, air, food and the maintenance of balance in all area of one's life. Developmental self-care requisites are the needs that arise as the individual grows and develops. This is has to do with more specific events in an individual's life, e.g. adjusting to the loss of a job, or adjusting to the birth of a newborn. Health-deviation self-care requisites result from the needs produced by disease or illness (DeLaune, Ladner 2002, p. 34). The theory of self-care deficit is the core of Orem's grand theory of nursing because it 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 (George 1995). The term "deficit" refers to a particular relationship between self-care agency and self-care demand that is said to exist when capabilities for engaging in self-care are less than the demand for self-care (Parker, 2005, p. 149). The nursing system designed by the nurse is based on the self-care needs and abilities of the patient to perform self-care activities. If there is a self-care deficit between what the individual can do and what needs to be done to maintain optimum functioning, then nursing care is needed. In the theory of nursing systems, the client's self-care needs will be met by the nurse, the client, or together. Orem has identified three classifications of nursing systems to meet the self-care requisites of the patient. These systems are the wholly compensatory, the partly compensatory system, and the supportive-educative system (George, 1995, p. 104). In the whole compensatory system as nurse provides complete universal and health function for the patient. An example in which this type of nursing system would be evident is when a patient is in a coma. In this situation,

the patient's ability to make proper judgments regarding the maintenance optimum health is very much impaired. The nurse needs to use critical thinking to in depth knowledge to anticipate and meet the needs of this kind of patient. Partly compensatory is the nursing system in which the both the nurse and the patient contributes to meeting the self-care needs of the patient. For example, A patient who have suffer from a CVA or a stroke, from which he or she may had become paralyzed on one side of his or her body. For this, patient, he or she may be able to do certain things for his or her self, but not completely. The supportive-educative system is the nursing system in which the persons is able to perform or can and should learn to perform required measures externally and internally oriented therapeutic self-care about cannot do so without assistance. In this nursing system, the primary role of the nurse is to teach and to provide educational support to the patient. For example, patients that are diabetic are able to meet all their basic self-care needs; however, they would require teaching as to what foods need to be eaten to maintain blood glucose level. Additionally, if insulin needs to be injected, the nurse will have to teach the patient how to give self-injections, the amount to draw in to the syringe, where on his or her body the insulin shot needs to be injected, and how to properly dispose of used needles. One of Orem's focuses was to diffuse the theory into nursing in a variety of settings. The comprehensive development of the self-care concepts enhances the usefulness of the Self-care Deficit Nursing theory as a guide to nursing practice situations involving individuals across the life span that are experiencing health or illness, and to nurse-client situations aimed at health promotion, health restoration, or health maintenance (Parker, 2005, p. 149). When planning and providing nursing care, according to Orem, the ultimate goal care Self-care theory is to enable the patient to achieve optimum health and to maintain that health status once it has been accomplished. The concept of self-

care agency In order for the nurse to effectively provide nursing care with Orem's theory, he or she needs to understand the various concepts of theory, and how to use it in conjunction with the nursing process. According to George (1995), Orem defined the nursing process as follows: "Nursing process is a term used by nurses to refer to the professional-technologic operations of nursing practice and to associated planning and evaluative operations" (p.108) Orem's Self-Care Deficit Theory can be utilized for Mr. Smith's case study. The first step is to obtain a detailed assessment and collect data about the patient's self-care agency and his self-care demand. The purpose of data collection is to determine a relationship between the self-care demands and Mr. Smith's ability to meet all of his self-care needs prior to his new diagnosis of Type II Diabetes and Obesity. Smith's basic conditioning factors were provided as 50yrs African American male, store manager, and married with four children. His universal self-care demands: smokes 1 pack per day, lack exercise, likes to eat fried foods and High cholesterol of 250, do not exercise, high blood sugar levels of 220, takes OTC medications for pain, no annual checkups and only seek medical help when needed. Mr. Smith worked 40-65 hours per week had a strong and supportive family, wife worked part time , with four children from age 8 -18, and a 18 year old going to college, the developmental self-care requisites noted and identified. He is in the developmental stage of generativity, which is displayed through a sense of accomplishment in providing for his family, and rearing children. In the case of Mr. Smith, his health deviation: potential to develop heart disease due to high cholesterol, and obesity and other complications due to high glucose levels Self-care deficits: The difference between Mr. Smith's knowledge and life style that increased risks for myocardial infarction or neuropathy and other physiological complications due to diabetes. Nursing diagnosis bases on self-care deficits are: Potential for cardiovascular impaired function related to lack of

knowledge and current lifestyle. The goal and plan of care: Mr. Smith will reduce cholesterol and blood sugar levels. In Mr. Smith's case, to effectively plan his care, the nurse needs to take into consideration the underlining concepts of the Self-Care Theory which are selfcare agency, factor conditions and the self-care requite category of Health Deviation Self-care. Mr. Smith is a self-care agency because he has the power to engage in his own self-care. The nurse needs to take into consideration the conditioning factors namely his age, cholesterol and blood sugar levels, inactive lifestyle, overweight, which are the main contributors to his health condition. The deficit in Mr. Smith's health is his inability to properly manage is weight and dietery intake which is one of the main causes of his diabetes and high cholesterol. Lack knowledge of the effects cholesterol on body systems and the relieving benefits of exercises The power of the nurse to design and produce nursing care for others is the critical power that is operative in nursing. The human power with its constituent capabilities and disposition is named the nursing agency. The centrality of the nursing agency as exercised by nurses in producing nursing care is made clear in the Nursing Development Conference Group's concept of nursing system (Parker, 2005, p. 143). The nursing system concept of wholly compensatory would not be applicable. Whole compensatory would only be used in cases where patients are unable to care for themselves, e.g. Newborns or an unconscious patient. Although the concept of partly compensatory involves both the nurse and the patient to meet particular needs, it would not be applicable in Mr. Smith's case. Partly compensatory would only be useful if Mr. Smith had pancreatic surgery, then the nurse would assist Mr. Smith with ambulation or range of motion. The most applicable nursing system in Mr. Smith's case is the supportive-educative system.

This is where the nurse focus on teaching the patient about various foods that will enhance is health and well-being. Provide outpatient resource for client to get follow treatment. The nurse will now have the opportunity to teach Mr. Smith how to use the glucose monitor to test his blood sugar levels on his own and how often. In conclusion, all the concepts are related in that, the patients is view holistically and not separate from his environment. Orem's Theory of Self-Care Deficit, takes into consideration the power or the abilities of both the nurse and the patient to restore, promote and maintain physical and physiological wholeness. The regardless of the health condition of patient, basic nursing knowledge and careful observation can significant health improvement patients. The utilization of theory in nursing increases the recognition of nursing as a discipline and rewarding profession. Annotated Bibliography DeLane. Sue. C., and Ladner P. K., (2002) Fundamentals of Nursing: Standards & Practice Albany, NY Thompson Delmar Learning (p.34) This book provides a detailed summary of basic concepts that Orem used to establish the Self-Care Deficit Theory. Basic examples were used to further clarify the meaning of certain concepts used in Orem's Theory. Foster, P.C., & Caine, R.M. (1995) Self-Care Deficit Nursing Theory: Dorothea E. Orem. In J.B. George (4th Edition) Nursing theories the base for professional nursing practice (pp. 100-150). Upper Saddle River, New Jersey: Prentice Hall.

