DOROTHEA-OREM-lecture-notes.docx

Lecture notes on Dorothe Orem\'s Self-care deficit nursing theory\ \ Slide 2\ \ Dorothea Elizabeth Orem (1914-2007) was a prominent American nurse and theorist, best known for developing the Self-Care Deficit Nursing Theory, which has had a profound influence on nursing practice and education.\ \ Ea...

Lecture notes on Dorothe Orem\'s Self-care deficit nursing theory\ \ Slide 2\ \ Dorothea Elizabeth Orem (1914-2007) was a prominent American nurse and theorist, best known for developing the Self-Care Deficit Nursing Theory, which has had a profound influence on nursing practice and education.\ \ Early Life and Education\ \ Orem was born in Baltimore, Maryland in 1914.\ \ She earned her diploma in nursing from Providence Hospital School of Nursing in Washington, D.C.\ \ She furthered her education by obtaining a Bachelor of Science in Nursing Education in 1939 and a Master of Science in Nursing Education in 1945, both from The Catholic University of America.\ \ Career and Contributions\ \ Orem began her career as a staff nurse and eventually moved into roles as a nursing educator and administrator. Her experiences in nursing education shaped her thinking about the need for nurses to support patients in managing their own care.\ \ Orem began her career as a staff nurse and eventually moved into roles as a nursing educator and administrator. Her experiences in nursing education shaped her thinking about the need for nurses to support patients in managing their own care.\ \ Throughout her career, she worked in nursing practice, education, and research, holding positions such as director of nursing service and education at various hospitals, and later as a consultant to schools of nursing and hospitals.\ \ Orem\'s theory, developed in the 1950s and 1960s, focused on the idea that patients should be active participants in their own care whenever possible. The core of her theory emphasizes that nursing is required when individuals are unable to perform self-care due to limitations.\ \ Her theory, Self-Care Deficit Nursing Theory, is based on three key concepts: self- care, self-care deficit, and nursing systems, and has been used widely in nursing practice and education.\ \ Publications and Recognition\ \ Orem published extensively on nursing and her theoretical ideas. Her book, \"Nursing: Concepts of Practice\", first published in 1971, became a cornerstone text for nursing students and professionals alike.\ \ She received numerous honors and awards throughout her career for her contributions to nursing theory and practice.\ \ Legacy\ \ Dorothea Orem passed away in 2007 but her impact on nursing remains significant. Her theory continues to influence nursing practice globally, particularly in encouraging nurses to foster patient independence and autonomy in self-care.\ \ Orem\'s work has shaped the field of nursing by emphasizing the role of patients in their care, advancing nursing practice towards patient-centered care and holistic health promotion.\ \ Slide 3\ \ 1. People should be self-reliant and responsible for their own care and the care of others in their family.\ \ \>Nurses educate patients (e.g., hypertensive patients) to take responsibility for managing their health.\ \ Explanation: Orem assumes that individuals have the capacity to take responsibility for their own health and well-being. Self-care is viewed as a learned behavior that individuals are capable of performing.\ \ Example: In the case of a patient with hypertension, the nurse educates the patient about the importance of adhering to prescribed medications, maintaining a proper diet, and engaging in regular exercise. The nurse empowers the patient to take responsibility for monitoring their blood pressure at home, thus promoting self-reliance in managing their health condition.\ \ 2. Nursing is needed when an individual is unable to maintain continuous self-care.\ \ \>Nurses provide compensatory care (e.g., post-stroke care) when patients cannot meet their self-care needs.\ \ Explanation: Orem\'s theory assumes that nursing care becomes necessary when patients experience self-care deficits and cannot meet their own health care needs due to physical, mental, or emotional limitations.\ \ Example: A patient who has suffered a stroke may be unable to perform activities of daily living (ADLS), such as feeding, bathing, or dressing. In this case, the nurse steps in to provide wholly compensatory care, assisting the patient with basic needs until they regain some independence.\ \ 3. People are distinct individuals.\ \ \>Nurses tailor care to the unique needs of each patient (e.g., individualized diabetes education).\ \ Explanation: Each person is a unique individual with specific self-care needs, capabilities, and limitations. Care must be individualized to meet the specific needs of each person.\ \ Example: A diabetic patient who has limited knowledge about managing their condition is distinct from another diabetic patient who is well-versed in their self-care routine. The nurse tailors education and interventions according to each patient\'s unique understanding and ability, providing more comprehensive guidance for the less experienced patient and reinforcing good habits for the more experienced one.\ \ 4. A person\'s knowledge of potential health problems is necessary for promoting self- care behaviors.\ \ \>Nurses promote self-care by increasing patients\' knowledge of their health conditions (e.g.. heart failure education).