INTRODUCTION Walter Guevarra
Nursing profession and practice wouldn’t be the same now, as it was yesterday, if not with the people we called as theorist, who’s in their initiative and deep concern to the profession richly contributed to the development of its standard of practice, and that a nurse is equally regarded and recognized together with other medical profession with its own unique functions and contibutions to patient recovery. In turn the soceity itself is benefiting from it. Dorothea Orem’s great contribution in conceptualizing a model or framework of nursing, is when she headed a nursing committee in creating a model that will guide research in nursing as it is now. From there it gave birth to the theories which is widely use now in standard of practice and as well as in educating individual who’s aspiring to be nurses.
Dorothea Orem’s theory of Self-Care Deficit is consider as a client centered, because it mainly evolves in the patient as the main focus of care, due to the patients inability and incapacity to perform self care which is brought about by health related problems. And she called it as a main theory from the three interrelated theory, namely the theory of self-care, theory of self-care deficit and the theory of nursing systems. As you go along on reading about the theory in our blog, we do hope that it will create deeper understanding and knowledge of the true essence of this theory. And that we may apply it in our daily practice. We hope that you will enjoy reading and learning. Thank you.
BIOGRAPHY Rosenald Sen She was born in Baltimore, Maryland on 1914. Her father was a construction worker and her mother is a home maker. She was the youngest among two daughters. She died in June 22, 2007 Education: She studied Diploma in Nursing in early 1930’s at the Providence Hospital School og Nursing In Washington D.C., In 1939 and 1945 she finished B.S. Nursing Education ( BSN Ed.) and MSN Ed successively in Catholic University of America, Washington D.C. In 1976, she become Honorary Doctorates: Doctors of Science from Georgetown University and Incarnate word college in San Antonio in Texas in 1980. In 1988 she finished Doctor of Humane Letters from Illinois Wesleyan University in Bloomington, Illinois. 1988 She Graduated from University of Missouri in Columbia, Doctor Honoris Causae.
She was born in Baltimore, Maryland on 1914. Her father was a construction worker and her mother is a home maker. She was the youngest among two daughters.
BIOGRAPHY Rosenald Sen
She died in June 22, 2007 Education: She studied Diploma in Nursing in early 1930’s at the Providence Hospital School og Nursing In Washington D.C., In 1939 and 1945 she finished B.S. Nursing Education ( BSN Ed.) and MSN Ed successively in Catholic University of America, Washington D.C. In 1976, she become Honorary Doctorates: Doctors of Science from Georgetown University and Incarnate word college in San Antonio in Texas in 1980. In 1988 she finished Doctor of Humane Letters from Illinois Wesleyan University in Bloomington, Illinois. 1988 She Graduated from University of Missouri in Columbia, Doctor Honoris Causae.
OREM’S NURSING PARADIGM Allan Andan MAN Orem viewed man as an integrated whole composed of an internal physical, psychologic, and social nature with varying degrees of self-care ability. He/she has the potential for learning and development as he/she is gifted with rational ability and capacity to reflect on his/her experience and use symbols (ideas and words). Under normal conditions, man is self-reliant, responsible and capable continuous self-care, not only of himself/herself, but also on his/her dependents. Orem viewed a patient as an individual with health related limitations that make him/her incapable of continuous self care or dependent care. His/ her self-care requisites or demands are beyond his/her self-care abilities which can be attributed to his/her lack of knowledge, skills, motivation or orientation.
