Transcript Strengths of Orem’s Theory - Kelly's Nursing Portfolio

GATHERING INFORMATION
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Nurse gathers basic conditioning factors through
review of the chart, report from ED and
interaction with the patient.
Basic Conditioning Factors
 Mr. Smith is a 38 year old male, married with
two children ages 12 and 10. Wife, children and
extended family are all supportive. Occupation is
a builder and he owns his own company. Enjoys
hunting and fishing as hobbies and is a self
proclaimed workaholic. Physically in good shape
but has not seen a doctor in over 5 years. Admits
to being frustrated because he is unable to work.
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SELF-CARE REQUISITES
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Using the self care requisites – Universal,
Developmental and Health Deviation the nurse
determines where there is a deficit and then is
able to focus her/his care. The mode of helping
chosen by the nurse is the partly compensatory
nursing system.
SELF-CARE DEFICITS
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The nurse identifies the following self care
deficits:
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Breathing is shallow due to pain
Bed Rest required due to pain and injuries
Needs assistance with ambulation
Needs assistance with ADLs
Needs support due to Mr. Smith having difficulty
coping with limitations
Needs education about injuries and medication
regimen
NURSING SYSTEMS
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To address these deficits the nurse:
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Assesses Mr. Smith’s pain level regularly and
medicates prn
Helps Mr. Smith with frequent position changes to
promote comfort level in bed
Provides support with ambulation
Provides assistance with ADLs
Encourages verbalization of feelings and provides
therapeutic listening.
Provide education about injuries and explain
medications and possible side effects
INDEPENDENCE
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The nurse also identifies areas of self care that
Mr. Smith can perform on his own:
Nurse to keep items for ADLs in easy reach for Mr.
Smith
 Encourage him to help set goals for the day and also
encourage his input with the plan of care
 Enlist help of Mr. Smith’s wife to bring items from
home to promote feeling of productivity in Mr. Smith.
Examples: magazines, lap top, paperwork from
business
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CONCEPTS UNIQUE TO OREM’S MODEL
Depth of Content
 Orem clearly labeled nursing participants.
She rejected the term client and preferred the
term patient.
 Orem clearly described the environment by
environmental features
 Orem described the health state as “a factor that
may impose new or different demands for selfcare on the person” (Fawcett, 2005, p. 250).
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UNIQUE CONCEPTS
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Orem distinguished nursing from physicians by
stating that physicians focus on what has been
interrupted by the injury or illness where nurses
focus what the patient needs for continuing care
 The nurse’s focus goes beyond the physician’s focus
to encompass:
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“the patient’s perspective of his or her own health situation”
(Fawcett, 2005, p. 242)
“the physician’s perspective of the patient’s health situation”
(Fawcett, p. 242)
“the patient’s state of health” (Fawcett, p. 242)
“the health results sought for the patient, which may be life,
normal or near normal functioning, or effective living despite
disability” (Fawcett, p. 242)
“the therapeutic self-care demand emanating from universal,
developmental, and health-deviation self-care requites”
(Fawcett, p. 242)
“the patient’s present abilities to engage in self-care and his or
her health-related disabilities in giving self-care” (Fawcett, p.
242)
UNIQUE CONCEPTS
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Orem’s theories can interrelate to provide a view in
nursing that is unique
Orem’s theory “follows a logical thought process”
(George, 1995, p. 118)
Orem’s theory is used in nursing education and
nursing practice. It is easily understood and can be
applied to all individuals, patients or be applied to
multiple patients
Orem’s theory “has been used to generate testable
hypotheses in a variety of settings (George, p. 118)
Orem’s theory is used by many nurse researchers,
and it focuses on the art of helping
Orem’s theory is used by many nurses in a multitude
of settings
Orem’s theory “is consistent with role theory, need
theory, field theory, and health promotion concepts
(George, p. 118)
STRENGTHS OF OREM’S THEORY
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Orem’s Self Care Framework has made a great
contribution to nursing knowledge
Orem defines the person wholly as it is related to
nursing
 Very clear on who receives nursing care legitimately
 Deductive reasoning is used throughout her work
 Provides a focus from nursing actions that is
different from other health care professionals
(Fawcett, 2005, p.293)
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“Its explicit focus on what matters to nurses and how that
focus helps nurses to retain a nursing perspective in the
multidisciplinary milieu of health care” (Fawcett, p. 293).
STRENGTHS
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Orem’s theory defines exactly when nursing is
needed:
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“Nursing is needed when the individual cannot
maintain continuously that amount and quality of
self-care necessary to sustain life and health, recover
from disease or injury, or cope with their effects”
(George, 1995, p. 120).
OREM’S THEORY COMES FROM A CLINICAL
BASE.
Orem states that, “in working on the components
of [her] theory [she] needs to work with other
people utilizing data from clinicians” (Trench,
Wallace, & Coberg, 1988).
 Provides a comprehensive base for nursing
practice
 It can be used by many different areas of nursing
such as education, administration, research
clinical practice and nursing information systems
(George, 1995, p. 120).
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OREM’S THEORY COMES FROM A CLINICAL
BASE.
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It can be applicable for the beginning practitioner
all the way to the advanced clinician
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The terms self-care, nursing systems, and self-care
deficit are understood by the new nursing student,
and can be explored in greater detail as the nurse
becomes more experienced. (George, 1995, p. 120).