\ \ Explanation: Orem assumes that knowledge about health conditions is essential for individuals to engage in self-care activities effectively. Without understanding their health needs, patients may be unable to make informed decisions about their care.\ \ Example: A nurse educating a patient with chronic heart failure about the signs and symptoms of fluid overload (e.g., weight gain, swelling, and shortness of breath) helps the patient recognize when to take action, such as adjusting their diet or contacting a healthcare provider. By increasing the patient\'s knowledge, the nurse promotes self-care behaviors that can prevent hospitalization.\ \ 5. Self-care and dependent care are behaviors learned within a socio-cultural context.\ \ \>Nurses respect cultural influences in caregiving (e.g., family Involvement in postpartum care).\ \ Explanation: Orem recognizes that self-care behaviors are influenced by an individual\'s socio-cultural background, including family values, cultural beliefs, and societal norms.\ \ Example: A nurse caring for a postpartum mother from a culture where family members are expected to assist with infant care would consider the family\'s role in the patient\'s self-care and recovery process. The nurse might involve family members in learning how to care for the newborn and the mother\'s postpartum needs, respecting the cultural practice of collective caregiving while still ensuring that the mother\'s health needs are met.\ \ 6. Humans are capable of learning and developing, and they can be taught to improve their self-care abilities.\ \ \>Nurses teach patients new skills (e.g., diabetes management), enabling them to become more Independent.\ Explanation: Orem\'s theory assumes that people can learn and improve their self-care abilities through education and support from healthcare professionals.\ \ Example: A patient newly diagnosed with type 2 diabetes may initially lack the skills to manage their condition. The nurse educates the patient on how to check blood glucose levels, administer insulin, and make dietary changes. Over time, the patient learns these skills and becomes more independent in managing their condition, moving from needing supportive-educative care to performing self-care with confidence.\ \ 7. Nursing is a form of action-interaction between two or more persons.\ \ \>Nurses work with patients through Interactions to assess needs and provide care (e.g., post- surgical education).\ \ Explanation: Orem assumes that nursing involves interpersonal interaction between the nurse and the patient. This interaction is essential for assessing self-care needs and providing the necessary interventions.\ \ Example: A nurse caring for a patient recovering from surgery actively Interacts with the patient to assess pain levels, teach post-surgical care (e.g., wound care, movement restrictions), and ensure that the patient understands discharge instructions. This Interaction helps the patient participate in their care and prepares them for independent management at home.\ \ Slide 4\ \ Definition: Orem defines nursing as a helping service that provides assistance to individuals who cannot meet their own self-care needs. Nursing Invoives helping individuals manage their self-care deficits by performing care for them, assisting them in self-care, or teaching them how to care for themselves. Application in nursing: Nurses assess the patient\'s self-care deficits and Intervene appropriately by providing total care, partial assistance, or education to enable the patient to achieve independence in self-care.\ \ On Nursing: It focuses on each individual\'s ability to perform self-care, defined as \"the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being.\"\ \ Nursing is an art, a helping service, and a technology.\ \ Goal of nursing - to render the patient or members of his family capable of meeting the patient\'s self-care needs\ \ Definition: Health is defined as a state of physical, mental, and social well-being. It is the ability to live life to its fullest and perform self-care activities that promote health and well-being. Orem\'s concept of health includes the person\'s ability to maintain structural and functional integrity. Application in nursing: Nurses support patients in maintaining health or managing Illness by helping them meet their self-care needs.\ \ Health health and healthy are terms used to describe living things\ \ It is when they are structurally and functionally whole or sound\... wholeness or Integrity. Includes that which makes a person human,\...operating in conjunction with physiological and psychophysiological mechanisms and a material structure and in relation to and Interacting with other human beings\ \ Slide 5\ \ Definition: Orem views the person as a self-care agent capable of engaging in self-care. Each person has the potential to care for themselves, but there are times when a person might be unable to meet their own self-care needs due to Illness, injury, or developmental limitations. Application in nursing: Nurses assess patients\' ability to perform self-care and determine when nursing interventions are required to help the patient achieve self-care.\ \ Humans are defined as \"men, women, and children cared for either singly or as social units\" and are the \"material object\" of nurses and others who provide direct care.\ \ A human being who has \"health-related/health derived limitations that render him incapable of continuous self-care or dependent care or limitations that result in ineffective/incomplete care.