HEALTH Orem defined health as a state of wholeness or integrity of a human being: a state where one is structurally and functionally whole or sound. She further added that a healthy being is one who has the necessary self-care ability to meet his/her changing self-care demands. She supported the concepts of health promotion and health maintenance and claimed that it is not just the individual’s responsibility, but also the society as a whole, including its members. ENVIRONMENT Orem viewed the environment as not just the elements external to man. She viewed man and environment as an integrated system. It includes conditions that can positively or negatively affect a person’s ability to provide self-care. She enumerated certain conditions which are conducive for one’s development and includes the following: opportunities to be helped; being with other persons or group where care is offered; opportunities for solitude and companionship; provision of help for personal and group concerns without limiting individual decisions and personal pursuits; shared respect and trust; recognition and fostering of developmental potential. NURSING According to Orem, nursing consists of actions deliberately selected and performed by nurses to help individuals or groups under their care to maintain or change conditions in themselves or their environment. She further viewed nursing as an art, community service and a technology. As an art, it has a theoretical base which serves as the basis in providing self-care towards improvement of one’s functioning and development. As a community service, it is geared towards deliberative actions of assisting another in maintaining or reestablishing balance between self-care abilities and demands also leading to improvement in one’s functioning and development. As a technology, it has specialized methods or practice of delivering self-care.
OREM’S THEORY OF SELF-CARE Rosinee Rosales Self – care is the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health and well-being. When self-care is effectively performed, it helps to maintain structural integrity and human functioning, and it contributes to human development (Orem, 1991). Self – care agency is the human’s ability or power to engage in self-care. The individual’s ability to engage in self-care is affected by basic conditioning factors. Basic conditioning factors are age, gender, developmental state, health state, sociocultural orientation, health care system factors, family system factors, patterns of living, environmental factors, and resource adequacy and availability. (Nursing theories, Julia George) “Normally, adults voluntarily care for themselves. Infants, children, the aged, the ill, and the disabled require complete care or assistance with self-care activities.” (Orem, 1991)
Developmental self-care requisites are either specialized expressions of universal self-care requisites that have been particularized for developmental processes or they are new requisites derived from a new condition or associated with an event (Orem, 1991). In other words, these are needs resulting from maturation or develop due to a condition or an event. Two categories of developmental self-care requisites: 1. Conditions that support life processes and promote specific developmental stages (Intrauterine life, neonatal life, infancy, childhood, adolescence, adulthood) 2. Conditions affecting human development: (a) concerns the provision of care to prevent deleterious effects of adverse conditions (e.g. provision of adequate rest and sleep during pregnancy) (b) concerns the provision of care to prevent or overcome existing or potential deleterious effects of particular conditions or life events (e.g. adjusting in new job or change in social status) Health deviation self-care is required in conditions of illness, injury, or disease, or may result from medical measure required to diagnose and correct the condition (e.g. learning to walk using crutches following fractured leg) Health deviation self-care requisites are as follows: (Orem, 1991) 1. Seeking and securing appropriate medical assistance 2. Being aware of and attending to the effects and results of pathologic conditions and states 3. Effectively carrying out medically prescribed diagnostic, therapeutic and rehabilitative measures 4. Being aware of and attending to or regulating the discomforting or deleterious effects of prescribed medical care measures 5. Modifying the self-concept in accepting oneself as being in a particular state of health and in need of specific forms of health care 6. Learning to live with the effects of pathologic conditions and states of medical diagnostic and treatment measures in a life-style that promotes continued personal development References: George, Julia B. (1995). Nursing theories: The base for professional practice (4th Ed.) Prentice-Hall International Orem, Dorothea E. (1991). Nursing: Concepts of practice (4th Ed.) St. Loius: Mosby
SELF-CARE DEFICIT THEORY Rose Ann Bunye When there is demand to care for oneself and the individual is able to meet that demand, self-care is possible. If, on the other hand, the demand is greater than the individual’s capacity or ability to meet it, an imbalance occurs and this is called a self care deficit. The theory of self-care deficit is the core of Orem’s grand theory of nursing because it delineates when nursing is needed. Nursing is required when an adult (or in the case of a dependent, the parent or guardian) is incapable of or limited in the provision of continuous effective self-care (George 1995). The term “deficit” refers to a particular relationship between self-care agency and selfcare demand that is said to exist when capabilities for engaging in self-care are less than the demand for self-care (Parker, 2005, p. 149).
