Question

A. Discuss the following conceptual model/framework of Orem's Self-Care Theory.

Diagram of the Orem's Self-Care Theory.

B. How will you apply the Conceptual Framework of Orem's Self-care Theory and in your clinical area of practice.

Answer 1

The self-care deficit nursing theory is a grand nursing theory that was developed between 1959 and 2001 by Dorothea Orem. The theory is also referred to as the Orem's Model of Nursing. It is particularly used in rehabilitation and primary care settings, where the patient is encouraged to be as independent as possible.
Self-Care Theory :-

* Dorothea Orem’s Self-Care Deficit Theory:-

It focuses on each “individual’s ability to perform self-care, defined as ‘the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being.'”
The Self-Care or Self-Care Deficit Theory of Nursing is composed of three interrelated theories:
* the theory of self-care,
* the self-care deficit theory, and
* the theory of nursing systems, which is further classified into wholly compensatory, partial compensatory and supportive-educative. It is discussed further below.
Dorothea Orem’s Self-Care Deficit Theory defined Nursing as “The act of assisting others in the provision and management of self-care to maintain or improve human functioning at home level of effectiveness.” It focuses on each individual’s ability to perform self-care, defined as “the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being.”

“The condition that validates the existence of a requirement for nursing in an adult is the absence of the ability to maintain continuously that amount and quality of self-care which is therapeutic in sustaining life and health, in recovering from disease or injury, or in coping with their effects. With children, the condition is the inability of the parent (or guardian) to maintain continuously for the child the amount and quality of care that is therapeutic.”

Major Concepts of the Self-Care Deficit
*Theory:-

In this section are the definitions of the major concepts of Dorothea Orem’s Self-Care Deficit Theory:

*Nursing:-
Nursing is an art through which the practitioner of nursing gives specialized assistance to persons with disabilities which makes more than ordinary assistance necessary to meet needs for self-care. The nurse also intelligently participates in the medical care the individual receives from the physician.

*Humans:-
Humans are defined as “men, women, and children cared for either singly or as social units,” and are the “material object” of nurses and others who provide direct care.

*Environment:-
The environment has physical, chemical and biological features. It includes the family, culture, and community.

Health
Health is “being structurally and functionally whole or sound.” Also, health is a state that encompasses both the health of individuals and of groups, and human health is the ability to reflect on one’s self, to symbolize experience, and to communicate with others.

Self-Care:-
Self-care is the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health, and well-being.

Self-Care Agency :
Self-care agency is the human’s ability or power to engage in self-care and is affected by basic conditioning factors.

Basic Conditioning Factors
Basic conditioning factors are age, gender, developmental state, health state, socio-cultural orientation, health care system factors, family system factors, patterns of living, environmental factors, and resource adequacy and availability.
Nursing Agency
Nursing Agency is a complex property or attribute of people educated and trained as nurses that enables them to act, to know, and to help others meet their therapeutic self-care demands by exercising or developing their own self-care agency.

Nursing System
Nursing System is the product of a series of relations between the persons: legitimate nurse and legitimate client. This system is activated when the client’s therapeutic self-care demand exceeds available self-care agency, leading to the need for nursing.
Theories:-
The Self-Care or Self-Care Deficit Theory of Nursing is composed of three interrelated theories:

1) the theory of self-care,

2) the self-care deficit theory, and

3) the theory of nursing systems, which is further classified into wholly compensatory, partial compensatory and supportive-educative.

Theory of Self-Care
This theory focuses on the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health and well-being.

Self-Care Requisites
Self-care Requisites or requirements can be defined as actions directed toward the provision of self-care. It is presented in three categories:

Universal Self-Care Requisites
Universal self-care requisites are associated with life processes and the maintenance of the integrity of human structure and functioning.

*The maintenance of a sufficient intake of air
*The maintenance of a sufficient intake of water
*The maintenance of a sufficient intake of food
*The provision of care associated with elimination process and excrements
*The maintenance of a balance between activity and rest
*The maintenance of a balance between solitude and social interaction
*The prevention of hazards to human life, human functioning, and human well-being
*The promotion of human functioning and development within social groups in accord with human potential, known human limitations, and the human desire to be normal
*Normalcy is used in the sense of that which is essentially human and that which is in accord with the genetic and constitutional characteristics and the talents of individuals.

*Developmental self-care requisites

Developmental self-care requisites are “either specialized expressions of universal self-care requisites that have been particularized for developmental processes or they are new requisites derived from a condition or associated with an event.”

Health deviation self-care requisites

Health deviation self-care requisites are required in conditions of illness, injury, or disease or may result from medical measures required to diagnose and correct the condition.

*Seeking and securing appropriate medical assistance
*Being aware of and attending to the effects and results of pathologic conditions and states
*Effectively carrying out medically prescribed diagnostic, therapeutic, and rehabilitative measures
*Being aware of and attending to or regulating the discomforting or deleterious effects of prescribed medical measures.
*Modifying the self-concept (and self-image) in accepting oneself as being in a particular state of health and in need of specific forms of health care
*Learning to live with the effects of pathologic conditions and states and the effects of medical diagnostic and treatment measures in a lifestyle that promotes continued personal development

Theory of Self-Care Deficit:-

This theory 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. Orem identified 5 methods of helping:

*Acting for and doing for others
*Guiding others
*Supporting another
*Providing an environment promoting personal development in relation to meet future demands
*Teaching another
Theory of Nursing System
This theory is the product of a series of relations between the persons: legitimate nurse and legitimate client. This system is activated when the client’s therapeutic self-care demand exceeds available self-care agency, leading to the need for nursing.

Wholly Compensatory Nursing System
This is represented by a situation in which the individual is unable “to engage in those self-care actions requiring self-directed and controlled ambulation and manipulative movement or the medical prescription to refrain from such activity… Persons with these limitations are socially dependent on others for their continued existence and well-being.”

Example: care of a newborn, care of client recovering from surgery in a post-anesthesia care unit

Partial Compensatory Nursing System
This is represented by a situation in which “both nurse and perform care measures or other actions involving manipulative tasks or ambulation… [Either] the patient or the nurse may have a major role in the performance of care measures.”

Example: Nurse can assist postoperative client to ambulate, Nurse can bring a meal tray for client who can feed himself

Supportive-Educative System
This is also known as supportive-developmental system, the person “is able to perform or can and should learn to perform required measures of externally or internally oriented therapeutic self-care but cannot do so without assistance.”

Example: Nurse guides a mother how to breastfeed her baby, Counseling a psychiatric client on more adaptive coping strategies.