Dorothea E. Orem’s Self-Care Model
The major aim of the current essay is to describe the Dorothea Orem’s Self-Care Model and analyze how it applies to nursing practice. The care model comprises of three theories that include nursing systems, self-care deficit, and self-care theories. It explains that a mature individual should be able to carry out self-care activities to meet self-care needs independently. However, self-care deficits occur when such a person fails to fulfill the needs because of the disease or any other problem. At this point, the nursing systems theory can be applied because such individuals need nursing care to perform self-care activities. Through this model, the four clearly defined metaparadigms of nursing that comprise of health, nursing, environment and the person are manifested. Nurses can help these individuals (currently patients) to fulfill their needs through three systems of nursing that include wholly compensatory, partially compensatory, and supportive educative systems. In clinical care settings, especially in the surgical care unit, all the three nursing systems are applied in both the provision of care and education of patients. The theory is therefore relevant and valuable for the practice of nursing in hospital facilities.
Keywords: Dorothea Orem’s Self-Care Model, nursing practice, self-care
Dorothea E. Orem's Self-Care Model
The nursing profession dwells on the body of knowledge that is full of nursing theories that guide many actions of medical workers in practice. According to Harnegie (2015), unless professional nursing practice is based on viable and sound theoretical frameworks and approaches, nursing will never be a profession. On the other hand, theories are created when there is a need to make nursing meaningful or organize observations and facts to solve serious health problems in the society. According to Orem and Taylor (2011), Dorothea Orem developed the now famous and influential Self-Care Model as a conceptual model that applies to all areas of nursing practice, education, and research. The development of this theory was marked by the transformations of the nursing profession because nurses now had a conceptual model that could provide and guide care delivery. Therefore, the profession relies on the model to guide its practice because of its outstanding value.
The Self-Care Model by Dorothea Orem is instrumental in nursing practice because it is applied in all aspects of nursing care provision. In normal cases, individuals should carry out the self-care activities to achieve their personal needs, but in the presence of the disease, performing relevant actions can be compromised, as in the case of Ms. Wong, who sustained accident injuries. As a result, nurses need to intervene to ensure these needs are achieved. Surgical units in hospitals and their nurses utilize the model to offer high-quality care. This essay describes Dorothea Orem’s Self-Care Model and its application in the implementation of health promotion activities in the context of managing surgical conditions, using the case of Ms. Wong, a surgical patient.
Overview of the Orem's Self-Care Model
The first theory in the Orem's care model is the Self-Care Theory. This theory describes why and how individuals take care of themselves in addition to suggesting that nursing help is needed in the case of inability to perform the care functions independently due to limitations. The theory comprises of the concepts of self-care agency, basic conditioning factors and therapeutic self-care demand (Smith & Parker, 2015). Orem refers to the self-care agency as the acquired abilities of both the mature and maturing individuals to be aware of and achieve their requirements for purposive and deliberate actions to regulate both their functioning and development (Alligood, 2014). On the other hand, therapeutic self-care demand comprises of the summation of all care measures required for meeting all the self-care requisites of the person. Basic conditioning factors are all the factors affecting the value of self-care agency and therapeutic self-care demand of the person (Masters, 2011). Orem further introduces requirements for life, wellbeing, and health (Smith & Parker, 2015). An individual who performs self-care should investigate what should be done before deciding to carry out the care.
The second theory is the Self-Care Deficit Theory, which describes why people need help through nursing actions when they are unable to carry out self-care. According to Masters (2011), the theory explains that either maturing or mature individuals deliberately learn and implement actions to enhance their quality of life, ensure survival, and most importantly, improve their wellbeing. Orem explains that nurses utilize five core methods to help their patients meet their self-care needs (Alligood, 2014). The methods include acting or doing for the patient, guiding and directing the patient with deficits to deliberately perform self-care. Others include providing physical support, teaching the patient, and providing and sustaining a conducive environment to promote the personal development.
The final model is the Theory of Nursing Systems that establishes the relationships that must exist to ensure all self-care needs of the patient are met. Nursing is needed when an individual has limitations that result in an inability to perform continuous and effective self-care. According to Smith and Parker (2015), the nursing profession has results-achieving operations, which need to be articulated with both social and interpersonal features of nursing. In the interpersonal category, communication is adjusted to both the health status and age of the patient. The role of the nurse in this case is to maintain inter-group, intra-group, and interpersonal relations (Renpenning & Taylor, 2011). Furthermore, nurses should maintain therapeutic relationships in the functioning mode in the state of disease. The Theory of Nursing Systems further introduces the regulatory technologies, a category that regulates and maintains the psychological and physiological modes of human functioning in both the state of wellness and disease (Masters, 2011). Most importantly, nurse professionals must promote individual growth and development through ensuring that all their patients and clients meet their care needs.
Other than defining the metaparadigm concepts of nursing, the Orem’s Self-Care Model discusses the systems that the nurses use to meet self-requisites of their patients. The first one is the supportive-educative system in which the patient can carry out self-care actions but requires assistance from the nurse only to make decisions or acquire knowledge and skills (Masters, 2011). In the partially compensatory system, both the nurse and the patient participate in performing patient self-care activities. However, the wholly compensatory system comes in place when the patient is completely unable to carry out any of the self-care activities, relying on the nurse to provide them. Describing the role of the nurse in self-care and defining the metaparadigms are the strengths of the model. The metaparadigm concepts defined in this theory include the person, environment, health, and nursing. Orem defines the person as a whole being with developmental and universal needs requiring self-care (Masters, 2011). The environment includes the social, biologic, chemical, and physical contexts in which the person exists while health is a state characterized by mental and bodily functioning of the developed human structures. Nursing refers to the therapeutic self-care that is designed to supplement the self-care requisites.
