Theory Analysis and Application Orems Self-Care Framework

Marsha Lester-Williams

Objectives
Theory influences Definition of Self-Care Orems Background/Education Approach, Theory, and Concepts Nursing Metaparadigm Usefulness of the theory Case Studies

Influences leading to Development of the Self-Care Theory

Orem worked as a nurse for many years. She noted:
Difficulty of nurses to communicate needs to hospital administrators.

Initially wanted to express what nursing is (International Orem Society, 1998, p. 9). Why do people need nursing? must be answered

What is Self-Care Theory

The theory of self-care describes the requisites necessary to maintain self-care through a delicate balance between self-care abilities and self-care demand (The University of Tennessee at Chattanooga, 2006, Philosophy Section, para 2).

Orems Background
Born in Baltimore, Maryland: 1914 Father Construction Worker

Mother Homemaker

Orems Education
Early 1930s Diploma of Nursing 1939 B.S. in Nursing Education 1946 M.S. in Nursing Education 1976 Honorary Doctorate, Georgetown University 1980 Honorary Doctorate, Incarnate Word College 1988 Honorary of Humane Letters, Illinois Wesleyan University 1992 Honorary Fellow of the American Academy of Nursing 1998 Doctor of Nursing Honoris Causae, University of Missourri

Orems Nursing Experience

Operating Room

Private duty

Hospital staff nursing Pedi/Adult Med Surg

Orems Nursing Experience

Emergency Room Supervisor

Biological Science Teaching

Orems Professional Background

1940-1949
Director of nursing school and department of nursing

1949-1957
Division of Hospital and Institutional Services of the Indiana State Board of Health

After this time, she developed her goal and definition of nursing practice

Approach to Theory
Theory of Self-Care Deficit Composed of:
Three related theories
Self-care Self-care deficit Nursing systems

Inductive

Theory Concepts
Self-Care
Self-Care Agency Self-Care Requisites
Universal Self-Care Requisites Developmental Self-Care Requisites Health Deviation Self-Care Requisites

Self-care Deficit Nursing Systems

Wholly-Compensatory System Partially-Compensatory System Supportive-educative System

Self-Care Agency
Normalcy

Prevention of Hazards Balance Between Solitude & Interaction

Balance Between Rest & Activity

Management of Elimination & Excrements

Air, Food, & Water

Similar to

Ministry of Agriculture, Food and Rural Affairs, 1997

Concepts: Nursing Metaparadigm

Nursing

Person

Health

Environment

Theory Application
Usefulness of Theory
Broad applicability
Individualized patient care
In-patient care Out-patient care

Community care Psychiatric care Health promotion

Research
Psychosocial health, pain, diabetes, abuse, nutrition, cancer, etc

Education
Several Nursing Programs are grounded in Orems Framework

Administration

Practice Project: Family Practice

Self-care is assessed upon patients entry into the family practice setting. Many deficits identified are categorized as partially-compensatory or educative.

Practice Project: Family Practice

Case study
Patient with diabetes enters the practice area and is assessed

Patient Assessment
Dimension Air Water Food Assessment Smoker Verbalizes frequent urination Verbalizes non-compliance with prescribed diet Dimension and Intervention Education/support-risks of smoking and increased risk for diabetic patient Education/support-discussed benefits of adequate hydration and benefits to the diabetic Partially compensatory-discussed diet and encouraged blood sugar checks and routine FU with healthcare provider for monitoring and patient centered planning of care. Discussed culturally sensitive diet and possible adaptations. Educative/support-related to polydipsia Education/supportive-Encouraged exercise routine and stressed benefits for the diabetic patient. Supportive Encouraged continued interaction. Referred to support group for diabetics.

Elimination Activity and Rest Solitude and Social Interaction

No problems Does not exercise regularly

Hazard Prevention

Promote Normalcy

Talkative and frequents social clubs. Does not like to socialize with family due to diabetes and shame of non-compliance. Demonstrates safety with insulin syringes and knowledge of medications and effects. Requires dietary modifications to maintain blood glucose. Patient states that this causes him distress.