In this book, the author used significant information to provide a clear understanding of Orem's personal and educational background. The key concepts of the Self-Care Deficit Theory was broken down step-by-step so that the reader could have a good ideas of what each of the concepts mean in relation to practicing nursing Hartweg., Donna (1991) Dorothea Orem: Self-Care Deficit Nursing Theory Newbury London, Sage Publications Inc. (p.4) The information presented in this book is practically readable and easily understood. The author provided a clear understanding of Orem's theory and how it was conceptualized. Parker, Marilyn E. (2005) Nursing Theories and Nursing Practice Philadephia F.A. Davis Company (p.149) This information presented in this books was quite interesting. The author incorporated detailed information about Dorothea E. Orem and other Nursing theorist. On a scale of 1-10, I would give this book a 8.

Self-care deficit nursing theory

From Wikipedia, the free encyclopedia Contents [hide]

1 Central philosophy 2 Self-care requisites 3 Self-care deficits 4 Support modalities 5 Universal Self-Care Requisites (SCRs) 6 Example nursing assessment 7 References

The self-care deficit nursing theory is a middle range nursing theory that was developed between 1959 and 2001 by Dorothea Orem. It is also known as the Orem model of nursing. It is particularly used in rehabilitation and primary care settings where the patient is encouraged to be asindependent as possible.

[edit]Central

philosophy

The nursing theory is based upon the philosophy that all "patients wish to care for themselves". They can recover more quickly and holistically if they are allowed to perform their own self-cares to the best of their ability.

[edit]Self-care

requisites

Self-care requisites are groups of needs or requirements that Orem identified. They are classified as either:

Universal self-care requisites - those needs that all people have Developmental self-care requisites - 1. maturational: progress toward higher level of maturation. 2. situational: prevention of deleterious effects related to development.

Health deviation requisites - those needs that arise as a result of a patient's condition

[edit]Self-care

deficits

When an individual is very unable to meet their own self-care requisites, a "self-care deficit" occurs. It is the job of the Registered Nurse to determine these deficits, and define a support modality.

[edit]Support

modalities

Nurses are encouraged to rate their patient's dependencies or each of the self-care deficits on the following scale:

Total Compensation

Partial Compensation Educative/Supportive

[edit]Universal

Self-Care Requisites (SCRs)

The Universal self-care requisites that all or health are:

Air Water Food Elimination Activity and Rest Solitude and Social Interaction Hazard Prevention Promotion of Normality

The nurse is encouraged to assign a support modality to each of the self-care requisites.

[edit]Example

nursing assessment

This patient is entirely fictitious and any likeness to any person, alive or dead, is purely coincidental. 'J' is a 50-year-old male who has just been diagnosed with type-two diabetes mellitus. He has a history of hypertension, and is a chronic smoker, smoking around 30 cigarettes daily.

AIR: Educative/Supportive - Provide education on the risks associated with smoking particularly for the diabetic patient.

WATER: Educative/Supportive - Ensure access to adequate hydration - risk of polydipsia due to hyperglycaemia.

FOOD: Partial Compensation - Education and provision of a diet that is suitable for his new diagnosis of diabetes, blood sugar monitoring after meals.

ELIMINATION: Educative/Supportive - May require monitoring. ACTIVITY AND REST: Educative/Supportive - Educate patient as to the benefits of cardiovascular exercise, especially for the diabetic

SOLITUDE AND SOCIAL INTERACTION: Partial Compensation - Nurses may provide social interaction as hospital admission will cause change is social behavior and interactions.

HAZARD PREVENTION: Partial Compensation - Nurses will need to educate regarding the medication that he may be taking, and administer this medication initially. Particularly relevant if J is taking insulin injections.

PROMOTE NORMALITY: Partial Compensation - Nurses will need to facilitate a return to normal lifestyle. This will involve advocating for the patient in a multi-disciplinary team, in order to achieve a medication regime that will fit with the patient's life.

The Self-Care Deficit Theory developed as a result of Dorothea E. Orem working toward her goal of improving the quality of nursing in general hospitals in her state. The model interrelates concepts in such a way as to create a different way of looking at a particular phenomenon. The theory is relatively simple, but generalizable to apply to a wide variety of patients. It can be used by nurses to guide and improve practice, but it must be consistent with other validated theories, laws and principles. The major assumptions of Orem's Self-Care Deficit Theory are:

People should be self-reliant, and responsible for their care, as well as others in their family who need care. People are distinct individuals. Nursing is a form of action. It is an interaction between two or more people. Successfully meeting universal and development self-care requisites is an important component of primary care prevention and ill health. A person's knowledge of potential health problems is needed for promoting self-care behaviors. Self-care and dependent care are behaviors learned within a socio-cultural context.

Orem's theory is comprised of three related parts: theory of self-care; theory of self-care deficit; and theory of nursing system. The theory of self-care includes self-care, which is the practice of activities that an individual initiates and performs on his or her own behalf to maintain life, health, and well-being; self-care agency, which is a human ability that is "the ability for engaging in self-care," conditioned by age, developmental state, life experience, socio-cultural orientation, health, and available resources; therapeutic self-care demand, which is the total self-care actions to be performed over a specific duration to meet self-care requisites by using valid methods and related sets of operations and actions; and self-care requisites, which include the

categories of universal, developmental, and health deviation self-care requisites. Universal self-care requisites are associated with life processes, as well as the maintenance of the integrity of human structure and functioning. Orem identifies these requisites, also called activities of daily living, or ADLs, as:
1. 2. 3. 4. 5. the maintenance of sufficient intake of air, food, and water provision of care associated with the elimination process a balance between activities and rest, as well as between solitude and social interaction the prevention of hazards to human life and well-being the promotion of human functioning

Dorothea Orem: Self-Care Deficit Theory UPOU Orems Supporters

The systematic accumulation of knowledge is essential to progress in any profession. However, theory and practice must be constantly interactive. Theory without practice is empty and practice without theory is blind (Cross,1981). Among the client-centered theory available to the nursing profession and students, with the exception of Florence Nightingales theory, Dorothea Orems Theory of SelfCare Deficit is probably one of the best known, easily understood and most applied in the clinical setting. While most of us would recognize the Self-Care Deficit Theory as Orems sole contribution to the development of nursing, she is in fact the author of three, namely: the Self-Care Theory, the Theory of Self-Care Deficit and the Theory of Nursing Systems. All three theories are related to one another. They espouse the idea that individual clients have the function, capability and knowledge to maintain health and well-being by taking care of themselves. Whenever imbalances, disability and illness occur, the individual client would seek the aid of the nurse who possesses the knowledge, skills and ability to help him/her recover. Alligood & Tomey (2006), stated that" Highly regarded for its usefulness in all aspects of nursing, Orem's Self Care Model continues to be the organizing frame work of many nurse researchers, educators, administrators and providers of client care". Its popularity and practicability can be seen by the different nursing bodies' interest in Orem's model and even the nurses interested in it, have formed an International Orem's Society for nursing science and scholarship (Alligood &Tomey,2006). This organization has worked a lot on Orem's work and utilizing Orem's theory in clinical practice, in nursing research and education.

