Application of Orem's self-care theory in ICU nursing practice

Orem's Theory And Critical Care

Background- The 21st century nursing profession has a greater exposure to new technologies, methods, and techniques than any other in the past. In fact, "the use of clinical judgment in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death" is one of the definitions of modern nursing (Royal College of Nursing, 2003). While this is certainly the case, it is also important not to lose touch of the holistic approach -- that of advocating and caring for the patient based on their individual needs. One approach that can help the nurse manage patient care and advocacy is the theory of "Self-Care Deficit," based on the book Nursing: Concepts of Practice (Orem, 2001).

Orem found the medical care system Post-World War II more attuned to disease than cure. She not only believed that quality of care and advocacy in hospitals should be improved and upgraded, but that patients should take some of the overall responsibility for their care and management of their own ability to deal with illness. . Orem's model has three major templates: 1) Nursing is required because of the individual's inability to perform self-care in many medical situations, 2) As adults age, they deliberately learn and master actions that help direct their survival, quality of life, and well-being, and 3) The product of nursing systems should be a nurses advocacy to help people meet their self-care requirements and avoid dependency on others (Dorthea Orem, 2010).

The nurse's role is not continual care with no prospect of improvement or change, nor is it to dispense medication without explanation. Instead, it is self-advocacy in helping the patient understand their issues, their care needs, learn to perform self-care, and remaining independent as long as possible. Educating clients and families then gives a greater level of empowerment and less need for complete dependence on the system (Alligood and Tomey, 2005, pp. 255-9)

In some ways, this is problematic in the ICU paradigm. For the ICU nurse, there are two major concerns: 1) Advanced technology is not conducive to the use or a holistic care model and tends to quantify body functions, and 2) Technology cannot care for the whole being in a health crisis. Instead, holistic caring, empathy, interconnection of experiences and need/response remain crucial for ICU nurses so they do not lose sight of the person in need (Hurlock, 1999).

Plan for Using Orem in a Critical Care Application -- ICU patients, in general, are more needful of robust medical care. However, self-care for Orem is the ability to interact with the environment as a patient to provide well-being. The theoretical precept is the potential for self-care. Even neonates can use behaviors to signal needs, and thus the potential is the basis from which to work via Orem. Each of the aspects below uses Orem's three pronged approach:

Universal Self-Care Requirements

Self-Care Abilities

Self-Care Limitations

Theoretical Aspect

ICU Implementation

Theoretical Overview

Appropriate training and use of resources to learn how to apply Orem's theories.

Introduction of the Client

Seeing the client as a whole person; not just a burn victim, but a client with a name, a history, and a potential.

Assessment

Clinical assessment of the client's needs based also not just on technology, but on personal nursing interaction.