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Dorothea Orems Theory of Self Care

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Title: Dorothea Orems Theory of Self Care


1
Dorothea Orems Theory of Self Care
  • Presented by Emily Bruce, Celeste Gagnon, Nicole
    Gendron, Laura Puteris and Ashley Tamblyn

2
Dorothea Orem
  • Born in Baltimore, Maryland.
  • One of Americas foremost nursing theorists.
  • Father was a construction worker
  • Mother was a homemaker.
  • Youngest of two daughters.

3
Education
  • Studied at Providence Hospital school of Nursing
    in Washington D.C. in 1930s
  • Got her B.S.N.E. in 1939 and her M.S.N.E in 1946
    both from the Catholic University of America Got
    her M.S.N.E. at Catholic University of America in
    1946
  • 1958-1960 upgraded practical nursing training at
    Department of Health, Education and Welfare
  • Was editor to several texts including Concepts
    Formalization in Nursing Process and Production,
    revised in 1980, 1985, 1991, 1995, 2001

4
Nursing Experience
  • Early nursing experience included operating room
    nursing, private duty nursing (in home and
    hospital), pediatric and adult medical and
    surgical units, evening supervisor in the
    emergency room, and biological science
    technician.
  • 1940-1949 Orem held directorship of both nursing
    school and the department of nursing at
    Providence Hospital in Detroit.

5
Development of Theory
  • 1949-1957 Orem worked for the Division of
    Hospital and Institutional Services of the
    Indiana State Board of Health. Her goal was to
    upgrade the quality of nursing in general
    hospitals throughout the state. During this time
    she developed her definition of nursing practice.
  • 1958-1960 U.S Department of Health, Education and
    Welfare where she help publish Guidelines for
    Developing Curricula for the Education of
    Practical Nurses in 1959.

6
Development of Theory
  • 1959 Orem subsequently served as acting dean of
    the school of Nursing and as an assistant
    professor of nursing education at CUA. She
    continued to develop her concept of nursing and
    self care during this time.
  • Orems Nursing Concept of Practice was first
    published in 1971 and subsequently in 1980,1985,
    1991, 1995, and 2001.
  • Continues to develop her theory after her
    retirement in 1984

7
Achievement
  • 1976 and 1980 Honorary degree of Doctor of
    Science.
  • 1980 CUA Alumni Association Award for Nursing
    Theory.
  • 1988 Doctor of Humane Letters from Illinois
    Wesleyan University
  • 1988 Linda Richards Award
  • 1991 National League for Nursing
  • 1992 Honorary Fellow of the American Academy of
    Nursing.
  • 1998 Doctor of Nursing Honoris Causae from the
    University of Missouri.

8
Image of Nursing
  • Orem began her theory development in the 1960s,
    and her first publication was in 1971. During
    that time the mass media played a small role in
    portraying nursing as a respected profession but
    unfortunately played a much larger role in the
    destruction of that image.

9
Image of Nursing
  • In the early 1960s Nurses were depicted as
    subordinate to Physicians in films and on
    television. For example, in TV shows such as Dr.
    Kildare and Ben Casey, nurses were shown
    delivering messages to the doctors, carrying
    trays and doing minimal skill level tasks.
    Throughout the show, the doctors were
    condescending towards the nurses, and constantly
    portrayed as superior.
  • In 1962 a revolutionary TV show came about, and
    for the first time nurses were depicted in a
    positive realistic light.

10
The Nurses1962-1964
  • This TV show was the first of medical dramas to
    focus on the nurse instead of the physician, and
    showed the nurses in their true profession. They
    were depicted as
  • -objective
  • -articulate
  • -disciplined
  • -concerned with professional development of
    herself and colleagues
  • -demonstrated the existence of nursing standards
    and organization

11
The Nurses1962-1964
  • For the first time in TV history, when problems
    arose, instead of waiting for the physician to
    arrive and give orders, the nurses identified the
    problem themselves and found solutions.
  • In the short time that it was on the air it did a
    great deal for the propagation of a positive
    nursing image.

12
Image of Nursing
  • In the mid 1960s the positive image of nursing
    took a plunge.
  • In the media, the obsession with nurses sex
    lives dominated over all other thematic elements.
  • Films, books and television shows depicted the
    nurse as a tall, thin, well endowed blonde whom
    every man craved. Nurses would often fall in
    love with their patients, and the physicians
    would woe them.

13
Image of Nursing
  • This ushered in an era of sexually suggestive
    material which included nurses as promiscuous
    women, having sex with patients, physicians and
    other male characters without any attachment,
    such as in Carry on Nurse.
  • Soon the context had completely left the screen
    and all that was left was outright pornography.
    Including such titles as Night Call Nurses, I,
    A Woman and Deep Throat.
  • Fortunately, although this portrayal hindered the
    progress nurses were making, this was not the
    image the majority of society assumed when
    thinking about what nurses do.