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Dorothea Orem

Dorothea Elizabeth Orem was born in Baltimore, Maryland on 1914. She received her diploma certificate at the Providence School of Nursing, Washington DC on the early 1930s. She pursued further studies and received both her Bachelor of Science in Nursing Degree on 1939, and her Master of Science in Nursing Education degree on 1945 from the Catholic University of America, Washington DC. During her professional career, she worked as a staff nurse , private duty nurse ,nurse educator and administrator and nurse consultant. Later on, she attained her honorary doctorates as Doctor of Science from Georgetown University on 1976 and from Incarnate Word College, San Antonio Texas on 1980; Doctor of Humane Letters from the Illinois Wesleyan University at Bloomington, Illinois on 1988; and Doctor Honoris Causae from the University of Missouri-Columbia on 1998. One of foremost nursing theorists, Orem made

several contributions for the development and improvement of nursing education and practice.

She began to develop foundations for the self-care deficit theory of nursing when she accepted the position as Director of Nursing Service and Director of Nursing Education at Providence Hospital in Detroit on 1945. Later on, when she was working with the Division of Hospital and Institutional Services of the Indiana State Board of Health as a nursing consultant from 1949-1957, she encountered more issues regarding the lack of a substantive and structured body of nursing knowledge. During this time, she made her definition of nursing practice with clear statements of the inherent distinction between the practice of nursing and medicine. Orem returned to Washington DC and worked with the Office of Education, Vocational Section of the Technical Division, where there was an ongoing project to upgrade practical nurse training.

Orem returned to the Catholic University of America School of Nursing in 1959. and became the acting dean of the school of Nursing and as an assistant professor of nursing education. She continued to develop her theory. She published her second book entitled Nursing Concepts of Practice in 1971 after completing her work on the Nursing Model Committee of the School of Nursing of the Catholic University of America. Then she left the university and started her own consulting firm called Orem and Shields Inc. at Chevy Chase, Maryland. Orem received the Catholic University of America Alumni Association Award for Nursing Theory in 1980. The second edition of Nursing: Concept of Practice was published in 1980. Orem retired in 1984 but continued to work on the third edition which was published in 1985. The fourth edition of her book was completed in 1991. (Anonuevo et al, 2000)

A Glimpse of Orems Accomplishments and Contributions:

Dorothea Orem as a member of a curriculum subcommittee at Catholic University recognized the need to continue in developing a conceptualization of nursing.

Orems Nursing: Concept of Practice was first published in 1971 and subsequently in 1980, 1985, 1991, 1995, and 2001.

Nursing: Concepts of Practice was the original publication of the conceptual framework (Orem, 1971)

1949-1957 Orem worked for the Division of Hospital and Institutional Services of the Indiana State Board of Health. Her objective was to improve the quality of nursing in general hospitals and she was able develop the definition of nursing by this time

1958-1960 she help publish "Guidelines for Developing Curricula for the Education of Practical Nurses" in 1959.

Washington D.C. in 1957, Orem further developed her ideas, first as a consultant in the Office of Education where her task was to improve the nursing component of a vocational nursing curriculum.

 Orems ideas were further formalized after her participation in the Nursing Development Conference Group (NDCG), the two were committed to the development of structured nursing knowledge and to nursing as a practice discipline (Hartweg, 1995)

Continues to develop her theory after her retirement in 1984

Dr. Orem continues to be active in theory development. She completed the 6th edition of Nursing: Concepts of Practice, published by Mosby in January 2001.

Self-Care Deficit Theory

Definition of Nursing

The provision of self-care which is therapeutic in sustaining life and health, in recovering from disease or injury, or coping with their effects. A service to people, not a derivative of medicine. Nursing promotes the goal of patient self-care.

Orems General Theory of Nursing (3 related theories collectively referred to as Orems General Theory of Nursing)

1. Self-care Theory: three types of self-care requisites (needs) or categories based on the concepts of:

a. SELF-CARE - comprises those activities performed independently by an individual to promote and maintain personal well-being throughout life.

b. SELF-CARE AGENCY - the individuals ability to perform self-care activities. Consists of TWO agents:

b1. Self-care Agent - person who provides the self-care b2. Dependent Care Agent - person other than the individual who provides the care (such as a parent)

c. SELF-CARE REQUISITES

- the actions or measures used to provide self-care. Consists of THREE categories:

c1. Universal - requisites/needs that are common to all individuals c2. Developmental - needs resulting from maturation or develop due to a condition or event c3. Health Deviation - needs resulting from illness, injury & disease or its treatment

d. THERAPEUTIC SELF-CARE DEMAND - Therapeutic self-care demand represents the totality of action required to meet a set of self-care requirements using a set of technologies (McLaughlin-Renpenning, & Taylor, 2002, p.175)

2. Self-Care Deficit Theory

Five Methods of Assistance

- is the central focus of Orems Grand Theory of Nursing - explains when nursing is needed - describes and explains how people can be helped through nursing - results when the Self-care Agency (patient) cant meet her/his self-care needs or administer self-care - nursing meets these self-care needs through five methods of help

Five Methods of Nursing Help

-Acting or doing for -Guiding -Teaching -Supporting -Providing an environment to promote the patients ability to meet current or future demands

3. Nursing Systems Theory

- Describes nursing responsibilities, roles of the nurse and patient, rationales for the nurse-patient relationship, and types of actions needed to meet the patients demands - Refers to a series of actions a nurse takes to meet a patients self-care needs, is determined by the patients self-care needs, is composed of THREE systems: Wholly compensatory Partly compensatory Supportive-educative

Major Concepts

I. Major Concepts

A. Person

A self-reliant, integrated whole who has the capacity to reflect and use symbols. Human beings are distinguished from other Human beings are distinguished from other Reflect upon themselves and their environment Symbolize what they experience Use symbolic creations (ideas, words) in thinking, communicating, and guiding efforts to make things that are beneficial for themselves and/or for others

 A total being with rational powers, universal and developmental needs, and has the capacity to do self-care and care for the wellbeing of his dependents. A unit functioning biologically, symbolically and socially. May also be a nursing client a human being who has health-related or health-derived limitations that render him incapable of continuous selfcare or dependent care or limitations that result in ineffective or incomplete care (http://currentnursing.com). The focus of nursing when self-care requisites exceed self-care capabilities. The recipient of nursing care A being who functions biologically, symbolically, and socially Is subject to the forces of nature Can engage in deliberate actions, interpret experiences, and perform beneficial actions

B. Health

It is a state of wholeness. It is the responsibility of a society. It is when a person is functionally and structurally whole or sound. It entails operating in conjunction with physiological and psychophysiological mechanisms and a material structure and in relation to and interacting with other persons. Supports health promotion and health maintenance

 Supports the premises of holistic health in that both RN and patient promote the individual responsibility for self care

C. Nursing

It is an art, a community service and a technology. Actions that are deliberately selected and performed by nurses to help individuals or groups under their care to maintain or improve conditions in themselves and/or in their environments. A service geared towards helping the self and others Is required when selfcare demands exceed a patients self care ability (agency) Promotes the patient as a self care agent

ROLE THEORY: the role of the nurse & patient are complementary as they work together to achieve self care Giving of direct assistance to person(s) unable to meet self-care needs. As an art: has ability to assist others in the design, provision and management of systems of self-care to improve or maintain effective human functioning. As a technology: has formalized methods of practice, clearly described ways of performing actions so that a certain result will be achieved.

