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Dorothea Orem Self-Care Deficit Theory

Nursing Theory
by

Rhonda Hamilton RN

on 13 October 2013

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Transcript of Dorothea Orem Self-Care Deficit Theory

DOROTHEA OREM
Refrences:
October 2013
Wilmington University
Rhonda Hamilton, RN
Biography
Dorothea E, Orem
1914 - 2007
Nursing diploma in the early 1930's
Bachelor in Nursing in 1939
Master of Science in 1945
Honorary Doctorate of Science from Georgetown University in 1976
Honorary Doctorate of Science from Incarnate Word College in 1980
Honorary Doctorate of Humane Letters from Wesleyan University in 1988
Doctorate of Honoris Causae from the University of Missouri in 1998
Dorothea Orem
Self-Care Theory
Self-Care
Self-Care Agency
Self-Care Requisites
Therapeutic Self-Care Demand
4 Concepts of Self-Care Theory
Self-Care
Activities an individual performs
independently throughout life
to promote and maintain
personal well-being
Self-Care Agency

An individual's ability to perform self-care activities
It Consists of 2 Agents
Self-Care Agent
Dependent-Care Agent
Self-Care Requisites
Measures or actions taken to regulate functioning & development
The goals of self-care
3 Categories
Universal requisites
Developmental requisites
Health Deviation requisites
Therapeutic Self-Care Demand
All self-care activities required to meet the requisites for certain conditions & circumstances, such as illness.
Universal Self-Care Requisites
Common to all people
Includes maintaining intake & elimination of
air, water & food
balancing rest, solitude & social interaction
preventing hazards to life & well being
promoting normal human functioning
Developmental Self-Care Requisites

Associated with developmental processes
derived from a condition or
associated with an event such as:
Adjusting to a new job
Adjusting to body changes
6 Health Deviation Requisites
Nursing Theory. Retrieved from: http://nursing-theory.org/ theories-and-models/orem-self-care-deficit-theory.php
Edney, K., Jaime, N., & Young, L. Retrieved from https://sites.google.com/site/oremstheory
description-of-the-model
4 Major Concepts of Nursing According to Dorothea Orem
Person
Environment
Health
Nursing
Person
The patient the nurse cares for
Capable of Self-Care
Possesses developmental, universal
A functioning whole or unity that is viewed socially, biologically, and symbolically
Environment
Provides the context within which the person exists
Sub-component of the person
Along with the person, makes an integrated system, given that the environment affects a patient's health needs
Can be motivated by the nurse to meet patient's needs
Components consist of environmental elements, conditions, factors, developmental environment
Health
"A state characterized by soundness or wholeness of developed human structures and of bodily and mental functioning" (Orem 1995 p,105).
Dependent on environment, therefore, deviation varies
Includes ability to achieve a level of innate potential while living within social, biological, and physical environments
Nursing
Actions by nurses used to assist patients
to accomplish therapeutic self-care
move towards responsible self-care
maintain care with supervision & consultation
Assists the patient with disease or injury to regain normal or near normal state of health
Stabilizes, controls, or minimizes the effects of
chronic poor health or disability
Goal is to provide patient or family members the necessities needed to meet the patient's self-care needs
Helps patients maintain a state of health
Self-Care Theory
Refrences
NU 303 Nurse As Professional
The Nurse Theorists: Excellence in Action-DorotheaOrem
Promo [Video Podcast] Retrieved from website:
http://youtube.com/watch2v=O_io_504B7U
Surucu H. A., Kizilci, S. (2012). Use of Orem's self-care deficit
nursing theory in the self-management education of
patients with type 2: A case study. Self-Care, Dependent-
Care, & Nursing 19(01), 53-59. Retrieved from
http://www.orem-society.com/images/publication/journal/Vol19No01Fall2012.pdf
Use of Orem's self-care deficit nursing theory in the self-management education of patients with type 2:
A Case Study
In this study, diabetes self-management education was provided based on self-care deficit nursing theory.
The objective of this study was to indicate the use of Self-care deficit nursing theory in the diabetes self-management education of patients with Type II diabetes.
The case study involved a female who resorted to the Diabetes Education Center affiliated to the Directorate of Nursing Services of Dokuz Eylül University, and was subsequently followed up for three months.
In this study, by assessing the 6 steps of health deviation self-care requisites of Orem's self-care deficit theory it was determined that the patient was deficient in several areas.
Seeking and securing appropriate medical assistance
Being aware of and prepared for effects and results of pathological conditions
Effective implementation of medically prescribed diagnostic, therapeutic, and rehabilitative measures
Being aware of and prepared for effects of medical care
Modifying the self- concept and self image in a particular state of health
Learning to live with effects of pathological conditions
Seeking and securing appropriate medical assistance
When she got ill, she resorted to institutions where internal-diseases or endocrine experts work for treatment and checks.