\ \ A human being is the focus of nursing only when a self-care requisites exceeds self-care capabilities\ \ Environment\ \ Definition: The environment consists of the physical, chemical, biological, and social factors that affect the person\'s ability to engage in self-care. Orem acknowledges the importance of external conditions in influencing health and self-care ability. Application in nursing: Nurses assess how environmental factors, such as living conditions, family support, or access to healthcare resources, impact the patient\'s ability to perform self-care. They also modify the environment to support the patient\'s health.\ \ Slide 6\ \ Dorothea Orem is primarily known for her Self-Care Deficit Theory of Nursing, but she did not develop a separate theory specifically called the \"Theory of Dependent Care\" as a distinct and widely recognized nursing theory. Instead, her work primarily focuses on self-care and the nurse\'s role in helping individuals meet their self-care needs, as discussed in the previous response.\ \ However, it\'s worth noting that Orem\'s Self-Care Deficit Theory encompasses the care of individuals who may have a self-care deficit and are dependent on others for assistance with their activities of daily living. In such cases, nursing care provided by healthcare professionals is designed to bridge the gap between the individual\'s self-care abilities and their self-care requirements.\ \ Orem\'s theory acknowledges that some individuals may be unable to perform self-care independently due to various factors, including illness, disability, or injury. In these situations, nurses play a crucial role in providing dependent care, which involves assisting patients with their self-care needs to promote recovery, maintain health, or manage chronic conditions.\ \ So, while Orem\'s theory primarily emphasizes self-care and the promotion of self-care independence, it implicitly recognizes the importance of dependent care when individuals are unable to meet their self-care needs on their own. Dependent care is an integral part of nursing practice, but it is not a separate theory developed by Orem. Instead, it is an aspect of nursing care that is addressed within the broader framework of her Self-Care Deficit Theory.\ \ Theory of Self-Care\ \ This theory focuses on the activities individuals perform on their own behalf to maintain life, health, and well-being. Self-care involves learned behaviors that individuals can practice to sustain health or manage illness.\ \ Example: Taking medication as prescribed, maintaining personal hygiene, and following a proper diet are examples of self-care activities.\ \ Slide 7\ Definition: Self-care is the practice of activities that individuals initiate and perform on their own behalf to maintain life, health, and well-being. It includes activities like eating, bathing. taking medications, and exercising. Application in nursing: Nurses assess the patient\'s capacity for self-care and provide interventions to promote self-care independence. For example, in a diabetic patient, the nurse teaches self-care skills like blood sugar monitoring and diet management.\ \ Self-Care Agency\ \ Definition: Self-care agency refers to a person\'s ability to engage in self-care activities. It is influenced by factors such as age, health status, and knowledge.\ \ Application in nursing: Nurses evaluate a patient\'s ability to care for themselves and determine whether they have a self-care deficit. For example, a patient with limited mobility after surgery may have reduced self-care agency and need assistance.\ \ Therapeutic Self-Care Demand\ Definition: The total self-care actions required to meet an individual\'s self-care needs.\ \ This includes the knowledge and skills needed to meet daily health maintenance activities.\ \ Application in nursing: Nurses assess the therapeutic self-care demand of the patient (e.g., medication administration, wound care) and provide interventions to meet\ \ that demand if the patient cagnot do it independently.\ \ Self-care requisites - action directed towards the provision of self-care. 3 categories of self-care requisites are-\ \ Universal self-care requisites\ \ Developmental self-care requisites\ \ Health deviation self-care requisites\ \ Slide 9\ \ Universal Self-Care Requisites\ \ These are basic self-care needs that are common to all individuals throughout life. They are necessary for maintaining health and well-being.\ \ Universal self-care requisites include:\ \ Air: Maintaining adequate oxygenation (e.g., breathing exercises for patients with lung conditions).\ \ Water: Ensuring proper hydration (e.g., teaching a patient to drink adequate fluids after surgery).\ \ Food: Maintaining a balanced diet (e.g., educating a diabetic patient on a low-sugar diet).\ \ Elimination: Managing waste elimination (e.g., assisting a post-op patient with bladder or bowel care).\ \ Activity and Rest: Balancing physical activity with adequate rest (e.g., encouraging a heart patient to take walks while getting enough rest).\ \ Solitude and Social Interaction: Ensuring a balance between time alone and with others (e.g., helping a patient find support groups to manage loneliness).\ \ Prevention of Hazards: Avoiding injury and promoting safety (e.g., teaching elderly patients fall-prevention techniques).\ \ Normalcy: Promoting a sense of normalcy in development and functioning (e.g.. supporting a child with developmental delays to achieve their growth milestones).