SPECIAL TECHNOLOGIES:

Interpersonal technologies- communicating, coordinating, establishing & maintaining therapeutic relations, rendering assistance

Regulatory technologies- maintaining and promoting life processes, growth/development, and psycho physiologic modes of functioning

SEVERAL COMPONENTS:

NURSING ART- the theoretical base of nursing and other disciplines such as sciences, art, humanities

NURSING PRUDENCE- the quality that enables the nurse to seek advice in new make correct judgments, to decide to act in a particular or difficult situations, to manner, and/or to act

NURSING SERVICE- a helping service

NURSING AGENCY- the ability of the RN

D. Environment

Components: environmental factors, environmental elements, conditions and developmental environment Together with man, it is an integrated system. Environmental conditions conducive to development:

1. Opportunities to be helped by being with other people where care is offered. 2. Available opportunities for solitude and companionship 3. Provision of help for personal and group concerns without limiting individual decisions and personal pursuits 4. Shared respect, belief and trust 5. Recognition and fostering of developmental potential

Developmental Environment- promotion of personal development through motivation to establish appropriate goals & to adjust behavior to meet those goals Can positively or negatively impact a personality to provide self care

Key Concepts

A. Theory of Self-care- It is a practice of activities that individuals usually perform on their own to maintain life, health and/or wellbeing.

3 Categories of Self-care:

Universal Self-care Requisites (common to all human beings)

1. sufficient intake of air 2. sufficient intake of water 3. sufficient intake of food 4. satisfactory eliminative functions 5. activity balance with rest 6. time spent alone balances with time spent with others 7. prevention of danger to self 8. being normal

Developmental Self-care Requisites (either a specialized expressions of universal self-care requisites specific for developmental processes, or a new requisite derived from conditions like pregnancy or loss)

Health Deviation Self-care Requisites (additional demands for self-care by an individual with illness, disease or injury)

B. Theory of Self-care Deficit

Critical constituent of Orems theory Qualitative or quantitative inadequacy of the self-care agency as related to therapeutic self-care demand Self-care deficit exists when therapeutic self-care demand cannot be met entirely by self-care agent

C. Theory of Nursing Systems

Approaches nurses use to assist patients with self-care deficits due to a condition of health

1. Wholly compensatory patient does not play an active role in the performance of his care. It is the nurse that acts for the patient. 2. Partly compensatory nurse and patient perform care measures requiring manipulative tasks or ambulation. 3. Supportive-Educative System patient can perform or learn to perform required measures of therapeutic self-care but cannot do it without assistance. The nurses role may be consultative only.

Orems Nursing Process

Step 1: determine why a patient needs care Step 2: design a nursing system &; plan the delivery of care Step 3: management of nursing systems - planning, initiating, & controlling nursing actions

A look at Orems theory of SelfCare Deficit

Many people are capable of carrying out the actions and routines required of nurses but it takes critical thinking and education to be able to be a professional nurse, fulfilling obligations to aid individuals towards health or the maintenance of well-being. To successfully perform as a nurse one must have a foundation of theory rooted in their philosophy that drives their actions. Without the driving force of theory in their practice nurses may lack motivation and goal attainment. Some nurses may occasionally stumble upon a goal but those nurses who have a strong sense of self and a clear direction of practice often yield more positive patient outcomes. That is why it is so crucial for future nursing to be able to identify their own philosophy of nursing and have a grounded understanding of nursing theory by which they practice. My own development of philosophy was able to progress after identifying with Orems Self-Care Deficit Theory of Nursing (SCDNT). Orems theory explains how individuals practice self-care in order to maintain health and identifies the need for nursing care only when there are deficits inhibiting an individual from conducting self-care fully. Orems theory puts the responsibility of care in the hands of the patient. The relationship between the patient and nurse is facilitated thru education, teaching, and support in a beneficial environment, which is maintained by the nurse. The main idea is that individuals are affected from

time to time by limitations that inhibit their ability to meet their self-care needs (Hartwig, 1991) Today Orem is recognized as one of the top-nursing theorist, actively refining her theory, which has now gained worldwide attention (Johnson & Webber, 2010), while numerous colleges and schools of nursing have adopted SCDNT in their curricula (McEwen & Wills, 2007). Orems grand theory explains the inter-relationship between persons, health, and environment. The theory is independent of time and space and is therefore applicable to numerous situations in numerous environments. As a grand theorist Orem recognizes the four metaparadigm concepts of nursing discipline. Those four concepts include; the nurse, health, environment, and person. Orems theory of self-care deficit and how she describes the meta-paradigm of nursing is synonymous with my own views of the nursing as a discipline. SCDNT focuses on the person (the physical, psychological, and environmental aspects of the person). In Orems theory concept of person is defined as an individual with physical and emotional needs that are required for the development and maintenance of the persons health defined as the degree of wellness experience by the individual . In SCDNT the environment is considered to be surroundings that an individual places himself or herself in. The external environment, elements of which the surroundings of the person is consisting of, has a direct effect of the internal environment of the individual. Maintenance of the internal environment to produce a structurally sound and functioning individual is considered the health state of a person. Health is a state that encompasses both the health of individuals and of groups, human health is the ability to reflect on ones self, to symbolize experience, and to communicate with others (McEwen & Wills, 2007) Wellness is achieved when the wholeness of the individual is in harmony, which is when all parts of the individual are working together in harmony. The nurse is the professionally trained individual who has the knowledge and skills to help a person deal with inadequacies that interfere with self-care. The processes Orem illustrates that a nurse uses to help the patient meet their self-care needs include: acting for or doing for another, guiding and

directing, providing physical or psychological support, providing and maintaining an environment that supports personal development and teaching. (Hartwig, 1991) Orems Theory of Self-care Deficit focuses on the ability of the person to manage and carry out self-care practices that maintain optimal health and wellness. The grand theory is composed of three theories; the theory of nursing systems, theory self-care deficits and theory of self-care. Orem explained how each human possesses the capabilities to perform these activities, leading to a healthy state of both body and mind. These learned behaviors are influenced and shaped by the four concepts of nursing: the person (their personalities, behaviors, and habits), their environment (people they surround themselves with, the quality of the air and water, and food), the nurse, and health (ability or handicaps that interfere with self-care). The theory of self-care is separated into three main components. First Orem addresses universal health care demands which include the most basic and essential aspects of self-care. Assessment of these universal selfcare requisitesidentify the degree of which the needs of the persontowards the state of optimal health are being met. Assessing the quality of air, water, food, elimination, activities of daily living (ADLs), sleep, social interactions, prevention of harm and degree of normalcy will allow a nurse to have a better understanding of the patient and the best plan of care.The universal self-care requisites the root of every individuals knowledge and capabilities of self-care. Self-care requisites (self-care needs) are the actions or measures that are used to provide self-care as opposed to self-care agency which is the individuals ability to perform self-care activities (Johnson & Webber, 2010). For instance individuals should be able to be aware of the air they are breathing, the water they are drinking, and the food they are putting into their bodies and how it will affect their state of health. Once a person has a foundation of universal self-care a nurse (or other individuals such as family) can work with the person towards meeting developmental self-care requisites. These needs include the intervention and