The self-care deficit may be actual or potential. For example: 1. In the case of premature birth, the actual infant-care deficit may be the parent’s lack of knowledge of how to provide care for the preterm infant. 2. The potential infant-care deficit could result in increased risk of infant abuse or neglect. Orem identifies 6 methods of helping:-1. Doing for or acting for another 2. Guiding or directing another 3. Providing physical support 4. Providing psychological support 5. Providing an environment supportive of development 6. Teaching another
THEORY OF NURSING SYSTEMS Theresa Baulita Theory of Nursing Systems 1. Refers to a series of actions a nurse undertakes to aid in meeting a person’s self-care needs. 2. Describes nursing responsibilities; roles of the nurse & patient 3. Rationales for the nurse-patient relationship 4. The essential organizing component of the Self-Care Deficit Theory of Nursing because it establishes the form of nursing and the relationship between patient and nurse properties. 5. Focused on person 6. There are three support modalities identified in theory: wholly compensatory; partly compensatory; supportive-educative Three Support Modalities: 1. The client’s ability for self-care involvement will determine under which support modality they would be considered 2. A person may fluctuate between support modalities at any given time
Wholly compensatory system 1. The patient has no active role in the performance of his care 2. The nurse acts for the patient 3. An individual requires total nursing care to fulfill self-care needs 4. A patient’s self-care agency is so limited that she or he depends on others for well-being 5. The nurse accomplishes patient’s therapeutic self-care; compensates for patient’s inability to engage in self-care; supports and protects patients Partly compensatory system 1. Both nurse and patient work together to perform activities to achieve desired self-care goals 2. A patient can do some self-care measures but needs a nurse to assist her to meet others 3. It has a give and take relationship between the nurse and the patient 4. The nurse compensates for self-care limitations of patient Supportive-educative system 1. Requires uses of resources and educational tools to teach the person & family to perform their own self-care 2. Indicates that the patient contributes mostly in his/her self-care and the nurse’s role is merely to monitor & regulate the patient’s self-care 3. The patient accomplishes self-care & regulates the exercise & development of self-care agency 4. The patient is able to perform, or can learn to perform, required measures of therapeutic self-care but cannot do so without assistance 5. A patient can meet self-care requisites but needs help in decision-making, behavior control, or knowledge acquisition
THEORETICAL ASSERTIONS Rachelle Dogao Dorothea Orem’s Self Care Deficit Theory encompasses all aspect relating to the patient’s health, nursing and all the factors that affect which. The concepts discussed revolve mainly around self care. It is the patient’s ability to care for himself and his dependents as well as others as dictated by the environment he lives in that determines health or the need for assistance in maintaining health. On the other hand, the society plays the major role into regulating the nursing care process as to when nursing care is needed and when and how the nursing system is implemented. It is also the environment and the society that directly affect the nurse-patient relationship and self care agency, which are all interconnected into achieving, restoring, and maintaining health.
As shown in this figure, health can be achieved if the person has knowledge and resources to perform self care activities to meet self care deficits. On the other side, self care deficit results when self care agency (ability to perform self-care) is not adequate to meet the known self care demand and/or the failure to meet the health care requisites (Kozier et.al, 2002) This then warrants the need for nursing intervention through the nursing system, which in turn is empowered by the nurse-patient relationship. The end result of all of this is the maintenance, restoration, or preservation of health.
COMPARISON OF OREM’S NURSING PROCESS WITH THE NURSING PROCESS Monaliza Pineda
5 MAJOR ASSUMPTIONS Yosef Brian Villanueva
(1) Human beings require continuous deliberate inputs to themselves and their environments to remain alive and functions in accord with natural human endowments.
