Orem's Theory in Nursing

Theory Application: Dorothea Orem’s Self-Care Theory
Introduction
Dorothea Orem was born in Baltimore, Maryland, in 1914 and received her BSN in 1939 and her MSN in 1945. She was a staff nurse, a private duty nurse, a nurse educator and a nurse consultant throughout her career. In 1976 she was awarded an honorary Doctorate of Science for her work in the nursing field. Her theory of self-care was published in 1971 (Nursing Theories, 2012). This paper will describe the theory, my rationale for selecting it, how it could be implemented in a hospital setting, what barriers to implementation there might be and how to overcome them.
Theory
Underlying Orem’s theory of self-care is the assumption that self-reliance is a quality people should possess for the sake of their own health. Inherent in the theory is the idea that by boosting a patient’s health literacy, the patient’s ability to engage in self-care and be self-reliant increases. Orem’s contribution to nursing was based on the observation that dependent care was a behavior that was learned by people in modern society and that, as such, it could be unlearned so that self-care could be taught (Orem, 1991). The theory of self-care showed that patients, so long as they were physically and mentally able, could initiate and provide care for themselves and thereby effectively maintain a healthy lifestyle.
One of the most important features of this theory is that it emphasizes the need of nurses to educate their patients so that the patients can embark upon self-care. As self-care is ultimately preventative in nature, the increase of health literacy to enhance self-care aligns with preventative care. The nurse’s duty is to assess the health of the patient, obtain information on the patient’s perspective of health; identify health goals, lifestyle of the patient and so on; evaluate the patient’s needs in terms of self-care, and decide the patient’s ability to provide self-care. With that information, the nurse then designs a system to enable self-care, using an educative process so that the patient learns and knows how to conduct self-care in an effective manner (Whelan, 1984).
Rationale
My rationale for selecting this nursing theory is that it is rational and aligns with the need for more preventative care in hospital settings. Patients come to hospitals for care because they do not have a high level of health literacy, which they could use to engage in self-care. If patients were simply taught the very basic steps of self-care for their individual health issues, there would be less need and less dependency upon the hospital for care. This would in turn free up space in the hospital for other patients and increase access to care for patients who require it. By increasing the general knowledge of patients, the nurse can better assist the population and prevent further health illnesses from forming.
The strengths of this nursing theory are that it allows the nurse to have a comprehensive foundation for nursing practice, and it has a great deal of utility in the field and works to empower both nurses and patients. The theory is good at showing where and what kind of nursing actions are needed based on the framework it provides. And finally the theory aligns with modern approaches to health, such as the need for preventative care to be increased in hospitals, which is something the Affordable Care Act was meant to do. Other theories, such as Leininger’s transcultural nursing theory, offer good insights into strategies a nurse could use when treating a patient, but they do not get to the heart of what it means to be a nurse in the same way Orem’s theory of self-care does. Orem shows that the goal of the nurse should be to empower the patient so that the patient is not dependent upon the hospital for all things. The patient can be shown how to care for himself, prevent illness and live a healthy life—and all it takes is to follow the steps of the theory.
Implementation
To implement this theory in the hospital setting basically requires the nurse to follow a few basic steps:
1. Collect data on the patient on six different points:
a. The patient’s health status
b. The doctor’s perspective on the patient’s health status
c. The patient’s own perspective on his or her health status
d. The patient’s health goals
e. The patient’s requirements for providing self-care
f. The patient’s capacity to provide self-care
2. Once the previous information is collected and none of the points serves as a deal breaker for self-care, the nurse can design a system for the patient that will enable the patient to overcome whatever self-care deficits exist—whether these are knowledge-related, resource-related, or support-related.
3. Provide assistance to the patient so that the self-care goals can be obtained.
4. Assess and evaluate the patient to ensure that self-care is working and being applied effectively.
This basic plan could be utilized in the hospital setting by all nurses treating patients in virtually any department.
Barriers to Implementation
Barriers to implementation of this theory tend to be the nurse’s ability to communicate the education required for the patient to understand the process of self-care. Sometimes there is a block between the patient and the nurse that the nurse does not know how to overcome. This is where training in raising health literacy of the patient can be effective. Leininger’s transcultural care theory can also be effective here because it shows the nurse the importance of having a competency in cultural understanding. Sometimes nurses who understand the patient’s culture very well are better prepared and able to explain the need for self-care, how to engage in self-care, and why the patient should embrace it. Nurses may also resist applying this theory because they are unsure of its effectiveness. Just like patients, nurses also need education and this barrier can be overcome through education in the nursing school or in additional training on the job.
Conclusion
This paper has shown the Orem theory of self-care is an effective way to practice preventative medicine. It increases the patient’s health literacy, provides the patient with the know-how needed to engage in self-care, and ultimately empowers the patient to take ownership of the care process instead of being dependent upon the hospital for all types of care. It especially useful because much of what sends a person to the hospital is something that could have been prevented had the patient just known how to engage in self-care in the first place. The nurse has to be able to assess the patient initially to see if the patient meets all the requirements for being a candidate for self-care, but so long as they are met, the nurse can promote it.

References
Nursing Theories. (2012). Retrieved from
http://currentnursing.com/nursing_theory/self_care_deficit_theory.html
Orem, D.E. (1991). Nursing: Concepts of practice (4th ed.). St. Louis, MO: Mosby-Year
Book Inc.
Whelan, E. G. (1984). Analysis and application of Dorothea Orem's self-care practice
model. Journal of Nursing Education, 23(8), 342-345.