Download ABBREVIATED TITLE Dorothea Orem`s Self

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Dorothea Orem’s Self-Care Framework
Our assignment is to compare and contrast nursing models while working
effectively in an on-line group. We also need to demonstrate the use of the critical thinking
process using the elements of reasoning. Our group has chosen to analyze Dorothea Orem’s
Self-Care Framework, also known as the Self-Care Deficit Theory of Nursing. The focus of
Orem’s Self-Care Framework is on the actions individuals take to meet their own and dependents
therapeutic self-care demands. It also focuses on nurse’s actions to implement nursing systems
that are designed to assist individuals and families who have limitations in these areas. Nursing
systems are defined as “A continuing series of actions.That are directed to meet [the patients]
therapeutic self-care demands or to regulate their self-care agency” (Orem, 1985). In today’s
world, people are living longer, becoming sicker and hospital stays are much shorter then they
use to be. To understand and use Orem’s theory is of great benefit as the need for self-care to
maintain optimal health and the responsibility of caring for oneself and their dependents is
increasing.
Orem’s Self-Care Framework is broken down into self-care, self-care agency, power
components, basic conditioning factors, therapeutic self-care demand, self-care deficit, nursing
agency and implications for nursing practice.
Self-Care
Self-care is voluntary activities that people perform to take care of themselves and their
environment to maintain life, health and well-being.
Self-Care Agency
A self-care agency is anindividual’s ability “to determine the presence and characteristics
of specific requirements for regulating their own functioning and development, make judgments
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and decisions about what to do, and perform care measures to meet specific self- care requisites”
(Kearney-Nunnery, 2008, p. 59). A self-care agency is acquired and can be affected by many
variables, such as one’s environment, age, developmental state, life experience, health and
available resources.
Power Components
According to Kearney-Nunnery (2008) the person’s ability to perform self-care is
influenced by 10 power components:
1.
Ability to maintain attention and exercise requisite vigilance with respect to self as
self-care agent, and internal and external conditions and factors significant for selfcare.
2. Controlled use of available physical energy that is sufficient for the initiation and
continuation of self-care operations.
3. Ability to control the position of the body and its parts in the execution of the
movements required for the initiation and completion of self-care operations.
4. Ability to reason within a self-care frame of reference.
5. Motivation.
6. Ability to make decisions about care of self and to operationalize these decisions.
7. Ability to acquire technical knowledge about self-care from authoritative sources, to
retain it, and to operationalize it.
8. A repertoire of cognitive, perceptual, manipulative, communication, and interpersonal
skills adapted to the performance of self-care operations.
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9. Ability to order discrete self-care actions or action systems into relationships with
prior and subsequent actions toward the final achievement of regulatory goals of selfcare.
10. Ability to consistently perform self-care operations, integrating them with relevant
aspects of personal, family, and community living.
Basic Conditioning Factors
According Kearney-Nunnery (2008) a person’s ability to perform self-care is also
influenced by 10 internal and external factors. These are called basic conditioning factors and
include: age, gender, developmental state, health state, sociocultural orientation, health-care
system factors, family system factors, patterns of living, environmental factors and resource
availability and adequacy.
Therapeutic Self-Care Demand
Therapeutic self-care demandsareactions that individualsneed toperform at certain times
or over a course of time to maintain life, health, and well-being and to meet all of an individual’s
known self-care requisites. There are three types of self-care requisites: universal self-care,
developmental self-care and health deviation self-care.
Universal self-care requisites are
“actions that need to be performed to maintain life processes, the integrity of human structure
and function, and general well-being” (Kearney-Nunnery, 2008, p.60). Examples of universal
self-care requisites include air, water, and food, elimination, balance between activity and rest
and between social interaction and solitude, prevention of harm and promotion of normalcy.
Developmental self-care requisites are “actions that need to be performed in relation to human
developmental processes, conditions, and events and in relation to events that may adversely
affect development (Kearney-Nunnery, 2008, p.60). Examples of these requisites include death
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of a loved one, adjusting to a new job, adjusting to body changes, toilet training a child and
learning healthy eating.
Health deviation self-care requisites are “actions that need to be
performed in relation to genetic and constitutional defects, human structural and functional
deviations and their effects, and medical diagnostic and treatment measures prescribed or
performed by physicians (Kearney- Nunnery, 2008, p.60). These requisites are required in
conditions of illness, injury, or disease.
Examples are obtaining appropriate medical care,
effectively caring out subscribed treatments or medications, learning about your condition and
how to deal with it and live with it if it’s a chronic condition.
Self-Care Deficit
The self-care deficit is an imbalance between the self-care agency and the therapeutic
self-care demand. A person’s self-care agency is unable to identify and care for all of their selfcare demands. When a person cannot meet their self-care needs due to limitations there is a
deficit. Nursing interventions are beneficial when a health related situation limits an individual’s
ability to care for oneself or creates a situation where the individual’s knowledge is not sufficient
enough to maintain their own health and wellness. For nursing to be needed there needs to be a
self-care deficit.
Nursing Agency
Nursing agency is a characteristic that allows nurses to know and help others to know
their therapeutic self-care demands, meet them and positively affect the development of their
self-care agency. When a nursing agency is activated, a nursing system is produced. A nursing
system is thought out actions carried out by the nurse or patient in efforts to meet the patient’s
therapeutic self-care demands and positively affect the development of the patient’s self-care
agency or dependent-care agency. There are 3 types of compensatory systems: total, partial and
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educative/supportive compensatory support. Total compensatory support is when the nurse
provides all the care for the patient. The patient is unable to care for themselves. Partial
compensatory support is when both the nurse and the patient provide in the self-care
requirements.