No problem
Being aware of and prepared for effects and results of pathological conditions
She knew neither HbA1c and lipid profile nor the complications to be caused by high HbA1c, changes in the lipid profile (triglyceride, LDL and reduction in the total cholesterol level and increase in HDL cholesterol) and overweight.

Self-care deficit: Insufficient awareness of effects and results of pathological condition due to lack of knowledge.
Effective implementation of medically prescribed diagnostic, therapeutic, and rehabilitative measures
Did not perform physical activities regularly.

Did not apply the diabetic diet plan and did not eat snacks.
Did not conduct the injection site control, did not pay importance to the insulin dose and distance between two injections, used only the umbilicus and around it as insulin injection site, performed injection with an injector of 8 mm without grabbing the skin at 90 C
Did not perform the daily foot examination, did not cut her nails properly, did not wear orthopedic shoes and cotton socks but wore flip-flops.
Performed self blood-glucose measurement at random.
Slept when her blood glucose was below 70 mg/dl after eating a piece of bread and did not measure her blood glucose for control, and ate something when her postprandial blood glucose was above 200.
Had never had a foot exam, eye exam and kidney function tests at random and took the lipid control and HbA1c follow-up once every six months. Measured her blood pressure when she felt ill


Being aware of and prepared for effects of medical care
She did not know the risks of developing hypoglycemia, hyperglycemia and lipo-hypertrophy depending on insulin treatment mistakes.
Self-care deficit: Insufficient awareness of the effects of medical care due to lack of knowledge.
Modifying the self- concept and self image in a particular state of health
No problem
Learning to live with effects of pathological conditions
She was not problematic with her diabetes and overweight and tried to manipulate her diabetes.

No problem.
The nursing process was used following Orem's theory. This enabled the nurses to develop several nursing diagnosis based upon the patients assessment.

Insufficient awareness of the effects and results of the pathological condition due to lack of knowledge
Self-care deficit
Goals
Explaining the concept of HbA1c
Explaining what the lipid profile is
Knowing the complications that may be provoked by high level of HbA1c

Knowing the complications that may be provoked by changes in the lipid profile

Knowing the complications that may be induced by overweight

Self-Care Deficit
Insufficiently effective handling
of medical treatments and rehabilitative interventions due to lack of knowledge, disbelief that her health
will improve, ignoring some disorders and the belief that these disorders will fade away on their own
Goals
Perform physical activity regularly
Start physical activity one hour after the meal
Eat the recommended main meals and snacks
Apply the insulin at the right dose, conducting the injection site control
Conduct the site rotation and in-site rotation per week
Use a 6 mm needle, grabbing the skin during injection,
Perform a daily foot examination
Cutting the nails properly
Wearing orthopedic shoes cotton socks and not wearing flip-flops
Perform the self blood glucose measurement as recommended
Perform her eyes and feet exam annually, taking the kidney tests annually, conducting the lipid control and HbA1c follow-up once in every three months.
Self-Care Deficit
Insufficient awareness of the effects of medical care due to lack of knowledge
Goal
Explaining the hypoglycemia, hyperglycemia and lipohypertrophy that may develop depending on insulin treatment mistakes
Blais, K. K., & Hayes, J. S. (2011). Professional nursing practice: concepts and perspectives (5th ed.). UpperSaddle River, NJ: Pearson Education, Inc.
and health deviation need
Self-care deficit. Insufficiently effective handling of medical treatments and rehabilitative interventions due to lack of knowledge, disbelief that her health could improve, ignoring some disorders and the belief that these disorders will fade away on their own.
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