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Dorothea Orem and her Self-Care Model of Nursing Theory
Born in Baltimore, Maryland in 1914, Dorothea Orem went on to become a much-revered nursing leader in the United States, innovating, developing and teaching her self-care model up until her death in 2007. Her self-care model is in great use today and is the subject of this paper. Orem received her nursing diploma in 1939 (from Providence Hospital) and in 1945 she received her M.S. In nursing education from Catholic University of America (Sitzman, et al., 2010, p. 93). During her career, Orem worked as a staff nurse, a private duty nurse, a faculty member in a nursing college, a consultant and an administrator, Sitzman explains on page 93.
Orem's Self-Care Model
"Communication is the key to positive health results, particularly for patients with low literacy skills, yet few studies have examined patients' ability to converse about healthy information taught to them by providers…"(Wilson, et al., 2008).
Being a person who was vitally interested in good communication between nurses and patients, at the age of 45, Orem published her self-care model for the first time. Through the succeeding years, Orem's model was fine-tuned and practiced in the healthcare industry, and in 1980, she published the first edition of Nursing: Concepts of Practice (Sitzman, 93). The model offers several "major assumptions" according to Current Nursing. Among those assumptions: a) individuals should be self-reliant and to the degree possible, they should be responsible "for their own care and others in their family needing care"; b) people are "distinct individuals" and nursing is a "form of action-interaction" between two or more persons; c) a person's knowledge of "potential health problems is necessary for promoting self-care behaviors"; and d) "self-care and dependent care are behaviors learned within a socio-cultural context" (http://currentnursing.com).
Orem's self-care model is made up of three interrelated concepts, including "self-care, self-care deficit, and nursing systems" (Sitzman, 94). The first, "self-care" is what it appears to be as a phrase: it is what people plan to do "on their own behalf to maintain life, health, and well-being," Sitzman explains (94). Clearly, when individuals are knowledgeable and perform self-care effectively and competently, they are helping themselves to keep up proper human functioning, they maintain their structural physical integrity, and they are contributing greatly to their own human development and potential. Helping to fully expose the first concept, Sitzman offers a sub-concept to "self-care" which is referred to as "self-care agency." Self-care agency is actually an individual's "acquired ability to engage in self-care," Sitzman continues (94).
Those self-care abilities that individuals acquire are based on:
"Basic conditioning factors that include age, gender, developmental and health state, sociocultural factors, healthcare system factors, family system factors, patterns of living, environmental factors, and adequacy / availability of resources" (Sitzman, 94).
Orem's second concept, self-care deficit, is just what it seems to be on the surface: when a person is incapable of self-care, there may be a need for nursing intervention. Orem presents five methods for use when a person is incapable of helping his self, or incapable of helping another person in the household that is in a self-care situation: acting for and "doing for" another person; directing and guiding; offering psychological / physical support; teaching; and offering and maintaining a supportive environment (Sitzman, 95).
And the third concept (nursing systems) has three nursing approaches: a) the nurse does all the work required in teaching the person self-care and protects the patient; b) the patient and nurse work cooperatively to meet self-care needs; and c) the patient continues giving self-care and nurse and patient work together to regulate self-care (Sitzman, 95).
How Orem's Self-Care is put to Use in Nursing Practice
An article in the journal Issues in Comprehensive Pediatric Nursing looks into the issue of how well self-care practices work among adolescents (Callaghan, 2006, p. 1). In this survey, which used 256 adolescents from a Southern New Jersey High School, the researchers were seeking to "identify the influences of selected basic conditioning factors on the practice of health behaviors, self-efficacy beliefs, and ability for self-care" in the adolescents (p.1). There were several research instruments that were utilized in this research; the "Health-Promoting Lifestyle Profile II Scale (HPLPII); the Self-Rated Abilities for Health Practices Scale (SRAHP); and the Exercise of Self-Care Agency Scale (ESCA), Callaghan explains. In designing this research project, he researchers used Bandura's Self-Efficacy Theory, Pender's Health Promotion Model, and Orem's Self-Care Deficit Nursing Theory (Callaghan, p. 1).