14
Images of Nursing
  • Media Portrayal

15
Image of Nursing
  • Realistic Portrayal

16
Metaparadigm Concept
  • Person An individual with physical and emotional
    requirements for development of self and
    maintenance of their well-being.
  • Environment Clients surroundings which may
    affect their ability to perform their self-care
    activities.
  • Health Structural and functional soundness and
    wholeness of the individual (Orem 1991).
  • Nursing The acts of a specially trained and able
    individual to help a person or multiple people
    deal with their actual or potential self-care
    deficits.

17
Orems Theory of Self Care
  • Each person has a need for self care in order to
    maintain optimal health and wellness.
  • Each person possesses the ability and
    responsibility to care for themselves and
    dependants.
  • Theory is seperated into three conceptual
    theories which include self care, self care
    deficit and nursing system.

18
Theory of Self Care
  • Self care is the ability to perform activities
    and meet personal needs with the goal of
    maintaining health and wellness of mind, body and
    spirit.
  • Self care is a learned behaviour influenced by
    the metaparadigm of person, environment, health
    and nursing.
  • Three components universal self care needs,
    developmental self care needs, and health
    deviation.

19
Universal Self Care
  • This includes activities which are essential to
    health and vitality.
  • Eight elements identified these include air,
    water, food, elimination, activity and rest,
    solitude and social interactions, prevention of
    harm, and promotion of normality.

20
Developmental Self Care Need
  • These include the interventions and teachings
    designed to return a person to or sustain a level
    of optimal health and well being.
  • Examples can include such things as toilet
    training a child or learning healthy eating.

21
Health Deviation Self Care
  • This encompasses the variations in self care
    which may occur as a result of disability,
    illness, or injury.
  • In other words the person with a variation is
    meeting self care and maintaining health and
    wellness in a more individualize meaning.

22
Theory of Self Care Deficit
  • Every mature person has the ability to meet self
    care needs, but when a person experiences the
    inability to do so due to limitations, thus
    exists a self care deficit.
  • A person benefits from nursing intervention when
    a health situation inhibits their ability to
    perform self care or creates a situation where
    their abilities are not sufficient to maintain
    own health and wellness.
  • Nursing action focuses on identification of
    limitation/deficit and implementing appropriate
    interventions to meet the needs of person.

23
Theory of Nursing Systems
  • The ability of the nurse to aid the person in
    meeting current and potential self care demands.
  • Focused on person
  • Three support modalities identified in theory
    including total compensatory, partial
    compensatory, and educative/supportive
    compensatory.
  • The clients ability for self care involvement
    will determine under which support modality they
    would be considered.

24
Support Modalities
  • Total compensatory support encompasses total
    nurse care- client unable to do for themselves.
  • Partial compensatory support involves both the
    nurse and the client sharing in the self care
    requirements.
  • Educative/supportive compensatory support elicits
    the help of the nurse solely as a consultant,
    teacher or resource person. Client is responsible
    for their own self care.
  • A person can fluctuate between support modalities
    at any given time throughout life.

25
Nurses Role
  • The nurses role in helping the client to achieve
    or maintain a level of optimal health and
    wellness is to act as an advocate, redirector,
    support person and teacher, and to provide an
    environment conducive to therapeutic development.

26
Application of Theory To Nursing Process
  • Orems theory of self-care is applied to many
    undergraduate nursing curricula.
  • The nursing care plan is one example of how her
    theory of self-care can be applied to nursing
    process

27
Nursing Care Plan
  • The nursing care plan includes assessment data
    pertaining to Gordons Functional Assessment, a
    NANDA nursing diagnosis, the identification of
    client expected outcomes, the nursing
    interventions and evaluation.

28
Nursing Theory in Practice
  • The self-care aspect of Orems theory applies to
    the assessment and evaluation of the nursing
    process. Orem emphasizes the importance of how
    ones own self-care is important for maintaining
    life, health development and wellbeing.
  • The only restriction to this method is that the
    nurse can only make assessments where there is
    direct contact between the nurse and the client
    and or the family.

29
Nursing Theory in Practice
  • The area of self-care deficit applies to the
    diagnosis area of the nursing care process.
  • Although self-care deficit is an abstract
    concept, it does provide a guideline for the
    selection of methods for helping and
    understanding the patient roles in self-care.