teaching that are required to steer the person in the path towards wellness. These teaching are designed to promote or sustain optimal health. The third aspect of self-care is health deviation self-care requisites. Health deviations result when there are qualities of unmet universal self-care requisites as a result of an illness or injury, causing difficulties for the individual to conduct self-care. Either a person has to adapt to the new circumstance and learn new ways to practice self-care or an individual can focus on those self-care activities that they are unable to attain. Self-care deficits are when a person experiences the inability to maintain self-care due to limitations of the body or mind. When a persons abilities are not sufficient to maintain their own health a nurse, or another person, will intervene and aid in their physical and psychological needs. The action of the nurse is to focus on the limitation presented by the person and implement appropriate means of aid to complete their self-care needs. Actively doing for, guiding, teaching or supporting are all methods a nurse may use depending on the severity of the persons handicap. When a nurse is using SCDNT the focus is on the individual and once a nurse classifies the individual as having self-care deficits the next step requires that the nurse determines the best means to support the individual back to health or to maintain wellness. A nurse would classify an individual in one of three support modalities, although a person can fluctuate from one to another. If an individual requires total nursing care to fulfill self-care needs, the person requires total compensatory support. Partially compensatory support is when an individual and nurse work together to achieve self-care goals. Educative-supportive compensatory modality requires that the nurse uses resources and educational tools to teach the person to perform their own self-care. Guided by the SCDNT, a nurse takes on the role of the advocate, a supporter, a teacher, and provides an environment conducive to therapeutic development. The processes used by nurses working with Orems theory of self-care deficit concentrate on assessment and implementation. During the assessment

the nurse will determine the awareness the person has concerning their own health, the ability they possess to care for self, and the motivation they have to conduct routine self-care requisites. Once a nurse has identified and diagnosed a patients strengths and deficits he or she can begin to strategize a plan of care that best fits meets that individuals self-care demands. Once a nurse has assessed, diagnosed and produced an objective outcome for the patient, he or she will begin to implement the plan of care while working together with the patient. It is during the implementation stage that requires the nurse use an appropriate nursing system. Self-care reciprocal requiring the nurse to demonstrate the importance of maintaining self-care to the patient as well as giving the patient proper explanation and demonstration of how to conduct self-care while at home and out of the health care setting. Lastly is it crucial for the nurse to provide the patient with encouragement and support during the implementation stage to avoid self doubt and sense of being overwhelmed. Once a patient has established the responsibilities of the plan of care a nurse must evaluate the success of the plan and determine if subsequent implementation is needed. For instance if a patient is not improving or not demonstrating that they are successfully meeting their universal self-care requisites a nurse may go back and adjust the plan of care; to complement the patients individual needs. Accommodating the needs of the individual patient may include more demonstrations of self-care agencies with the patient, more education on the importance of self-care, and developing a stronger support team for the patient. In October of 2009 Armer er al used Orems theory of self-care deficits in recently diagnosed post-surgery breast cancer survivors and their risk for developing lymphedema. The importance of implementing a supportiveeducative nursing system in order to reduce the risk of post-breast cancer lymphedema was recognized. Lymphedema results from a failure of the lymphconducting system to accept the lymph back into the blood circulation, resulting in the buildup of lymph in the interstitial space (Browse, Bernand, & Mortimer, 2003). Post-breast cancer survivors are particularly at risk for developing an

obstruction in the lymph due to surgery and radiation treatment (Fu, Axelrod, & Haber, 2008). In post-breast cancer survivor lymphedema can manifest as a chronic and life long condition, putting 10 million breast cancer survivors at risk for developing the lymphedema. (Armer et al. 2009) Fortunately there are selfcare activities that can reduce ones risk for developing lymphedema as well as standards of care that reduce the severity of the condition. Armer et al. examined the use of education and self-care activities and evaluated the outcomes and the degree of affectation of the self-care requisites exhibited by the subjects in the study. Self care for the prevention or reduced risk of lymphedema include (but are not limited to) avoiding weight gain and obesity, keeping affected area free from infection, and reducing the use of the hand. Disease management with selfcare include manual lymph drainage, deep breathing techniques, abdominal message and auxiliary clearance which will improve the function of the lymph. (Armer et al. 2009) The supportive-educative nursing system used in this study is consistent with Orems theory of self-care deficit. Orem as quoted in Armer, Self-care agency, which is the power to engage in self-care, develops through spontaneous process of learning. Its development is aided by intellectual curiosity, instruction, and supervision of others and by experience in performing self-care measures. Although both the researchers of this particular study and Orem would agree on the use the self-care requisites to encourage wellness of the individual Armer et al. found some holes within their process of care. During the study (from field notes, return visits, and phone call follow ups) it was discovered that many of the patients where not performing their self-care activities as had been instructed during the nursing intervention. The researchers recognized the lack of support that was being supplied to the patients and modified their research and techniques. These modifications included motivational interviewing and solution focused therapy. These modifications are methods that support Orems theory of self-care; therefore with motivation and goal attainment reinforce the ideals selfcare by making the process therapeutic for the patient. When a patient takes on

the responsibilities of self-care and understands the benefits of, as well as the risks of not fulfilling, self-care requisites the degree of satisfaction is greater. While the patient is benefiting from the fulfillment of their self-care goals physiologically, they are also benefiting from the satisfaction based on ones own achievements, which in itself can be therapeutic. The data from the study revealed that participants where having trouble with four components: 1. Ability to maintain attention and exercise requisites vigilance concerning self as self-care agent, internal and external conditions, and factors significant for self-care; 2. Ability to reason within a selfcare frame of reference; 3. Motivation; and 4. Ability to consistently perform selfcare operations, integrating them with relevant aspects of personal, family and community living (Armer et al.) The researchers went on to categorize the subjects in the study depending on their level of self-care with what they called self-care agencies. These selfcare capabilities reflect to a nurse what actions to take at a particular point in the plan of care. This continuum of self-care started with the un-developed self-care agency, where the patient lacks the discipline, motivation and knowledge to fulfill self-care needs. Un-developed self-care agency moves on to developing self-care agency where by the patient is beginning to become aware of the risk of lymphedema, is attempting the exercises to reduce risk, but does not fully understand the importance for the self-care activities. Once a person demonstrates and acknowledges the importance and routine of self-care they have reached the developed self-care agency but due to the lack of support of others this agency is not yet stabilized. Only when a person is able to illustrate self-care requisites and has the support of nurses and family can they reach the developed and stabilized self-care agency. The subjects from this particular study were scattered throughout all self-care agencies. This demonstrates that postbreast cancer survivors will experience a range of self-care capabilities in demonstrating the preventative interventions that reduce their risk of lymphedema (Armer et al.)

