The theory stems from totality paradigm based on adaptation to one’s environment (Masters, 2014). Thanks to this theory there has been improved quality of care from numerous randomized controlled trials carried out in the nursing discipline. Many use this theory especially in primary care and rehabilitation settings where patients are encouraged to strive for independence.
That is one of the main caveats of the theory when applied to primary care or rehabilitative settings. To have patients achieve independence as soon as possible part of the adaptation aspect of the theory. Human beings have the amazing ability to adapt to their surroundings. Therefore, creating an environment where they can achieve independence quickly may produce better results, better outcomes.
Orem herself, described the model as a general theory consisting of three related theories. “The three inter-related theories include the theory of self-care, the theory of self-care deficit, and the theory of nursing systems” (Masters, 2014, p. 154). These three parts of theory focus not on the individual, rather on persons in relations. The emphasis is on the ‘I’, the ‘you and me’, and the ‘we’. When applying these three theories together, it generates Orem’s personal theory. Meaning, if there is no one there to care for the patient, there is a model that exists for self-care.
Imagining how this can be applied to my practice as an emergency department nurse, there are patients often that must wait hours to be seen. In their state of pain and anxiety, a nurse can come over and help them get over such a frazzled state. The nurse can teach the patient for example, to elevate a leg if it is in pain, or take deep breaths if one is anxious. These things teach the patient independence and allows them to adapt to the current situation.
There is the expectation in the theory that patients want to take care of themselves. When they are permitted to take care of themselves to the best of their ability, the assumption is that they recover quicker and holistically. Orem in her theory, identified self-care requisites and are classified as either:
· Developmental self-care requisites that are 1 of 2 things, maturational: progress toward higher levels of maturation and situational: aversion of deleterious effects associated with development
· Universal self-care requisites: those needs everyone has
· Health deviation requisites: needs arising from a patient’s condition (Parker, 1993).
There are also self-care deficits that mean a person cannot meet his or her own self-care requisites. This is when the nurse determines these deficits and defines support modalities.
Bringing this back to my practice, there can be patient who is obese and needs his blood pressure measured. He is writhing in pain and cannot sit still to take the reading. Now because of the person’s weight, a regular pressure cuff cannot fit, so a larger one can be used. The nurse has to determine if the patient can sit still or not. If not due to pain, the nurse can give the patient a pain killer to then take the reading.
Some recent literature points to a long time before patients receive pain relief for injuries in the emergency department. “The median time to pain medication administration for patients presenting to our ED with extremity fractures was 72.5 minutes” (Heilman, Tanski, Burns, Lin, & Ma, 2016, p. 1). If the patient is suffering an extremity fracture, there should be a shorter window of time to administer pain medication. While theoretically, this seems viable, practicality may lend to a different interpretation. But that is the point of nurse theory and theories like Orem’s. It is to think differently and see where it leads.
At times patients cannot support themselves and experience self-care deficits. That is where Orem’s theory includes support modalities. Meaning, nurses are encouraged to recognize and rate a patient’s dependency or any of identified self-care deficits on the following scale:
1. Partial Compensation
2. Total Compensation
3. Education/Supportive (Meleis, 2012).
Total compensation is when there is an utter lack of independence on the part of the patient. This means the nurse needs to assist the patient in everything. Partial Compensatory, means a patient can do some things like for example, go to the bathroom on their own, but needs help to walk. Educative/Supportive, in this system, means a patient is independent, but needs assistance in behavior control, decision-making, as well as getting hold of information (Meleis, 2012) (Abotalebidariasari, Memarian, Vanaki, Kazemnejad, & Naderi, 2016).
If this were to be seen through my practice, three patients could be in the emergency department. One is bedridden and cannot move because of recent surgery. This person needs complete help in everything. Another person, who underwent minor surgery needs help with bathing but can take his or her own medication. And the last one, a patient experiencing an infection, that just needs an education on proper antibiotics.
Orem described a nurse in terms of a counselor, advocator, educator and teacher. This is true. Orem included the concept of inductive and deductive thinking in this theory and provided the stage from which to understand the various complexities of patient recovery (Dickson, Buck, & Riegel, 2011). Overall, one can understand how important theory is in relating to patients, in…
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