Orem's self-care deficit nursing theory model

Orem's Model Of Self-Care And Contemporary Nursing

Orem's self-care model of modern nursing was first developed to address the basic care needs of individuals who were unable to perform the basic functions of self-care as they were accustomed to, such as soldiers returning from wartime. However, this nursing model continues to be highly useful to nursing practitioners today. This is especially true given the increasing dependence of elderly patients upon family support systems for basic care, as well as the need for families to deal with individuals in a state of crisis within the family structure. The essential features of the model are addressing the self-care needs of the patient by the nurse through assessment and facilitation. The model deals with the responsibilities of the nurse practitioner to the patient in assessing the patient's ability to care for him or herself on a daily basis, how this care can be improved, and providing essential aid to individuals who cannot perform basic functions of self-care. (Orem, 1995) The nurse is a facilitator and a provider of care only when the patient's ability to care for him or herself in a variety of ways is absent.

First, in terms of assessment, Orem's model 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. (Orem, 1995) When an individual cannot fulfill these functions, a nurse practitioner may step in as a facilitator, to act as an enabler to the individual to provide basic means of care.

When asking if an individual is capable of self-care, the intimates of that person as well as the nursing practitioner must ask, even if there is a temporary deficit in self-care, will this potentially improve? For instance, in the case of a child, is the practice of daily activities likely to eventually be able to be performed by the individual over the course of the maturing process? This does not mean that intervention may or may not be necessary in a pediatric context, but is important in assessing the needs of temporary or long-term care, and if nursing care is required. (Fawsett, 1995)

Particularly in the case of an adult, when assessing care needs the practitioner must next ask the question, does the capacity of self-care seem to be diminished or diminishing, as with an elderly or disabled person? Can, with instruction, the individual find new ways of performing self-care? Can a newly blind individual or a cataract-afflicted elder find a way of getting around other than driving, for example? Or must other persons aid the patient in the skills of life maintenance? Thus, according to Orem's model, self-care is defined as key to human functioning and to nursing, not simply in its relations to healthful functioning of the body, but as it is related to emotional personal development and a sense of self-empowerment and a more generalized sense of well being and functionality in the world. (Orem, 1995) If an individual cannot establish connections with the community, a nurse must be aware of this and facilitate means for the individual to find such connections. It is not enough just to care for an elderly patient who is suddenly home bound in a physical sense; the nurse must treat the whole person in all social and psychological aspects of health care.

Orem's model suggests that for all persons, improving self-care is a goal as well as a necessity. Of course, the maintenance of enough air, water and food is a necessity that is perhaps obvious to the eye of most nurses. Every time a nurse cares for and evaluates a patient, in essence, the nurse asks is the individual able to feed him or herself and maintain his or her body abode in a healthful manner? If not, what must he nurse do to enable a state of homeostasis in that individual's environment to take place? But Orem also stresses the nurse, in assessing self-care must regard whether the individual him or herself can identify when that patient's body or abode is under threat -- for instance, can an elderly person take precautions when cooking? Will he or she know when the stove is left on or off? On the most basic of levels, of course, self-care regarding the provision of elimination and excrements and the basic functional tasks of physical maintenance are necessary. But less obviously, in terms of wellness, a nurse must ask, can the individual maintain a balance between activities and rest? Will an unattended child, for instance, tire him or herself out but refuse to go to sleep? Or can an adolescent get him or herself out of bed on time, to be functional for school or will he or she burn the midnight oil, partying into the wee hours of the night, if left alone? (Orem, 1995)