The study illustrates the SCDNT theory of how nurses help a patient by developing a system of support and education. The study further illustrates how integrating methods such as goal attainment and motivational instructions can be beneficial when using the SCDNT theory. This study highlights some potential problems with Orems theory. It should be acknowledged that there are differences (culture, age, gender) within the patient population that nurses work with which may affect the amount of time that would be required to fulfill sufficient educative techniques. Orems self-care deficit theory may not always be successfully implemented due to the amount of undertaking required of the nurse. SCDNT focuses on the patients self-care but relies on the relationship the nurse is able to build with the patient that results in positive communication about self-care management. Not only does a nurse take on the role of the educator and teacher but also the constant motivator and support system if needed. This can put tremendous pressure on the nurse. Nursing must be legitimate, based on the relationship between the patient and nurse that establishes a need for nursing and not some other condition, such as a medical condition (Hartwig, 2001). Orems grand theory continues to be modified and used around the world, encouraging people to take on the responsibility of their own physical health and psychological wellness. In life there are un-expectations with illness and disease causing the balance to shift from self-care abilities to self-care demands that the nurse compensates for (Johnson & Webber, 2010). As nursing students, family members, human beings, we can each do our part to promote wellness thru the use of self-care agencies and help others who are unable to do so.

References Armer, J.M., Shook, R.P., Schneider, M.K., Brooks, C.W., Peterson, J., Stewart, B.R. (2009) Enhancing Supportive-Educative Nursing Systems Reduce Risk of

Post-Breast Cancer Lymphedema. Self-Care, Dependence-Care & Nursing. 17:10 6-15 Browse, N., Burnarnd, K.G., & Mortimer, P.S. (2003). Disease of the lymphatics. London: Arnold. Fu, M.R., Axelrod, D., & Haber, J. (2008). Breast-cancer-related lymphedema: Information, symptoms, and risk-reduction behaviors. Journal of Nursing Scholarship, 40, 341-348 Hartweg, D.L. (1991) Dorothea Orem: self-care deficit theory. SAGE puplications, Inc. California. Johnson, B.M. & Webber, P.B. (2010) An Introduction to Theory and Research in Nursing. Wolters Kluwer health, Lippincott Williams and Wilkins. Philadelphia McEwen, M. and Wills, E.M. (2007) Theoretical Basis For Nursing.Lippincott Williams & Wilkins. Philadelphia. Application of Orems Self-Deficit Theory.

Vignette
Kuya Eddie, a 45 year-old jeepney driver suffered a vehicular accident along the highway of EDSA after an almost direct collision with a delivery truck. He was lucky though, having been found still alive by the paramedics and rescue squads upon their arrival. He was rushed to the hospital, where he was given emergency treatment for severe blood loss. Eddies lower left leg was torn off upon impact. Upon examination by the physician and nurse, it was revealed that he suffered complete fracture of the leg, severe injury to the right inner thigh and foot, massive muscle damage and head injuries. Emergency surgery was initiated to repair extensive damage. After the surgery though, Eddie went into a coma, due to a developed blood clot, and it was very successful. Eddie however, did not wake up after surgery. The physicians are starting to give up on him, knowing that few patients mange to recover from a comatose state. His family prayed for a miraculous recover. Then, after a month, he woke up. His body however, became like a vegetable. The physicians said that Eddie would be paralyzed for life, but he, being a man of faith, did not accept this. Walang impossible sa Diyos, Dok. Siya lang ang paniniwalan ko nang lubos, he told the medical staff surrounding his bed. Everyday with the desire burning in a focused mind he willed

himself to walk. Eddie imagined himself walking, and held that mental picture as the nurses old range-of-motion exercises, massaged cared and cleaned his body. After a few months of therapy, the attending physicians were stunned. One morning, Eddie suddenly sat in the bedside. It was a miracle. He could move his legs a little at first, then some more, until after a few weeks he could stand and walk with a limp. The physicians ordered that the patient be given and taught the use of crutch as assistive device. Lissa, an orthopedic nurse was tasked to perform health teaching and guidance to Kuya Eddie.

Assessment
Read more in Nursing
Seven Career Options for Nurses District Nurses Fail Their Patients or Do They? Keeping Orems Self-Care in mind, the nurse would then identify probable needs and evaluate clients potential for independence. Nursing care would start at the patients compensatory state, which is from comatose to paralysis. Then it would proceed to partially compensatory state, wherein the client is taught the use of assistive device to aid in mobility nurse would recall the principles of crutch walking, including correct usage, posture and pacing. The client support system in also taken as an important consideration, including Eddies perception of disability and possible lifestyle adjustments and considerations.

Diagnosis

Self-care deficit related to total paralysis Knowledge deficit related to use of crutches

Planning
The nurse would collaborate with patient in setting attainable goals with emphasis on client empowerment and attaining independent as quickly as possible.

Implementation
1. Assess clients perception on disability, lifestyle changes, and coping mechanisms. 2. Demonstrate use of crutch walking pacing using visual aids, proper therapeutic communication and demonstration. 3. Involve support system (family, loved ones) on the discussion and address their questions and concerns.

4. Refer the client to a physical therapist for collaboration and further guidance. 5. Ask the client to demonstrate knowledge and competency to evaluate self-care capacity.

Evaluation
The nurse, together with the patient, after a few days of instruction and counseling, would agree on whether the goal is met or not. Eddie would then ne encouraged to set new goals for himself.

Read more: http://healthmad.com/nursing/orems-self-deficit-theory/#ixzz22rIpH8Uu

Application of Orem's Self -Care Deficit theory

This page was last updated on October 17, 2011

OBJECTIVES

to assess the patient condition by the various methods explained by the nursing theory

to identify the needs of the patient to demonstrate an effective communication and interaction with the patient.

to select a theory for the application according to the need of the patient

to apply the theory to solve the identified problems of the patient

to evaluate the extent to which the process was fruitful.

PATIENT PROFILE Areas Name Age Sex Education Occupation Marital status Religion Diagnosis Theory applied Patient details Mrs. X 56 years Female No formal education House hold Married Hindu Rheumatoid arthritis Orems theory of self care deficit.

OREMS THEORY OF SELF CARE DEFICIT

The self care deficit theory proposed by Orem is a combination of three theories, i.e. theory of self care, theory of self care deficit and the theory of nursing systems.

In the theory of self care, she explains self care as the activities carried out by the individual to maintain their own health.

The self care agency is the acquired ability to perform the self care and this will be affected by the basic conditioning factors such as age, gender, health care system, family system etc.

Therapeutic self-care demand is the totality of the self care measures required.

The self care is carried out to fulfill the self-care requisites. There are mainly 3 types of self care requisites such as universal, developmental and health deviation self care requisites.

Whenever there is an inadequacy of any of these self care requisite, the person will be in need of self care or will have a deficit in self care.

The deficit is identified by the nurse through the thorough assessment of the patient.

Once the need is identified, the nurse has to select required

nursing systems to provide care: wholly compensatory, partly compensatory or supportive and educative system.

The care will be provided according to the degree of deficit the patient is presenting with.

Once the care is provided, the nursing activities and the use of the nursing systems are to be evaluated to get an idea about whether the mutually planned goals are met or not.

Thus the theory could be successfully applied into the nursing practice. For Mrs. X. She came to the hospital with complaints of pain over all the joints, stiffness which is more in the morning and reduces by the activities.

