Nurses delivering patient care need are expected to assess and apply the several models and theories proposed as guides to nursing practice. Dorothea Orem was born in 1914 in Maryland. She got her diploma in nursing in 1930’s, and later he degree in nursing in education in 1945. Orem’s nursing concept of self-care was published in 1959. After developing the theory for some years, she published the first edition of Nursing: Concepts of Practice. This model was developed with the aim of helping the patient and the family achieves self-care. According to Orem, the main goal of nursing is reducing the self-care demand to a level whereby the individual or parent is able to meet the demand independently (McElligott et al., 2009).
Orem’s Nursing Concept
Orem’s Self-care model has generated considerable interest among nursing researchers. For instance, in 1984, Chang and Colleagues examined components of nurse practitioner care in the context of Orem’s model to determine what aspects of the care contributed most to the elderly patient’s intentions to adhere to care plan. Orem’s model of self-care has been comprehensively researched and is internationally applicable in modern nursing. Nursing systems from Orem’s view is a system that helps patients by resolving their needs to nurses’ help. In this view, nursing is necessary just when the care patients need is beyond their capacity and ability. In such cases, nurses respond by educating, guiding, supporting and providing relative or complete care the patients need.
Orem’s theory is based on the premise that people have a right, innate ability, and responsibility to take care of them. Individuals have self-care needs, which they can meet except when their ability to do so has been compromised. When undertaking a comprehensive assessment, this self-care model identifies what care the patient or the family can do for themselves. It reflects a concept of human development that maturation is accompanied by self-reliance and a desire to be self-direct. According to the Orem’s model, the aim of nursing is to assist patients in meeting their own therapeutic demands. Therapeutic in this context refers to support of life processes, maintenance of normal growth, development, and maturation (Freysteinson, 2009). It refers to prevention of or compensation for disability and promotion of well-being. Self-care is perceived as behavior cultured in childhood and perpetuated in later life. It comprises of those activities one initiates and performs to maintain health, life, and well-being. Self-care can be simply explained as the practice of activities that individual initiate and carry out on their own in maintaining their well-being health.
According to Wadensten (2009), performing self-care requires an individual to make a good decision as well as an appropriate choice. This is so even in the case of routine activities such as personal hygiene and food selection. Unless these self-care activities have become habitual practices, there is a need for reflection about what should be done and how it will be done. Self-care refers to a situation whereby the patient establishes a partnership with a professional for the purpose of availing services. As such, problems are identified and appropriate actions and methods of intervention determined. However, the patients’ participation in the care plans is necessary since it facilitates the evolution of the plan itself. This is due to the manner in which it reduces the patients’ dependence on health practitioners’ services.
Orem’s Self-Care Model comprises if three interconnected concept of self-care, nursing system, and self-care deficit. Self-care concerns various activities that individuals carry out on their own to preserve and improve their well-being and health. Furthermore, it also identifies actions for meeting the universal care requisites. Self-care entails the four aspects of self-care, basic conditioning factors, the self-care agency, and therapeutic demand. Self-care agencies are affected by basic conditioning factors, which include gender, age, healthcare system factors, state of health, patterns of living, availability of required resources, and socio-cultural factors. Self-care agency is an individual’s acquired the ability to engage in self-care.
According to Orem the best person placed to meet the stipulated requisites is the individual themselves, whom she call the self-care agent. In the case of an infant and young children, this would be the parents, this known as dependent care. Nursing agency is a characteristic of a nurse. It is his/her capability to determine a patient’s need for assistance in self-care. It can also be defined as the power to device and execute a nursing system. Therapeutic self-care demand is what required at various stages in an individual’s life when healthcare is required to meet self-care needs, by appropriate actions and interventions. Nursing systems are a series of actions performed by nurses in relation to patients in order to meet their therapeutic self-care demand or to stimulate their self-care agency.
When an individual or in the case of a child demand for self-care is greater than the individual or parents’ ability to meet it, then self-care deficit occurs and nursing may then be required. Orem identifies three forms of nursing systems, which include wholly compensatory, partially compensatory, and supporting-educative systems. In wholly compensatory nursing system, the nurse compensates for the patient’s total inability to perform self-care services. Partially compensatory system is where the nurse compensates for the patient partial inability to perform self-care services (Villa, 2012). Finally, supporting-educative nursing system is where the nurse assists the patient in making decisions and acquiring knowledge and skills. The following are Orem’s self-care requisites:
1. Universal Self-Care
Orem’s Self-Care Model identifies needs that must be met by all human beings to promote adequate self-care. These needs include balance between activity and rest, sufficient intake of air, food and water, adequate care and functioning of elimination processes and excrement, and balance between social interaction and solitude. Additional needs include prevention of hazards to human functioning, life, and well being, promotion of functioning and appropriate development within social groups in accord with human limitations, potential, and the human desire to be normal (McElligott et al, 2009).