LIMITATIONS OF OREM’S THEORY
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Orem’s theory is clouded by ancillary descriptions
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The term self-care is used many different ways
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Self-care agency, self-care demand, self-care premise, selfcare deficit, self-care requisites, and universal self-care
Orem’s discussion on health is very limited
 Her model suggests three static conditions of
health
 Orem’s suggest that physical movement is a
major determining factor in placement of her
system
 Discusses very little about the patients emotional
needs (George, 1995, p.120-121)
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RESEARCH
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Orem’s first publication was in 1971.
Working with colleagues, her final edition was released in
2001.
Orem Study Group was created from 2000-2004 which
focused on learning the complexity of nursing diagnoses
based on the Self-Care Deficit Nursing Theory (Bekel,
Renpenning, Banfield, Flues, & Hohdorf, 2004).
CURRENT RESEARCH
In 1993 the International Orem Society for
Nursing Science and Scholarship (IOS) was
created.
 “The purpose of the IOS is to advance nursing
science and scholarship through the use of
Dorothea E. Orem’s nursing conceptualizations
in nursing education, practice, and research”
(Alligood, 2010, p. 276)
 The 11th World Congress Self-Care Deficit
Nursing Theory will be held from November 5-7,
2010 in Bangkok, Thailand (www.scdnt.com)
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CURRENT RESEARCH
Orem’s framework can be used as a guide for
nursing research
 Some researchers base their research on her
beliefs or definitions in the model
 Others will use her concepts, but grow with
others theorist ideas (Hartweg, 1991, p. 39).
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CURRENT RESEARCH
Currently many employers are focused on disease
prevention and health promotion (Healthy People
2010).
 “Orem’s self-care deficit nursing theory is
particularly valuable for examining disease
prevention and health promotion because of its
emphasis on individual responsibility for both
activities and on nursing assistance when deficits
in self-care occur” (Moore & Pichler, 2000, p. 137)
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EDUCATION
Orem’s theory has been a guide to nursing
curricula at the associate degree and
baccalaureate degree level.
 “Many schools utilize Orem’s nursing process in
clinical practice, developing extensive assessment
tools, teaching packets, and evaluation models”
(Hartweg, 1991, p.38).
 The University of Tennessee-Chattanooga’s
School of Nursing organized its’ philosophy and
structure within Dorothea Orem’s Self-Care
Deficit Nursing Theory (UTC, 2010).
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The University’s definition of person, environment,
health, and nursing is based on Orem’s terminology.
ANALYSIS OF OVERALL MODEL
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Orem focuses on nursing as a helping art that assists an
individual to meet self-care needs.
It is within this model that helps a nurse determine the
deficits and actions needed (by the nurse) in order to
restore the patients independence.
Orem’s theory can also be used by nurses in a variety of
settings.
Her work related nursing as a practical science and
identified three practice sciences and three nursing
sciences. These sciences that Orem identified offer a
structure for the organization of existing nursing
knowledge, and new knowledge(Alligood, 2010, p. 278).
NEW INSIGHTS
Considering the limitations in Dorothea Orem’s
model, an emotional/mental deficit should also be
added which would further treat the patient as a
whole.
 Orem’s theory could also be enhanced by the
incorporation of ancillary staff (Dietitian,
Occupational Therapy, Social Worker) to help the
patient achieve maximal independence.
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On June 22, 2007, Dorothea Orem passed away
at her residence on Skidaway Island, Georgia
(Alligood, 2010, p. 266).
REFERENCES
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Alligood, M. R., & Tomey, A. M. (2010). Nursing theorists
and their work. Maryland Heights, Missouri: Mosby
Elsevier.
Bekel, G, Renpenning, K, Banfield, B, Flues, I, & Hohdorf,
M. (2004). Learning the complexity of nursing diagnosis
based on scdnt through a computer-based training
program. Retrieved from
http://docs.google.com/viewer?a=v&q=cache:SYbgZxIem8EJ
:www.scdntconferences.com/download/day3/Plenary_9_Bekel.pdf
Current Nursing (2010, February 14). Nursing theories.
Retrieved from http://currentnursing.com/nursing_theory/
DeLane, S. C., & Ladner P. K., (2002) Fundamentals of
nursing: standards & practice, Albany, NY: Thompson
Delmar Learning.
REFERENCES
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Fawcett, J. (2005). Contemporary Nursing Knowledge:
Analysis and Evaluation of Nursing Models and Theories
(2nd ed.). Philadelphia, PA: F. A. Davis Company.
George, J. B. (1995). Nursing Theories: The Base for
Professional Nursing Practice (4th ed.). East Norwalk, CT:
Appleton & Lange.
Hartweg, D. L. (1991). Dorothea Orem: Self-Care Deficit
Theory. Newbury Park, Ca: Sage Publications.
Moore, J, & Pichler, V. (2000). Measurement of orem's basic
conditioning factors: A review of published research.
Nursing Science Quarterly, 2(13), 137-142. doi:
10.1177/08943180022107573
Santrock, J. W., (2009). Child Development. (12th ed.). New
York, NY: McGraw-Hill
University of Tennessee (2010). University of Tennessee
Chattanooga School of Nursing Philosophy, Retrieved from
http://www.utc.edu/Academic/Nursing/philosophy.php