Supportive/educative-encouraged continued compliance. Encouraged compliance due to healthcare related concerns with patient care if non-compliant. Educative-supportive Referred to support group and discussed normal lifestyle attainable with proper management.

Practice Project: Psychiatric

Psychiatric Nurse Practitioners have a distinct role in mental health services Self-care is the goal of mental health nursing services

Practice Project: Psychiatric Theory Implementation

Identification of patients with actual or potential self-care deficits related to mental health issues
Comprehensive psychiatric/mental health history and assessment:
Life events Neurobiological factors Cognitive abilities Precipitating events Family dynamics and social support systems Patient insight, beliefs and feelings Severity of symptoms Willingness to learn Strengths and limitations

Practice Project: Psychiatric Theory Implementation, Contd.

Main focus:
Specific to patients diagnosed with Schizophrenia
Recognition of delusions/hallucinations Identification of self-care actions Determination of self-care actions necessary to achieve therapeutic self-care demands

Practice Project: Psychiatric Evaluation

Most patients demonstrated the ability to identify self-care deficits Several required wholly compensatory intervention

Additional Theorists
Henderson
Patient viewed as an individual needing assistance toward achieving independence

Ima Jean King

Interacting Systems Framework and Middle Range Theory of Goal Attainment

Research Questions
What is the effect of hallucinations on selfcare agency and how are individuals capability to engage in their mental health care measured? The relationship of factors related to selfcare in the medical professional and how this affects adherence and self-care agency.

Evaluation and Conclusion

Orems Self-Care Deficit Model is broadly applicable. This practice project demonstrated the need for careful assessment of patient self-care requisites, identification of therapeutic selfcare demands, improvement of self-care agency, and assistance in developing selfcare systems.

Questions/Comments?

References

Cody,W.K. (2006). Philosophical and theoretical perspectives for advanced nursing Practice. (4th. Ed.) Sudbury, MA: Jones & Bartlett. Comley, A. (1994). A comparative analysis of Orems self-care model and Peplaus interpersonal theory. Journal of Advanced Nursing, 20(20), 755-760. Retrieved November 20, 2007 from: CINAHL Plus Database. Hanucharurnkul, S. (1988). Comparative analysis of Orems and Kings theories. Journal of Advanced Nursing, 14(5), 365-372. Retrieved November 20, 2006 from: CINAHL Plus Database. International Orem Society Newsletter.(1998). November Edition. Retrieved November 20, 2007 from: http://www.scdnt.com/download/NL-Vol6Ed2-1998.pdf Grando, V. (2005). A self-care deficit nursing theory practice model for advanced practice psychiatric/mental health nursing. Self-Care, Dependent-Care & Nursing, 13(1), 4-8. Retrieved Monday, November 11, 2006 from the CINAHL Plus database. Ministry of Agriculture, Food and Rural Affairs. (1997). Maslows hierarchy of needs. Retrieved November 21, 2006 from: http://images.google.com/imgres?imgurl=http://www.omafra.gov.on.ca/english/rural/facts/96001f1.gif&imgrefurl=http://www.omafra.gov.on.ca/english/rural/facts/96001.htm&h=573&w=597&sz=16&hl=en&start=16&tbnid=AuW7iE2pMm_FqM:&tbnh=130&tbnw=135&prev=/ima ges%3Fq%3DMaslow%2527s%2BHeirarchy%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DG The International Orem Society. (1993). October 1993 Newsletter. Retrieved November 16, 2003 from: http://www.scdnt.com/download/NL-Vol1Ed1-1993.pdf Orem model of nursing. Retrieved November 15, 2007 from: http://en.wikipedia.org/wiki/Orem_model_of_nursing The University of Tennessee at Chattanooga. (2006). School of nursing. Retrieved November 12, 2006 from: http://www.utc.edu/Academic/Nursing/philosophy.php Tomey, A. & Alligood, M. (2006). Nursing theorists and their work.St. Louis: Elseveir. West, P., & Isenberg, M. (1997). Instrument development: the Mental Health-Related Self-Care Agency Scale. Archives of Psychiatric Nursing, 11(3), 126-132. Retrieved Monday, November 11, 2006 from the CINAHL Plus database.