Educative/ supportive compensatory support is when the nurse is only the
educator, consultant or resource person and the patient provides all of their own self-care.The
goal of nursing is to help people meet their therapeutic self-care demands through the application
of nursing systems.
Implications for Nursing Practice
Nurse’s actions are intended to help people meet their own and their dependents
therapeutic self-care demands. Orem’s practice approach to ensure this is called ProfessionalTechnologic Operations of Nursing Practice. It includes case management operations, diagnostic
operations, prescriptive operations, regulatory operations and control operations.
In case management operations the nurse uses a case management method to direct each
of the nursing diagnostic, prescriptive, regulatory, and control operations. The nurse maintains
an overview of the interrelationships between the social, interpersonal, and professional
technological systems of nursing. They also use appropriate tools to collect and document
information, and to measure the quality of nursing.
In diagnostic operations the nurse determines the unit of service for nursing practice and
why the patient needs nursing. They gather demographic information about the patient and
information about the type and limitations of their health-care situation and nursing’s authority
within those boundaries.
In prescriptive operations the nurse collaborates with the patient and if appropriate their
family to identify all care measures needed to meet all therapeutic self-care demands. They also
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identify the roles to be played by the nurse or nurses, patient and dependent or dependents in
meeting the therapeutic self-care demands and in regulating the patient’s development of selfcare agency or dependent-care agency.
The regulatory operations include design of nursing systems for performance of
regulatory operations, planning for regulatory operations and production of regulatory care. In
regulatory operations: design of nursing systems for performance of regulatory operationsthe
nurse designs systems (actions/ interventions) and chooses whether to use the wholly
compensatory, partially compensatory or supportive-educative nursing systemdepending on who
can or should perform the self-care activities.The systems are then implemented using one or
more of the following: acting or doing for the patient, providing a developmental environment,
supporting the patient psychologically, guiding the patient and teaching the patient.
In regulatory operations: planning for regulatory operationsthe nurse determines what is
needed to carry out the actions selected for the patient. Such as what time and place, necessary
environmental conditions, equipment, supplies, the number and qualifications of nurses and other
health-care providers needed to carry out the systems and evaluate the effects, the organization
and timing of tasks to be performed and designation of who is to perform the tasks.
In regulatory operations: production of regulatory care nursing systems are produced by
the actions of the nurses and patients during their encounters. The nurse produces and manages
the selected nursing systems and methods of helping for as long as the patient has a self-care or
dependent-care deficit. They do this by performing and regulating or assisting patient’s with
their self/ dependent-care tasks, coordinating self/ dependent care tasks performance, helping
patients, their families and others bring about systems of daily living for patients that support the
completion of self/ dependent-care. Also by guiding, directing and supporting patients in their
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exercise or in their withholding of their self/ dependent-care agency, stimulating patient’s
interests in self/dependent-care, by being available when questions arise, supporting and guiding
patients in learning activities and as they experience illness or disability and their need for
change to meet new self-care requisites.
In control operations the nurse determines if the nursing system that was created is
produced and if there is a fit between the current subscription for nursing and the nursing system
being used. Nurses ensure the patient’s functioning is achieved through performance of care
measures to meet their self-care demand and their use of self/dependent- care agency is being
properly regulated. They also determine if developmental change is in the process and is
adequate and the patient is adjusting to any decrease in powers to participate in self/dependent
care.
Case Study
Sarah S. is a 45-year-old single American woman who has had type 2 diabetes for 7 years. She
recently had a scab to her right big toe from stubbing it that wasn’t healing. Sarah was referred
to a vascular surgeon from her primary care physician.
The surgeon ruled out peripheral
vascular disease and referred Sarah to his office’s diabetes educator. Sarah is a secretary at a
local school and struggles to pay her bills as she is the sole provider for herself and her mother.
She enjoys eating out, watching movies and being with her family. She is an only child who
lives in an apartment with her 80 year old widowed mother who has limited mobility due to her
chronic rheumatoid arthritis. Sarah’s mother is dependent on her for all of her activities, house
work, shopping, etc. With Sarah being overweight, heavy cleaning is exhausting for her. She
tells the diabetes educator, “I’m so tired all the time, but my mother doesn’t think we need to hire
a cleaning lady. She was so good to me growing up, now I need to return the favor.” When the
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nurse questioned her about her blood glucose monitor she stated “I have one somewhere, I don’t
have time to use it, but I try avoiding foods I shouldn’t eat.” Sarah also stated that she is too
exhausted to participate in an exercise program. Through assessment of Sarah and her family,
the diabetes educator was able to identify Sarah’s needs and discussed and carried out actions to
help Sarah meet her self-care demands and enhance her self-care agency.
Questions and Answers
Q: What is affecting Sarah’s self-care agency?
A: Her exhaustion from taking care of her elderly, sick mother, financial hardship and lack of
time.
Q: As a diabetic what should some of Sarah’s therapeutic self-care demands be?
A: Checking her blood sugars regularly, eating proper food, exercising and maintaining a
healthy weight.
Q: Does Sarah have a self-care deficit, if so why?
A: Yes, her self-care agency is unable to meet her therapeutic self-care demands.
Q: What type of compensatory system was the diabetes educator using?
A: Educative/ supportive compensatory support.
References
Kearney-Nunnery, R. (2008). Advancing Your Career: Concepts of Professional
Nursing.Philadelphia, PA: F. A. Davis Company.
Kumar, C. (2007). Application of Orem’s Self-Care Deficit Theory and Standardized Nursing
Languages in a Case Study of a Woman with Diabetes.International Journal of Nursing
Terminologies and Classifications, 18(3), 103-110. doi:10.1111/j.1744618X.2007.00058.x
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Alligood, M.R. &Tomey, A.M. (2006).Nursing Theorists and Their Work (6thed.). St Louis,
MO: Mosby Elsevier.
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