2. Developmental self-care requisites
Developmental self-care requisites are related to developmental processes throughout the life cycle. They include physical, psychological, and social changes. They also include provisions for preventing exposure to hazardous conditions.
3. Health deviation self-care requisites
Arise out of ill health and injury and are associated with the effect and changes of disease or trauma on the individual. They also include preventive and proactive health-seeking, compliance with medical measures, awareness of adverse effects of health care, and accepting and adjusting to health deviation consequences. Thus, self-care refers to the functional capacity towards the handling of such requirements and is considered as a deliberate action, either routine or programmed.
Villa (2012) explains that nursing is more practical than theoretical in nature. Orem’s self-care concepts offer the opportunity to describe and explain nursing practice. Orem explicitly differentiates between the nature of nursing practice and that of medical nursing. According to her, every service has a special concern with some aspect of human functioning. That concern defines what differentiates the service from human-care services of physician, clinical psychologists, and social workers. Orem further explains that the reason why individuals require nursing is their need for self-care. She further notes that the current society expects adults to be self-reliant as well as responsible for their health and also for the well-being of those who depends of them. Most social groups further accept that individuals who are aged, sick, disabled, and helpless should be helped in their immediate distress. Therefore, both self-help and help for others are valued by society as desirable qualities. Nursing, as a specific type of human service, is based on the above-mentioned values.
In nursing, Orem’s model of self-care is an edition of a functional health model. Orem conceptualizes health in relation to self-care deficits, which are articulated as deficiencies in any one of the stated categories, that is, universal, developmental, and health deviation. Heath is a state of wholeness of an individual and his/her ability to provide self-care. Since Orem sees a human being as a unity functioning symbolically, biologically, and socially, one has to be able to perform deliberate actions to be healthy and functional. Thus, health is achieved by adequate and satisfactory self-care measures responding to changing demands for interest to self. Effectively performed self-care action contributes to human integrity, human functioning, and development. Dorothea Orem’s Self-care theory places strong emphasis on the capabilities, rather than the limitations of patients. Furthermore, it does not view the patient in a dependent, passive role (Moorman, 2012).
Meaning and Logical Adequacy
Orem discusses her theories, relevant to the nursing focus, as the index or key in estimating the complexity of the nursing situation. Thus, the theory determines the levels of nursing preparation needed to meet the patients’ requirements (Moorman, 2012). She discusses necessary knowledge and motivation, person elements for both patient and nurse and the availability of resources.
Operational and Empirical Adequacy-this Calls for Critical Analysis of Literature
There are some problems with overlapping literature and some awkwardness in terminologies. However, once the uses of terminology are mastered, the direction for nursing practice, education, and research become clear.
Testability
As to testability, which is needed tentatively to provide flexibility, the implied vales in the Orem model seems rather absolutist. This limits its tentative nature and thus perhaps limiting the flexibility of the model.
Generality
Orem provides a high degree of specificity and seems to include all major aspects of theory in her model. However, because of the specificity to given situations, many groupings lists and systems are needed.
Contribution to Understanding
The model has potential for generating many hypotheses. It was designed more to guide practice than to provide a body of substantive knowledge (Freysteinson, 2009). Furthermore, the continuous evolution of the inventive theory further defines nursing practice functions, self-care needs and nursing systems based on research.
Pragmatic Adequacy
Hardy considers pragmatic adequacy as an important criteria in evaluating a theory. Orem’s theory does demonstrate the ability to control the phenomena of interest, self-care demands, and the self-care actions designed to meet them. The specificity provides a high degree of usefulness in the current practice situation but is limited in created alternatives (McElligott et al, 2009). Overall, the theory demonstrates a relatively high degree of internal consistency and pragmatic adequacy for nursing practice.
References
- Freysteinson, W. (2009). “Therapeutic mirror interventions: an integrated review of the literature.” Journal of Holistic Nursing, 27(4), 241-252.
- McElligott, D., Siemers, S., & Thomas, L. (2009). “Health promotion in nurses: Is there a healthy nurse in the house?” Applied Nursing Research, 22(3), 211-216.
- Moorman, S. (2012). “Help Patients Defy Diverticular Disease.” Journal of Christian Nursing, 29(2), 82-87.
- Villa, J. (2012). “Catholic Orders’ Influence on Nursing: 1900-1920.” Journal of Christian Nursing, 29(2), 90-95.
- Wadensten, B. (2009). “Older People’s Experiences of Dream Coaching.” Journal of Holistic Nursing, 27(4), 266-275.