Overview of the Current Nursing Practice
Currently, my nursing practice revolves around the provision of healthcare services to patients admitted to the orthopedic ward within the surgical unit of the hospital. Most of the patients have challenges in moving because of the broken bones, mainly the upper and lower limbs. As a result, they cannot move to get the necessary resources needed for their survival. It is the duty of nurses in this ward to ensure that they meet their needs. For instance, they receive food and water at the bedside and eat using their hands that are not restricted by injuries. However, some patients have all their limbs broken, something that compels nurses to help them eat, take bath, and get dressed, and turn them in addition to providing other services as the need arises. In some cases, patients are unable to talk because of the injuries they have sustained, and the nurse communicates with them through other providers of care and passes the messages to the patient through writing and many other ways.
Application of the Orem's Self-Care Model
This theory is relevant and valuable since it applies to my current practice of nursing when providing healthcare services to patients. For instance, Ms. Wong, a 48-year-old female fell from a bicycle while riding at moderate speed and landing on her left side of the body, which resulted in the sustenance of certain injuries. She came to the hospital where I practice nursing with complaints about a swollen deformed and painful left elbow that could not tolerate any movements because of the pain. Wong was admitted because she had a fractured and open reduction with plating that was done to the broken proximal radius and proximal ulnar. Additionally, an external fixator was also applied.
The Dorothea Orem’s Self-Care Model applies to my nursing practice. In the case of Ms. Wong, the theory first gives the framework for conducting an assessment to find out whether or not there are deficits that can impact self-care. Furthermore, the coming of this patient to the hospital illustrates the concept of the self-care deficit, shown in this theory. Ms. Wong should be able to function well by carrying out self-care activities without the help of any nurse. However, just like many other patients in my clinical area of practice, she has an injury that results in self-care deficits because her hand cannot function due to the fracture and pain. Orem asserts that if one is unable to meet self-care needs, he or she becomes a patient who requires nursing care and nursing professionals should intervene to address the necessary needs (Smith & Parker, 2015). The patient comes to the hospital to receive care from the health professionals because of the deficits produced by the injury.
Besides, the three primary systems of nursing in the Orem's model are utilized during care delivery in my current practice. For patients who are in a state of coma and cannot do anything, the nurse performs all the self-care activities the patient is unable to carry out because of the condition. In this case, the wholly compensatory nursing system is put in place, because of its immense value. However, for the case of Ms. Wong and many other patients that are mobile to some extent, the partly compensatory and supportive-educative systems can be applied. In case patients require surgical care, nurses use this opportunity to educate them concerning pain and the overall experience of the surgical process. According to Goyal, Parikh, and Austin (2008), preoperative and postoperative education and administration of medications to relieve pain remain vital in improving the functional ability after surgery and ensuring better patient outcomes. The relevant and valuable self-care model can be applied in this case because education is a major issue addressed in this theory.
When patients leave the hospital, the supportive educative system of nursing according to the Orem’s model applies the most. Being also called the supportive developmental system, nurses use this system to support the patient as a self-care agent by offering the necessary knowledge and skills to make decisions and carry out self-care activities (McEwen & Wills, 2011). In most cases, patient come to the surgical unit when having many physical deficits that provide a hindrance to carry out normal activities of daily living because of their health conditions. Ms. Wong visits the hospital because she cannot move her left upper limb because of the fractured and painful immobile elbow. However, the use of Nursing Systems Theory by the care professionals helps the patients to leave the hospital in an improved state with or without minimal short-term self-care deficits. When the patients are discharged, nurses still educate them on how to take care of the surgical sites among many other things. For the case of Ms. Wong, the use of education by applying the supportive-educative system will help her understand the need to bath carefully without contaminating the elbow, as well as why it is important to restrict movement of the arm with the broken radius and ulnar bones, and so forth. The only limitation of this model in my current practice is that it does not describe the role of the nurse in emotional care of the patient, but only emphasizes meeting the self-care deficits. Therefore, the model can be applied to all activities in my area of nursing practice, except the patients’ emotional state.
The Dorothea Orem’s Self-Care model applies to nursing practice. The self-care model comprises of three main theories: nursing systems, self-care, and self-care deficit. The self-care theory explains why and how people carry out self-care activities, and further explains what the concepts of basic conditioning, self-care agency, and therapeutic self-care require. In the self-care deficit theory, mature individuals are unable to independently carry out self-care activities, something that brings about the need for nurses to offer the necessary assistance to meet their self-care needs. The theory of nursing systems explains the relationship that should exist between the nurse and the patient during care provision. Just like many other nursing theories, Orem's theory defines the four metaparadigms of nursing including health, person, nursing, and the environment. This theory is relevant and valuable because all of its concepts apply to nursing practice through the three theories of the model and the three systems of nursing. The systems of nursing include wholly-compensatory, partially compensatory, and supportive educative systems.