\ \ Example: A nurse caring for a post-operative patient ensures that the patient meets their universal self-care requisites by monitoring fluid intake, helping with ambulation to prevent complications, and providing guidance on proper nutrition for recovery.\ \ Slide 10\ \ 2. Developmental Self-Care Requisites\ These requisites relate to the development of an individual over different stages of life. They address growth, maturity, and changes in health status. Developmental self-care requisites involve adapting to health-related challenges at different life stages.\ \ Developmental self-care requisites include:\ \ Developmental milestones: Supporting physical and cognitive development in children.\ \ Life transitions: Helping individuals cope with major life events such as adolescence, pregnancy, or aging.\ \ Developmental challenges: Managing chronic conditions, illness, or trauma during different life stages.\ \ Example: A nurse might help a pregnant teenager manage her pregnancy by offering education and emotional support, addressing both the developmental requisites of adolescence and pregnancy.\ \ Slide 11\ Health Deviation Self-Care Requisites\ \ These requisites apply when individuals experience illnesses, injuries, or disabilities. They address specific healthcare needs that arise from medical conditions or treatments.\ \ Health deviation self-care requisites include:\ \ Seeking and securing appropriate medical care: Encouraging patients to attend follow-up appointments after diagnosis.\ \ Carrying out prescribed medical treatments: Assisting patients in understanding and\ \ adhering to their treatment plans (e.g., taking medications or following dietary\ \ restrictions).\ \ Being aware of and attending to side effects: Educating patients about recognizing and managing the side effects of medications.\ \ Learning to adjust to changes in health status: Helping patients adapt to limitations caused by illness or injury (e.g., providing physical therapy support for stroke recovery).\ \ Modifying self-concept in light of health problems: Supporting patients in adjusting their self-image after an illness (e.g., counseling a cancer survivor on body image changes).\ \ Example: A nurse working with a diabetic patient ensures that the patient understands how to monitor their blood glucose levels, administer insulin, and recognize signs of hypoglycemia, thus addressing the patient\'s health deviation requisites.\ \ Slide 12\ \ Dorothea Orem\'s theory of nursing systems is a component of her broader Self-Care Deficit Theory of Nursing. This theory, often referred to as the \"Nursing Systems Theory,\" outlines how nurses and healthcare professionals organize themselves to deliver care to individuals with self- care deficits. Orem\'s Nursing Systenis Theory is essential in understanding how nurses and other caregivers work together to provide care and support to patients who are unable to meet their self-care needs independently.\ \ Here are the key components of Orem\'s Nursing Systems Theory:\ \ Wholly Compensatory System:\ \ This nursing system is employed when individuals are entirely incapable of meeting their self- care needs. In such cases, nurses assume full responsibility for all aspects of care.\ \ The nurse performs all required self-care activities on behalf of the patient, essentially compensating for the individual\'s inability to care for themselves.\ \ This system is typically used for patients who are acutely ill, critically injured, or completely dependent on others due to severe physical or cognitive limitations.\ \ Partially Compensatory System:\ \ In this nursing system, both the patient and the nurse share the responsibility for self-care.\ \ The patient is capable of performing some self-care activities but requires assistance with others. Nurses assess the patient\'s abilities and deficits and then provide assistance and support accordingly, focusing on the aspects of self-care that the patient cannot manage independently.\ \ Supportive-Educative System:\ \ The supportive-educative nursing system is utilized when individuals can perform most self-care activities but require education, guidance, or emotional support to maintain their health and well- being.\ \ Nurses serve as educators, counselors, and facilitators in this system, helping patients learn how to care for themselves effectively.\ \ Patients are encouraged to take an active role in their own care and decision-making, with nurses providing the necessary information and emotional support.\ \ Basic Conditioning Factors:\ \ Orem\'s theory also includes the concept of basic conditioning factors, which are factors or Influences that affect an individual\'s ability to engage in self-care.\ \ These factors include age, developmental stage, gender, environment, health state, and family and sociocultural factors. They can either support or hinder an individual\'s ability to perform self- care.\ \ In summary, Orem\'s Nursing Systems Theory recognizes that nursing care is not a one-size-fits- all approach. Instead, it outlines different nursing systems based on the degree of self-care deficit exhibited by the patient. The choice of nursing system is determined by the patient\'s abilities and needs, with the goal of promoting self-care independence whenever possible. This theory provides a structured framework for nurses to tailor their care interventions to the specific requirements of each patient, ultimately aiming to improve their health and well-being.