Orem's Theory of Self Care Deficit

Orem's theory viewed nursing as an act of helping those who are self care deficit with best nursing care. She described her theory into three interrelated concepts, viz., Theory of self care , Theory of self care deficit, Theory of nursing system.

1. SELFCARE DEFICIT THEORY OF NURSING DOROTHEA E.OREM

2. CREDENTIAL AND BACKGROUND OF THE THEORIST 1914 - Dorothea E. Orem was born in Baltimore, Maryland 1930 – She received her diploma in Nursing 1939 – She received her Bachelor Science in Nursing Education 1946 – She received Master of Science in Nursing Education both in Catholic University in America.

3. 1976 – Honorary degree of Doctor of Science from George Town University 1971 – First published Book in Nursing; Concepts of practice 1984 – Retired and continues to work on SCDN Theory

4. OREM’S GENERAL THEORY OF NURSING THEORY OF SELF CARE SELF CARE DEFICIT THEORY THEORY OF NURSING SYSTEMS

5. The theory of Self Care – which describes how people care for themselves. The theory of self care deficit – describes how people can be helped through Nursing. The theory of Nursing systems – describes the relationships that must be brought about and maintained for nursing to be produced and how self care Agency is developed.

6. SIX CONCEPTS Self care Self care agency Therapeutic self care demand Self care deficit Nursing agency Nursing system

7. THE THEORY OF SELF - CARE Self care is performances (or) practice of activities, that individual initiate to perform on their own to maintain life, health, personal development and well being . Self care requisites :- Actions to be performed for human functioning and development. The complexity of self care or dependent care system is increased due to health deviation requisites.

8. SELF CARE REQUISITES Actions to be performed for human functioning and development. Universal 3 categories Developmental Health deviation

9. UNIVERSAL SELFCARE REQUISITES :- These needs are common to all. The maintenance of a sufficient intake of air, water and food The provision of care associated with elimination process The maintenance of balance between activity and rest Prevention of hazards to human life. The maintenance of balance between solitude and social interaction.

10. DEVELOPMENTAL SELFCARE REQUISITES:- Conditions that promote development Maintenance of maturational body changes (Aging). Self development - New job, New family. Prevention of life situations that can adversely affect human development. (Loss of spouse, change in Image)

11. HEALTH DEVIATION SELFCARE REQUISITES:- These self care requisites exist for persons who are ill or injured, who have specific forms of pathological conditions or disorders, including defects and disabilities. Physiological – care demand due to pathological conditions

12. Injury to the integrated human functioning – MR, Comatose, Autism Power of Agency are seriously impaired  (CVA, Paraplegia)

13. THERAPEUTIC SELF CARE DEMAND:- It refers to self care activities required to meet the self care requisites. If the Selfcare Agency is unable to meet the therapeutic care on their own, Nursing agency to carryout deliberate actions.

14. THEORY OF SELF - CARE DEFICIT Occurs when the self care capabilities within the selfcare agency are not adequate to meet the projected selfcare demand.

15. SELF CARE AGENCY:- What the individual can do? Self care agency is the human’s ability or power to regulate their own human functioning and development. Self care abilities are influenced by age, life experience & socio cultural background.

16. NURSING AGENCY :- Nurse – helps others to meet their therapeutic self care demands, or developing their own Self Care Agency.

17. DEPENDENT CARE AGENCY :- A person who fulfills the responsibility to meet the therapeutic self care demand of relevant others who are socially dependent or Family members. Dependent care deficit : If relatives are unable to take care of the patients. (Institutionalizing MR/Cerebral palsy children)

18. OREM’S CONCEPTUAL FRAME WORK FOR NURSING PATIENT Self care needs – abilities of the patient to perform self care activities. If self care deficit – occurs, what individual can do is self care Agency. What needs to be done to maintain optimum functioning is (self care demand). It is done by Nursing agency or dependent Agency.

19. < = Deficit relationship, Current or Projected CF = Conditioning factors CF SELF – CARE SELF – CARE AGENCY DEFICIT NURSING AGENCY R < CF R SELF – CARE DEMANDS R R R CF

20. THEORY OF NURSING SYSTEM The nursing system is designed by the nurse. It is based on the self care needs or dependent care of the patient to perform self care activities if there is a self care deficit. (Selfcare Agency) If there is deficit between, what individual can do (self care agency) and therapeutic self care demand then the Nursing Agency is required.

21. CLASSIFICATION OF NURSING SYSTEMS 3 Systems:- WHOLLY COMPENSATORY PARTLY COMPENSATORY SUPPORTIVE EDUCATIVE

22. I. WHOLLY COMPENSATORY NURSING SYSTEM When the individual is unable to engage in those self care action required, self directed and controlled. eg: Ambulation and manipulative movement or medical prescription to restrict from such activity.

23. Sub types :-  Unable to engage in any form of deliberate action (coma patient)  They can observe, judge and decide but could not perform ambulatory and manipulative movement. (C3 - C4 vertebral fracture) (Paraplegia and Quadriplegia)  Unable to attend to themselves, but able to perform some measures of selfcare with continuous guidance and supervision. (MR)

24. II. PARTLY COMPENSATORY NURSING SYSTEM Both nurse and patient performs care measures or other actions involving manipulative task or ambulation. e.g. Pt who had abdominal surgery.

25. III. SUPPORTIVE EDUCATIVE SYSTEM In this patient is able to perform or can and can learn to perform required measure of externally or internally oriented therapeutic self care, but cannot do so without assistance. Eg: Self administration of insulin injection. One or more of the 3 types of systems may be used with a single patient.