30
Nursing Theory In Practice
  • The third area of her theory, nursing systems,
    applies to the interventions of the nursing care.
  • In order to help explain this concept, Orem also
    created three areas of how care can be
    administrated to a client depending on the
    physical and mental capabilities of the client.
  • Wholly compensatory, partly compensatory and
    supportive-educative role

31
Case Study
  • The wholly compensatory system accomplishes the
    clients therapeutic self-care, compensates for
    the clients inability to participate in their
    self-care, provides support and protects the
    client.
  • Bedridden oncology patient arrives via ambulance
    for chemotherapy. Family insists upon keeping
    patient at home however, leaves patient alone
    with nurse in chemo clinic for treatment. Patient
    requires O2 at 2L/min, continuous tube feeding at
    90cc hour, foley catheter, bedpan. Nurse in
    clinic administers chemo premeds and chemo
    changes dressing around g-tube due to leaking
    administers O2 at 2L empties Foley at end of
    treatment places patient on bed pan one time.

32
Case Study
  • The partly compensatory system has a give and
    take system in between the nurse and the client.
    The nurse performs, compensates for limitations,
    regulates and assists the client as needed. The
    client participates in some self-care procedures,
    regulates and accepts care and assistance from
    the nurse.
  • Preterm labour patient regularly visits clinic
    for BP monitoring, etc. Patient on bed rest (at
    home), except for weekly visit to module. Nurse
    assists patient out of wheel chair into bathroom,
    assists with urine sample collection, and onto
    exam table. Nurse administers injection of
    terbutaline and educates patient regarding oral
    terbutaline.

33
Case Study
  • The supportive-educative role indicates that the
    client is participating in most of their
    self-care, and the nurses role is simply to
    monitor and regulate the clients self-care.
  • Newly diagnosed diabetic patient received
    diabetic care teaching while in hospital. Now,
    patient visits module and reports highly variable
    BS/chemstrip readings. Nurse suspects patient may
    be performing procedure incorrectly. Nurse
    assesses that patient has been cutting some of
    his chemstrips in half to save money. Nurse
    instructs patient that cutting strips exposes
    chemicals and inaccurate readings may result.
    Additionally, nurse assesses that patient's wife
    (who does family cooking) did not receive any
    nutritional education while patient was
    hospitalized. Nurse begins nutritional counseling
    and provides wife with referral to nutritional
    services department.

34
Personal Philosophy of Nursing
  • Nursing is the art of caring, nurturing and
    healing. Nursing goes beyond simply caring for
    illness, disease or ailment it is caring for the
    person. Part of the person is caring enough to
    aid them return to a state of optimal health and
    wellness in mind, body and spirit. These are
    believe to be the basic aspects essential to a
    fundament nursing philosophy.

35
Personal Nursing Philosophy
  • Nursing is being able to intervene when the
    person is unable to care for themselves and teach
    them methods to help them move beyond their
    inability. This can include offering information,
    teaching and tools necessary for their well being.

36
Orems Philosophy
  • It is believed that Orems theory portrays the
    idea that nursing is the ability to care for
    another, especially when they are unable to care
    for themselves. This corresponds to our
    philosophy of caring for person with the goal of
    achieving optimal level of health and wellness.

37
Game
  • While watching the video clip, think of a
    self-care nursing diagnosis related to this
    situation.
  • Come up with self-care deficit as a class
  • Divide the class into two groups
  • Each group is asked to come up with as many
    nursing interventions as they can related to this
    person and the self-care deficit.

38
Game
  • Flip a coin to find out which team gets to answer
    first. Then it will go back and forth.
  • For every intervention that is appropriate, the
    team will receive a game piece.
  • The object of the game is to connect four.
  • Prizes at the end!! Good luck

39
References
  • Hartweg, D.L. (1995). Dorthea Orem Self-care
    deficit theory. In C.M.
  • Kalisch, P. A. Kalisch, B.J. (1987). The
    Changing Image of the Nurse. Menlo Park, CA
    Addison-Wesley Publishing Company.
  • Mayo, A. (1997). Professional nursing web site.
    Retrieved October 31, 2006 from
    http//members.aol.com/annmrn/nursing_portfolio_I_
    index.html
  • McQuiston A.A. Webb (Eds.), Foundations of
    nursing theory Contributions of 12 key theorists
    (pp. 139-202). USA Sage Publications Inc.

40
References
  • Orem, D.E. (1991). Nursing Concepts of practice
    (4th ed.). St. Louis, MO Mosby-Year Book Inc.
  • Taylor, S.G. (2006). Dorthea E. Orem Self-care
    deficit theory of nursing. In A.M.
  • Tomey, A. Alligood, M. (2002). Significance of
    theory for nursing as a discipline and
    profession. Nursing Theorists and their work.
    Mosby, St. Louis, Missouri, United States of
    America.
  • Whelan, E. G. (1984). Analysis and application
    of dorothea orems self-care practuce model.
    Retrieved October 31, 2006 from
    http//www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd
    RetrievedbPubmedlist_uids6094754doptAbstract
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