Orem's Self-Care Deficit Theory in nursing practice

Orem's Self-Care Deficit Theory

Topic self-practice model

Using Orem's Self-Care Deficit Theory to care for the patient and the nurse

Using Orem's Self-Care Deficit Theory to care for the patient and the nurse

The need for patient self-care has been increasingly emphasized within the healthcare system for economic and social reasons. More and more patients are being cared for at home, often by individuals such as family members who lack formal healthcare training. This requires patients and family to become better-versed at administrating care to themselves and others. Additionally, preventative medicine, or preventing illness from occurring through appropriate diet, exercise, and other prophylactic treatment is seen as more cost-effective and better for the patient's overall health. Orem's Self-Care Deficit Theory, which emphasizes recognizing, and addressing patient self-care deficits, and promoting patient self-care whenever possible seems uniquely beneficial in addressing such concerns. Additionally, it also provides guidance for the practitioner of medicine about how to engage in effective self-care, to deal with the stresses of the current healthcare environment.

Orem's Self-Care Deficit Theory

Today, nurses are more and more frequently asked to take on new responsibilities, to "focus on health care problems involving multi-system disorders, co-morbidity, case complexity, and duration of health care needs which impact the clients' ability to care for themselves" (Hohdorf 2010: 19). Nurses are also called upon to "actively control the length of stay in hospitals and ensure that health deviation self-care requisites are met by the patients and their dependent care agents when they are discharged from hospital" (Hohdorf 2010: 19). The increased importance of self-care for patients because of institutional changes in medicine makes Orem's Self-Care Deficit Theory uniquely relevant. Orem (1997) "postulated that people can and want to learn self-care. In order to meet what she defined as self-care requisites, they use their self-care abilities (or access help in the form of a dependent-care agent) to meet the demands they face. As long as self-care abilities equal or exceed self-care demands, they (or their dependent care agents) have no need for nursing. When the demands exceed the abilities, a self-care deficit occurs" (Hohdorf 2010: 20). The individual is viewed as inherently capable of performing self-care, and even when in a state of deficit, of desiring to perform self-care. Rather than wholly assuming responsibility for all of the patient's needs, the nurse must identify deficits and remedy them, while still facilitating the patient's capabilities in the area where he or she is still functional.

These needs may be physical, but they may also be psychological or spiritual in nature. A patient undergoing treatment for cancer, for example, may need the nurse to remedy his or her self-care deficit regarding the administration of chemotherapy, and to be taught how to administer anti-nausea medication at home. Psychologically, the patient may need someone to talk to like a nurse who has seen other people go through the same experience, because he or she cannot 'self-treat' his or her psychological distress. Spiritually, the nurse can help deal with the patient's fears of what may happen to his or her family, if the patient does not survive.

Implementing into practice

In my practice, Orem's theory is a reminder to encourage patients to be independent as possible, within the bounds of their health issues. Although it can be difficult, encouraging an older person who is about to be released to the care of patients to engage in basic self-care, like reviewing her medicine schedule or showering with minimal support, is ultimately beneficial for the patient's prognosis, as well as psychological and spiritual outlook. However, forcing a patient beyond the capabilities of his or her self-care threshold can be dangerous, and also psychologically discouraging. Also in line with Orem's Self-Care Deficit Theory I will also try to be vigilant to recognize that even when someone is physically capable (like the adult child of a dying parent) of self-care, he or she may need other self-care deficits to be remedied, to be fully functional (such as the need to be referred to counseling, to deal with the loss of a parent or the stressors of being a caregiver).

Conclusion

From my own perspective, as a nurse, I will also continue to monitor myself for self -are deficits. I know that I am most fully functional in my profession when I am eating and sleeping regularly as much as my schedule allows. I will try to work with my fellow nurses so that we are scheduled in a manner that does not result in overwork, or certain nurses working too many nighttime or double shifts. And nurses like myself must be mindful when they need support, either when providing care to patients, or psychological support when performing difficult duties.