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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 self-care 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 theoryFrom 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. the maintenance of sufficient intake of air, food, and water2. provision of care associated with the elimination process3. a balance between activities and rest, as well as between solitude and social interaction4. the prevention of hazards to human life and well-being5. the promotion of human functioning
Dorothea Orem: Self-Care Deficit Theory
UPOU Orem’s SupportersThe 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 Nightingale’s theory, Dorothea Orem’s Theory of Self-Care 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 Orem’s 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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http://oremselfcaredeficittheory.blogspot.com/p/dorothea-orem.html
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 1930’s. 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 Shield’s 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 Orem’s 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.
• Orem’s 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.
• Orem’s 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.
Orem’s General Theory of Nursing
(3 related theories collectively referred to as “Orem’s 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 individual’s 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 Orem’s 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) can’t 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 patient’s 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 patient’s demands
- Refers to a series of actions a nurse takes to meet a patient’s self-care needs, is determined by the patient’s 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 self-care 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 patient’s 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 Orem’s 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 nurse’s role may be consultative only.
Orem’s 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 Orem’s theory of Self-Care DeficitMany 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 Orem’s Self-Care Deficit Theory of Nursing (SCDNT).
Orem’s 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. Orem’s 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).
Orem’s 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. Orem’s 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 Orem’s theory
concept of person is defined as an individual with physical and
emotional needs that are required for the development and
maintenance of the person’s 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 one’s 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)
Orem’s 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 self-care 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 individual’s 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 individual’s 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
person’s 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 Orem’s 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 patient’s
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 Orem’s theory of self-care
deficits in recently diagnosed post-surgery breast cancer survivors
and their risk for developing lymphedema. The importance of
implementing a supportive-educative nursing system in order to
reduce the risk of post-breast cancer lymphedema was recognized.
Lymphedema results from a failure of the lymph-conducting 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 self-care 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 self-care 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 Orem’s 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
Orem’s theory of self-care; therefore with motivation and goal
attainment reinforce the ideals self-care 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 self-care frame of reference; 3.
Motivation; and 4. Ability to consistently perform self-care 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 self-care 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 post-breast 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 Orem’s
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. Orem’s 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). Orem’s 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 Orem’s Self-Deficit Theory.
VignetteKuya 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. Eddie’s 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.
AssessmentRead more in Nursing
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Keeping Orem’s Self-Care in mind, the nurse would then identify probable needs and evaluate
client’s potential for independence. Nursing care would start at the patient’s 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 Eddie’s perception of disability
and possible lifestyle adjustments and considerations.
Diagnosis
Self-care deficit related to total paralysis
Knowledge deficit related to use of crutches
PlanningThe nurse would collaborate with patient in setting attainable goals with emphasis on client
empowerment and attaining independent as quickly as possible.
Implementation
1. Assess client’s 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.
EvaluationThe 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
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O B J E C T I V E S
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.
P A T I E N T P R O F I L E
AreasPatient details
Name Age Sex Education Occupation Marital status Religion Diagnosis Theory applied
Mrs. X 56 years Female No formal education House hold Married Hindu Rheumatoid arthritis Orem’s theory of self care deficit.
O R E M ’ S T H E O R Y O F S E L F C A R E D E F I C I T
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.
D A T A C O L L E C T I O N A C C O R D I N G T O O R E M ’ S
T H E O R Y O F S E L F C A R E D E F I C I T
1. BASIC CONDITIONING FACTORS
Age 56 yearGender FemaleHealth state Disability due to health
condition, therapeutic self care demand
Development state Ego integrity vs despairSociocultural orientation No formal education, Indian,
HinduHealth care system Institutional health careFamily system Married, husband workingPatterns of living At home with partner
Environment Rural area, items for ADL not in easy reach, no special precautions to prevent injuries
resources Husband, daughter, sister’s son
2. UNIVERSAL SELF-CARE REQUISITES
AirBreaths without difficulty, no pallor cyanosis
Water Fluid intake is sufficient. Edema present over ankles. Turgor normal for the age
Food Hb – 9.6gm%, BMI = 14.Food intake is not adequate or the diet is not nutritious.
Elimination Voids and eliminates bowel without difficulty.
Activity/ rest 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.
Social interaction Communicates well with neighbors and calls the daughter by phone Need for medical care is communicated to the daughter.
Prevention of hazards
Need instruction on care of joints and prevention of falls. Need instruction on improvement of nutritional status. Prefer to walk bare foot.
Promotion of normalcy
Has good relation with daughter
3. DEVELOPMENTAL SELF-CARE REQUISITES
Maintenance of developmental environment
Able to feed self , Difficult to perform the dressing, toileting etc
Prevention/ management of the conditions threatening the normal development
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 Reports the problems to the
medical regimen physician when in the hospital. Cooperates with the medication, Not much aware about the use and side effects of medicines
Awareness of potential problem associated with the regimen
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
Modification of self image to incorporates changes in health status
Has adapted to limitation in mobility.
The adoption of new ways for activities leads to deformities and progression of the disease.
Adjustment of lifestyle to accommodate changes in the health status and medical regimen.
Adjusted with the deformities. Pain tolerance not achieved
5. MEDICAL PROBLEM AND PLAN
Physician’s 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 OREM’S 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
N U R S I N G C A R E P L A N A C C O R D I N G T O
O R E M ’ S T H E O R Y O F S E L F C A R E D E F I C I T
Nursing diagnosis (diagnostic operations)
Outcome and plan (Prescriptive operations)
Implementation (control operations)
Evaluation (regulatory operations)
Based on self care deficits
Outcome Nursing goal and objectives Design of nursing system Appropriate method of helping
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
A P P L Y I N G T H E O R E M ’ S T H E O R Y O F S E L F -
C A R E D E F I C I T , A N U R S I N G C A R E P L A N F O R
M R S . X C O U L D B E P R E P A R E D A S F O L L O W S
…
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
E V A L U A T I O N O F T H E A P P L I C A T I O N O F S E L F
C A R E D E F I C I T T H E O R Y
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.
R E F E R E N C E S
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.
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