26. CLASSIFICATION OF NURSING SYSTEMS

27. Patient’s action is limited Nurse Action Accomplishes patient’s Therapeutic self-care Compensates for patients inability to engage in self-care Support and protects patients Performs some self-care measures for patients Regulates self-care agency Compensates for self-care limitations of patients Assist patients as required Performs some self-care measures Accepts care and assistance from nurse Accomplishes self-care Regulates the exercise and development of self care agency Nurse Action Patient action Patient action Nurse Action Supportive – Educative System Partly Compensatory System Wholly Compensatory System

28. METAPARADIGM :- 1. PERSON The patient is the recipient of nursing care . Human being who function biologically, psychologically and socially, has the potential for learning and development. If the person cannot learn self care measures, others must provide the care.

29. 2. ENVIRONMENT Consist of environmental factors. (External, physical and psychological) Promote Normalcy – Create an environment that allows to function as normally as possible.

30. 3. HEALTH Health state is characterized by soundness or wholeness of bodily structure and function, illness is its opposite.

31. Consist of physical, psychological, inter personal and social well being. According to Orem, these aspects are inseparable. Preventive health care includes promotion and maintenance of health, treatment of illness and prevention of complications .

32. 4. NURSING Nursing is needed when the self care demands are greater than the self care abilities. The art of nursing is, “The quality of individual nurses to make analysis of the conditioning factors with in Nursing situations, for effective assistance for individual”. Nursing prudence is the quality that enables the nurse to seek advice in new or difficult situation, to make correct judgment, to decide to act in a particular manner and to take action.

33. Nursing service as a helping service to human. She describe the ability of nursing agency is to maintain continuously the self care, when the adult/ children is unable to do. Role of nurse and patients are complementary, working together to achieve self care. Maintenance, Promotion, prescribing and providing, prevention, Teaching and NPR are the Nurses role.

34. THEORY APPLICATION Orem’s theory can be applied in Clinical practice while taking care of patient with, Organ Tx CVA Paraplegia ICU Patients – Critically ill, unconscious, Fracture Patient, Post Operative Patient, Asthma, CCF. Diabetic, HT, MI Post Operative children, critically ill children (Cardiac, Neuro Surgery, B.Tx Patient ) Caesarian pop

35. N / Care of patient with Colostomy Universal Self care requisites - Maintenance of Sufficient air - Ineffective airway clearance related to inability to clear tenacious secretions as manifested by abnormal breath sounds, low O2 saturation

36. - Maintenance of sufficient intake of food Imbalanced Nutrition: Less than body requirement related to  ed appetite as manifested by wt.loss. - Maintenance of sufficient in take of water Deficient fluid volume related to excess fluid loss, less intake of fluids as manifested by  ed urine output. Elimination Bowel incontinence related to presence of colostomy as manifested by frequent change of colostomy bag.

37. - Activity and rest - Activity intolerance related to POP pain as manifested by inability to perform selfcare Activities. - Fatigue related to Nut. deficits as manifested by inability to perform ADL - Prevention of hazards - Risk for infection related to  ed susceptibility to environmental pathogens.

38. - Maintenance of balance between solitude and social interaction. - Anxiety related to possible life style changes as manifested by agitation. - Social isolation related to diminished social relationships as manifested by feeling of uselessness. - Promotion of human functioning and development within social groups. Ineffective coping related to lifestyle changes stress as manifested by inability to express feelings of concerns.

39. Developmental Self care requisites :- - Promote Development - Disturbed self esteem related to altered body image as manifested by verbalization of negative feelings regarding personal appearance. - Distributed body image related to presence of Ostomy. - Self development - Powerlessness related to sudden change in life style as manifested by verbalization of inability to cope with stress.

40. Health Deviation requisites :- Risk for impaired skin integrity r to irritation from fecal drainage around peri ostomal area. Therapeutic Self care demand - Risk for infection of the surgical wound / related to presence of colostomy. - Delayed Surgical recovery related to Pop complications.

41. Self Care Deficit - Self care deficit related to incision pain as manifested by inability to perform all activities of Daily living. - Selfcare deficit – bathing / hygiene Dressing / grooming Feeding Toileting

42. Wholly Compensatory System :- Immediate POP period to first 2 days. Nurse Agency to meet the selfcare deficit and therapeutic care demands. Patient fully dependent. Pop Care – Airway, Fluid & Electrolyte, therapeutic care, Self care needs.

43. Partly Compensatory System :- From 3rd Pop day - 7th Pop day Patient performs selfcare activities with assistance Ambulation, Self Sponge bath, grooming Accepts therapeutic care demands from Nurse Agency - Medications and Dressings.

44. Supportive – Educative System:- Discharge phase Ineffective therapeutic regimen management related to lack of Knowledge. Knowledge deficit related to colostomy care. Ostomy selfcare Dietary & fluid intake guidelines Colostomy irrigation

45. Follow up care Other Stoma problems Patient performs self care activities Learn to change colostomy bags Gain knowledge on home care

46. Wholly Compensatory System Airway – O 2 Therapeutic care, Vital signs, Medications, chest physio, inhalation S.Bath, Mouth care, Grooming, Catheter care, Surgical Dressing, Colostomy dressing Positioning, Surgical aspesis Fluid & electrolyte – IV fluids Partly Compensatory System Assist in Ambulation Self Sponge bath, Brushing, Backcare, Grooming, Oral fluids Passive exercises Regulates self-care agency Vital signs, Medications, Surgical wound dressing, changing colostomy bags, Inhalation, suture removal Supportive Educative System Accomplishes self-care Self Care Agency developed Teaching – change of col.bag, Diet at home, Followup care. Demonstrate Changing col.bag Nurse Action Nurse Action Nurse Action Patient’s action is limited Patient action Patient action

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