She has these complaints since 5 years and has taken treatment from local hospital.

The symptoms were not reducing and came to --MC, Hospital for further management.

Patient was able to do the ADL by herself but the way she performed and the posture she used was making her prone to develop the complications of the disease.

She also was malnourished and was not having awareness about the deficiencies and effects.

DATA COLLECTION ACCORDING TO OREMS THEORY OF SELF CARE DEFICIT 1. BASIC CONDITIONING FACTORS Age Gender Health state 56 year Female Disability due to health condition, therapeutic self care demand Ego integrity vs despair No formal education, Indian, Hindu Institutional health care Married, husband working

Development state Sociocultural orientation Health care system Family system

Patterns of living Environment

resources

At home with partner Rural area, items for ADL not in easy reach, no special precautions to prevent injuries Husband, daughter, sisters son

2. UNIVERSAL SELF-CARE REQUISITES Breaths without difficulty, no pallor cyanosis Fluid intake is sufficient. Edema present over ankles. Turgor normal for the age Hb 9.6gm%, BMI = 14.Food intake is not adequate or the diet is not nutritious. Voids and eliminates bowel without difficulty. Frequent rest is required due to pain. Pain not completely relieved, Activity level ha s come down. Deformity of the joint secondary to the disease process and use of the joints. Communicates well with neighbors and calls the daughter by phone Need for medical care is communicated to the daughter. Need instruction on care of joints and prevention of falls. Need instruction on improvement of nutritional status. Prefer to walk bare foot. Has good relation with daughter

Air Water

Food

Elimination Activity/ rest

Social interaction

Prevention of hazards

Promotion of normalcy

3. DEVELOPMENTAL SELF-CARE REQUISITES Maintenance of developmental environment Prevention/ management of the conditions threatening the normal development Able to feed self , Difficult to perform the dressing, toileting etc Feels that the problems are due to her own behaviours and discusses the problems with husband and daughter.

4. HEALTH DEVIATION SELF CARE REQUISITES Adherence to medical regimen Reports the problems to the physician when in the hospital. Cooperates with the medication, Not much aware about the use and side effects of medicines Not aware about the actual disease process. Not compliant with the diet and prevention of hazards. Not aware about the side effects of the medications Has adapted to limitation in mobility. The adoption of new ways for activities leads to deformities and progression of the disease. Adjusted with the deformities. Pain tolerance not achieved

Awareness of potential problem associated with the regimen

Modification of self image to incorporates changes in health status Adjustment of lifestyle to accommodate changes in the health status and medical regimen.

5. MEDICAL PROBLEM AND PLAN Physicians perspective of the condition: Diagnosed with rheumatoid arthritis and is on the following medications:

T. Valus SR OD T. Pan 40 mg OD T. Tramazac 50 mg OD T. Recofix Forte BD T. Shelcal BD Syp. Heamup 2tsp TID

Medical Diagnosis: Rheumatoid arthritis Medical Treatment: Medication and physical therapy. AREAS AND PRIORITY ACCORDING TO OREMS THEORY OF

SELF-CARE DEFICIT: IMPORTANT FOR PRIORITIZING THE NURSING DIAGNOSIS.

Air Water Food Elimination Activity/ Rest Solitude/ Interaction Prevention of hazards Promotion of normalcy Maintain a developmental environment. Prevent or manage the developmental threats Maintenance of health status Awareness and management of the disease process. Adherence to the medical regimen Awareness of potential problem. modify self image Adjust life style to accommodate health status changes and MR

NURSING CARE PLAN ACCORDING TO OREMS THEORY OF SELF CARE DEFICIT Nursing diagnosis (diagnostic operations) Based on self care deficits Outcome and plan (Prescriptive operations) Outcome Nursing goal and objectives Design of nursing system Appropriate method of helping Implementation Evaluation (control (regulatory operations) operations) Nurse- patient actions to - Promote patient as self care agent - Meet self care needs - Decrease the self care deficit. 1. Effectiveness of the nurse patient action to -Promote patient as self care agent - Meet self care needs - Decrease the self care deficit.

2. Effectiveness of the selected nursing system to meet the needs. Thus in the patient Mrs. X the areas that need assistance were

Air Water Food Elimination Activity/ Rest(2) Solitude/ Interaction Prevention of hazards(2) Promotion of normalcy Maintain a developmental environment. Prevent or manage the developmental threats Maintenance of health status Awareness and management of the disease process. Adherence to the medical regimen Awareness of potential problem. modify self image Adjust life style to accommodate health status changes and medical regimen

APPLYING THE OREMS THEORY OF SELFCARE DEFICIT, A NURSING CARE PLAN FOR MRS. X COULD BE PREPARED AS FOLLOWS A. THERAPEUTIC SELF CARE DEMAND: DEFICIENT AREA: FOOD ADEQUACY OF SELF CARE AGENCY: INADEQUATE

NURSING DIAGNOSIS

Inability to maintain the ideal nutrition related to inadequate intake and knowledge deficit

OUTCOMES AND PLAN a. Outcome:

Improved nutrition Maintenance of a balanced diet with adequate iron supplementation.

b. Nursing Goals and objectives Goal: to achieve optimal levels of nutrition. Objectives: Mrs. X will:

state the importance of maintaining a balanced diet. List the food items rich in iron , that are available in the locality.

c. Design of the nursing system:

supportive educative

d. Method of helping:

guidance support Teaching Providing developmental environment

IMPLEMENTATION

Mutually planned and identified the objectives and the patient were made to understand about the required changes in the

behaviour to have the requisites met. EVALUATION

Mrs. X understood the importance of maintaining an optimum nutrition.

She told that she will select the iron rich diet for her food. She listed the foods that are rich in iron and that are locally available.

The self care deficit in terms of food will be decreased with the initiation of the nutritional intake.

The supportive educative system was useful for Mrs. X ----------------------------------------------------------------------

B. THERAPEUTIC SELF CARE DEMAND: DEFICIENT AREA: ACTIVITY ADEQUACY OF SELF CARE AGENCY: INADEQUATE NURSING DIAGNOSIS

Self-care deficit: dressing, toileting related to restricted joint movement, secondary to the inflammatory process in the joints.

OUTCOMES AND PLAN a. Outcome:

improved self-care maintain the ability to perform the toileting and dressing with modification as required.

b. Nursing Goals and objectives Goal: to achieve optimal levels of ability for self care.

Objectives: Mrs. X will:

perform the dressing activities within limitations utilize the alternative measures available for improving the toileting

perform the other activities of daily living with minimal assistance.

c. Design of the nursing system: Partly compensatory d. Method of helping: 1. Guidance:

Assess the various hindering factors for self care and how to tackle them.

2. Support:

Provide all the articles needed for self care, near to the patient and ask the family members also to give the articles near to her.

Provide passive exercises and make to perform active exercises so as to promote the mobility of the joint.

Make the patient use commodes or stools to perform toileting and insist on avoidance of squatting position

Provide assistance whenever needed for the self care activities

Provide encouragement and positive reinforcement for minor improvement in the activity level.

Initiate the pain relieving measures always before the patient go for any of the activities of daily living

Make the patient to use loose fitting clothes which will be easy to wear and remove.