In the HPLPII there were 52 items embracing health responsibility, physical action, nutrition, interpersonal relations, spiritual growth and stress management; in the SRAHP, 28 points covered variables of self-care and self-efficacy in exercise, psychological well-being, nutrition and health practices; and in the ESCA, there were 35 items for the adolescents to consider. Students that answered "Yes" to this question -- "Do you have a support system (family, friends, teachers, neighbors, healthcare providers, clergy) who you feel free to ask for help when needed?" -- practiced health behaviors, had higher levels of self-efficacy and has more "abilities for self-care" (Callaghan, p. 5). Students who said "Yes" to "Do you feel that your family has an adequate income to meet your daily needs" had more self-care abilities as well. What's the point of the study and what value is attached to the outcomes? Based on the findings of this research, nurses in school districts should be able to determine the "self-care deficits" within the demographics of the student body which students have the ability for self-care; indeed, students that report having a support system had more abilities for self-care than those who did not have a support system (Callaghan, p. 8).
How does Orem's self-care model apply to patients in burn care facilities? According to an article in the Journal of Burn Care Research, there is not currently a great deal of valid research with reference to a theory-based approach to the care of burn victims. That having been said, the article did two things: it pointed out the "deficiency of nursing theory in the specialty of burn nursing"; and two, it suggests that using Orem's Self-Care Model would be "valid basis for delivering care and increasing the level of professionalism in this specialty area" (Wilson, et al., 2009, p. 852).
The unique care needs of burn victims were correlated with Orem's three systems ("wholly compensatory system, partially compensatory system, and supportive/education system"); the burn victims had varying levels of "acuity" and that was the "key to understanding the application of this theory" (Wilson, 852). The authors suggest that more research needs to be conducted into theory as it applies to burn victims; and that "no single theory addresses each aspect of care precisely" (852). However they add that while "Orem's theory is quite applicable to burn care, two other theories are also applicable (Watson's Caring Theory, and Roy's Adaptation Model") (852).
A 2007 article in the European Journal of Cardiovascular Nursing reports that following a study of the value of using Orem's self-care deficit nursing theory (SCDNT), it was found that the self-care model "provides a comprehensive and holistic approach to the care of people in coronary care" (Timmins, 2006, p. 32). This study was conducted over a five-year span of time as researchers investigated existing studies from Hong Kong, Finland, Canada and the U.S. that related to the use of SCDNT in medical procedural situations. Not many applications were found specifically relating to the use of SCDNT in cardiac environments. However on page 36 the authors insist the model could be a "particularly useful guide" for the education of patients "leaving coronary care" because those leaving coronary units "report information deficits" (Timmins, 36).
The literature reviewed over five years "abounds with papers suggesting the identification of individual patient information needs and the provision of structured in hospital education" (Timmins, 36). Moreover, patients are known to require useful information in order to lessen the stress they experienced doing through cardiac operations, hence coronary care nurses should heed Orem's view that nursing systems are really just "helping systems"; the patient must have the tools and the knowledge to help himself once he's out of coronary care, Timmins continues. In conclusion, Timmins writes that notwithstanding the dearth of practical application within the literature -- which limits the understanding and application of the Orem model in practice -- it could be and should be used as part of education programs for patients following angioplasty (37). After all, Timmins concludes (37), nursing is at "a crossroads" having abandoned "archaic" rituals like insisting patients be confined to bed following myocardial infarction; it is time, Timmins insists, to utilize Orem's model in coronary units.
An editorial in the International Journal of Nursing Practice (Pearson, 2008) lists Orem's list of basic human needs (air, water, food, digestive systems, rest and activity balance, socialization, prevention of hazards, and social development / human functioning ) and adds that Orem has identified two "further categories of self-care requisites that arise out of the influence of events" mentioned above. When…[continue]
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