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The Self-Care Deficit Theory By Dorothea Orem

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The Self-Care Deficit Theory or Orem Model was developed by Dorothea Orem. This theory most closely aligns with my own personal philosophy of nursing. The Orem Model is a tool that allows nurses to use the holistic approach with every patient. I believe that the holistic approach is one that all nurses should keep in mind when they are treating patients. Nurses aren’t just patient caregivers. Nurses are also advocates and teachers. It is the nurse’s duty to care for the whole patient and not just the symptoms of a patient’s illness. A nurse must teach patients how to care for themselves and create nursing implementations that adhere to that philosophy. Francie Bernier (2002) states, “the independent professional practice of nursing is distinguished from other health-related disciplines in that it strives to care for the entire client.” Nurses are encouraged to implement strategies to allow the patients to take care of themselves. Patients that can take care of themselves are ultimately happier and healthier. The Orem Model provides a framework for nurses to understand and implement the most effective holistic care.

Explain the nursing theory as well as the application of the theory to your personal philosophy or experience.

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The best place the Orem Model can be applied is in long term care facilities. Specifically, dementia related long term care facilities. In these settings patients regularly have multiple health problems that require different levels of care. I spent time working in one of these facilities. The patients were split into two groups independent and dependent. Independent patients could take care of themselves. These patients would need help with remembering medications or when meal times were but they had the ability to take care of their basic needs like hygiene. Dependent patients had very little ability to do any sort of self-care. These patients needed help with everything from hygiene to going to the bathroom.

Patients that were once independent but moved to dependent status were quick to decline in health. This is due to the fact that even though these patients were in a high level of care it is impossible to anticipate every need that patient has as it arises. Nursing intuition goes a long way but even the best nurses can never know exactly when a patient’s needs might change. Nurses try to make care plans that will allow patients to be cared for appropriately and timely but these care plans can never anticipate every need a patient has as the need arises. A patient that can care for themselves will be able to take care of critical needs as they arise.

The facility I worked at was understaffed as most dementia care facilities are. I would frequently have ten or more patients that I would have to take care of daily. Many of these patients had a long list of health problems that required a fine attention to detail. I found it incredibly difficult to take care of every patients needs in time. For example, one patient could do all of her hygiene by herself but had to be prompted for each activity. She could brush her teeth but I would have to make sure she got the back of the molars and she washed the toothpaste out when she was done. It would have been much easier to brush the patient’s teeth for her. However, doing so would take away that patient’s independence.

I always tried to let patients do what they could when it came to hygiene. Not only did this make my job easier but I could see patients reacting positively when they could do their own care. Most patients enjoyed having me as their caregiver for the day. The families of the patients also noticed that I took the time to individualize care. Despite the positive feedback I was getting from patients, family, and my superiors the other caregivers at the facility frequently criticized me for the extra time needed to complete each task. As a male I was frequently asked to help lift patients and when I would refuse the other caregivers would get frustrated. These caregivers were only concerned with getting tasks done and not the health and wellbeing of the patients they were taking care of.

Discuss the key points of the theory

Dorothea Orem’s Self Care Deficit Theory gives nurses a framework to assess, care, and teach individuals who cannot care for themselves. This model also focuses on working towards the patient’s independence and ability to conduct self-care. Nurses need to realize that patients can more easily recover if they can take care of themselves. According to Orem, D.E., Taylor, S.G., & Renpenning, K.M. (2001).

A person initiates and performs self-care for maintaining life, healthful functioning, and well-being…self-care is influenced by basic conditioning factors (BCFs). BCFs include age, gender, developmental state, environmental factors, family system factors, sociocultural factors, health state, pattern of living, healthcare system factors, and availability of resources

The BCFs are the factors that indicate a patient’s need for self-care. A nurse needs to take the BCFs into account with each patient in order to provide a high level of care. Once a nurse knows a patient’s needs they must be that patient’s teacher as well as their caregiver. In an interview of Dorothea Orem conducted by Jacqueline Fawcett, Orem stated (2001), “it is increasingly important for nurses to empower patients to develop the capability to monitor change and adjust to or learn to provide self or dependent-care.” Not only does the Orem model focus on the patients understanding of self-care but it also empowers nurses to develop implementations to further the self-care abilities of the patient.

How does this theory impact nursing practice?

The Orem Model is a model that every nurse should think about with every patient. When a nursing care plan is drawn the Orem Model should be considered. These plans can be as simple as taking time to allow patients to brush their own teeth. This maintains the patient’s dignity and promotes a greater sense of wellbeing. Chiba, R., Miyamoto, Y., Kawakami, N., & Harada, N. (2014) “To facilitate recovery for people with health problems, it is important to strengthen each person’s positive aspects. This necessarily includes promoting benefit finding and providing support to enhance their awareness of their own abilities.” Strengthening wellbeing and awareness of the patients abilities are steps that nurses have to take in order to provide a high level of care. Better self-care practices equate to better overall health and happiness for every patient.

Dorothea Orem’s Self Care Deficit Theory is a tool that can allow nurses to better prepare patients for the challenges associated with self-care. A patient that has the skill and knowledge to provide their own self-care will be healthier than a patient who cannot.

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