3. Teaching:

Teach the family members the limitation in the activity level the patient has and the cooperation required

4. Promoting a developmental environment:

Teach the family and help them to practice how to help the patient according to her needs

IMPLEMENTATION

Mutually planned and identified the objectives and the patient was made to understand about the required changes in the behaviour to have the requisites met.

EVALUATION

Patient was performing some of the activities and she practiced toileting using a commode in the hospital.

She verbalized an improved comfort and self care ability. She performed the dressing activities with minimal assistance

Patient verbalized that she will perform the activities as instructed to get her ADL done.

The partly compensatory system was useful for Mrs. X ----------------------------------------------------------------------

C. THERAPEUTIC SELF CARE DEMAND: DEFICIENT AREA: PAIN CONTROL ADEQUACY OF SELF CARE AGENCY: INADEQUATE NURSING DIAGNOSIS

Ineffective pain control related to lack of utilization of pain relief measures

OUTCOMES AND PLAN a. Outcome:

improved pain self control achieve and maintain a reduction in the pain.

b. Nursing Goals and objectives Goal: to achieve reduction in the pain. Objectives: Mrs. X will:

describe the total plan of pharmacological and non pharmacological pain relief

demonstrate a reduction in the pain behaviours verbalize a reduction in the pain scale score from 7 4

c. Design of the nursing system: supportive educative d. method of helping: Guidance:

Explore the past experience of pain and methods used to manage them.

Ask the client to report the intensity, location, severity, associated and aggravating factors.

Support:

Provide rest to the joints and avoid excessive manipulations provide hot and cold application to have better mobility. Encourage exercises to the joints by immersing in the warm water.

Administer T. Ultracet and Tab Diclofecac as prescribed. Provide diversion and psychological support to the patient

Teaching:

Teach the non pharmacological method to the patient once the pain is a little reduced.

Providing the developmental environment:

Discuss with the patient the necessity to maintain a pain diary with all information regarding episodes of pain and refer to that periodically

Enquire from the health team, the need for opioid analgesics or other analgesics and get a prescription for the patient.

IMPLEMENTATION ----------------------------------------------------------------------------EVALUATION

Patient still has pain over the joints and she agreed that she will use the measures for pain relief that is told to her.

The pain scale score was 6 after the measures were provided to the patient.

She demonstrated slight reduction in the pain behaviours. The supportive educative system was useful for Mrs. X --------------------------------------------------------------

D. THERAPEUTIC SELF CARE DEMAND: DEFICIENT AREA: PREVENTION OF HAZARDS. ADEQUACY OF SELF CARE AGENCY: INADEQUATE NURSING DIAGNOSIS

Potential for fall and fractures related to rheumatoid arthritis.

OUTCOMES AND PLAN a. Outcome:

Absence of falls and injury to the patient

b. Nursing Goals and objectives Goal: prevent the falls and injury and to maintain a good body mechanics. Objectives: Mrs. X will:

remain free from injury as evidenced by: absence of signs and symptoms of fall or injury Explaining the methods to prevent the injury.

c. Design of the nursing system: supportive educative d. method of helping: Support

Never leave the client alone in the unit Assess the patients gait, activities and the mental status for any confusion or disorientation

Encourage the patient to use supportive devices as required.

Provide a safe environment in the hospital by avoiding sharp objects or wooden objects on the way and slippery floor.

Involve the family members in providing and maintaining a safe environment in the home

Involve the family members to provide support to the patient whenever necessary

Plan a balanced diet for the patient with a mutual interaction

IMPLEMENTATION

-----------------------------------------------------------------EVALUATION

Patient remained free from injury as evidenced by absence of signs and symptoms.

Patient explained the various measures that they will take to prevent the injury.

The supportive educative system was useful for Mrs. X

-----------------------------------------------------------------E. THERAPEUTIC SELF CARE DEMAND: DEFICIENT AREA: PREVENTION OF HAZARDS. ADEQUACY OF SELF CARE AGENCY: INADEQUATE NURSING DIAGNOSIS:

Potential for impaired skin integrity related to edema secondary to renal cysts.

OUTCOMES AND PLAN: a. Outcome:

Maintenance of normal skin integrity.

b. nursing Goals and objectives Goal: Maintain the skin integrity and take measures to prevent skin impairment. Objectives: Mrs. X will:

maintain a normal skin integrity list the measures to prevent the loss of skin integrity identify the measures to relieve edema.

c. Design of the nursing system: supportive educative d. method of helping: Support:

Assess the skin regularly for any excoriation or loss of integrity or colour changes. Keep the skin clean always

Avoid stress or pressure over the area of edema by providing extra cushions or padding

Monitor the lab values as well as the patient for any signs and symptoms of renal failure.

Encourage the patient to use slippers while walking and that should not be tight fitting.

Assess the edema for its degree, pitting or non pitting and continue the assessment daily.

Provide a leg end elevated position or elevation of the leg on a pillow if no cardiac abnormalities are identified.

Explain the patient the need for taking care of the edematous parts

Explain the patient to report the symptoms like decreased urine output, palpitations, increased edema etc. to the health team

IMPLEMENTATION ------------------------------------------------------------------EVALUATION

Patient remained free from impaired skin integrity She listed the measures to prevent the loss of skin integrity She identified the measures to relieve edema. The supportive educative system was useful for Mrs. x

----------------------------------------------------------------F. THERAPEUTIC SELF CARE DEMAND: DEFICIENT AREA: AWARENESS OF THE DISEASE PROCESS AND MANAGEMENT ADEQUACY OF SELF CARE AGENCY: INADEQUATE NURSING DIAGNOSIS

Potential for complications related to rheumatoid arthritis secondary to knowledge deficit.

OUTCOMES AND PLAN a. Outcome:

Absence of complications and improved awareness about the disease process.

b. nursing Goals and objectives Goal: Improve the knowledge of the patient about the disease process and the complications. Objectives: Mrs. X will:

verbalize the various complication and their preventions verbalize the changes occurring with the disease process and the treatment available

describe the actions and side effects of the medications which she is using

c. Design of the nursing system:

supportive educative

d. Methods of helping:

Guidance

Teaching Promoting a developmental environment

IMPLEMENTATION

------------------------------------------------------------EVALUATION

Patient got adequate information regarding the disease She verbalized what she understood about the disease and its management.

Patient has cleared her doubts regarding the medication actions and the side effect

The supportive educative system was useful for Mrs. X

EVALUATION OF THE APPLICATION OF SELF CARE DEFICIT THEORY The theory of self-care deficit when applied could identify the self care requisites of Mrs. X from various aspects. This was helpful to provide care in a comprehensive manner. Patient was very cooperative. the application of this theory revealed how well the supportive and educative and partly compensatory system could be used for solving the problems in a patient with rheumatoid arthritis. REFERENCES 1. Alligood M R, Tomey A M. Nursing Theory: Utilization &Application .3rd ed. Missouri: Elsevier Mosby Publications; 2002. 2. Tomey AM, Alligood. MR. Nursing theorists and their work. (5th ed.). Mosby, Philadelphia, 2002

3. George JB .Nursing Theories: The Base for Professional Nursing Practice .5th ed. New Jersey :Prentice Hall;2002.