(2) Human agency, the power to act deliberately, is exercised in the form of care of self and others in identifying needs for and in making needed inputs. (3) Mature human beings experience privations in the form of limitations or action in care of self and others involving and making of life sustaining and functioning- regulating inputs. (4) Human agency is exercised in discovering, developing, and transmitting to others ways and means to identify needs for and make inputs to self and others. (5) Groups of human beings with structures relationships cluster tasks and allocate responsibilities for providing care to group members who experience privation for making required deliberate input to self and others
Self care is a requirement for every person Universal self-care involves meeting basic human needs Health-deviation self care is related to disease or injury Each adult has both the right and the responsibility to care for his/her self in order to maintain rational life and health. He/she also has responsibilities to dependents Self-care is learned behavior processed by the ego and influenced by both self-concept and level of maturity Self-care is a deliberative action Awareness of relevant factors and their meaning is a prerequisite condition for self-care action References http://prism.troy.edu/~scabell/Orem.pdf (Taylor et al, 1998, p. 179). Theoretical Foundations of Nursing, p46
STRENGTHS & Myrene LIMITATIONS Leviste Buban-Aseron Strengths Orem’s theory provide a comprehensive base to nursing practice. It is functional in the different fields of nursing. May it be in clinical setting, education, research or administration. Moreover, this theory is as applicable for nursing by the beginning practitioner as much as the advanced clinician(George JB., 1995). Another major strength of Orem’s theory is it’s advocacy for the use of the Nursing Process (Balabagno, et.al, 2006). Orem specifically identified the steps of this process. She also mentioned that the nursing process involves intellectual and practical phases.
Limitations The ambiguity of applying theory to nursing practice may lie in the fact that one theory does not always specifically support all aspects of nursing care. Orem’s self care deficit theory may not encompass all aspects of care and needs of a specific client. For instance, some dilemma with Orem’s theory include having an unclear definition of family, the nurse-society relationship and public education areas are weak. These issues are essential in the management and treatment plan in caring for patients. Although the family, community and environment are considered in self care action, the focus is primarily on the individual (Balabagno, et.al, 2006). Another limitation is the definition of health as being dynamic and ever changing with states ranging from health or non health, wellness or illness (Fitzpatrick JJ, 2005). This definition of health directly contradicts the experience of some patients with varying needs and levels of care requirements. One of the most obvious limitations of Orem’s theory is that throughout her work, it can be said that a limited recognition of an individual’s emotional needs is present within the theory (George JB., 1995). It focuses more on physical care and gives lesser emphasis to psychological care. Other theories address this limitation quite adequately such as Jean Watson’s Theory of Caring. REFERENCES Fitzpatrick JJ, Whall AL. Conceptual models of nursing, analysis and application. 4th ed. Upper Saddle River, New Jersey: Pearson Prentice-Hall; 2005. George JB. Nursing theories, the basis for professional nursing practice. 4th ed. Norwalk: Appleton & Lange; 1995. Balabagno, et al., Pathophysiology, UP Open University; 2006
CRITIQUES Reynar Christian Reyes Clarity Despite the comprehensiveness and the wide applications of Orem’s theory, there still some issues regarding its clarity. Orem’s theory is known for its multiple terms that can make the learner confused. According to Mendoza, et al (2004), most of the students who are studying Orem’s work are perplexed on the different terminologies with similar meanings. For example, Orem both defined self care and self care agency as learned behaviors/abilities that deliberately regulate human structural integrity, functioning and development. A similar definition is also noted on Self care action. Another is the difference between Therapeutic, Practical and Health deviation self care need/demand. All of these terms are defined as self care needs or demands that arises when an illness or disease affect the self care agent. These terminologies can cause uncertainty to the learner.
Abdul (2002) also stated that Orem’s theory is redundant in some way. As you have known, Orem’s work was divided into three theories: the theory of self care, theory of self care deficit, and theory of nursing system. Each of these theories is defined separately on their own. However, as it grew more detailed, the redundancy of the concepts occurs. For example, in the theory of self care, Orem defined what are self care, self care agency, and self care requisites. Self care requisites itself can define the theory of self care deficit. And it can also define the theory of the nursing systems if you will view it on a different angle. We think that Orem created her theory this way to have a broader scope and better explain her concepts no matter how redundant it is. Simplicity Dorothea Orem’s work is simple as it is, a person must have the ability to take care for himself. And if the person cannot do so, the nurse will do it for him. However, once you studied her theory more closely, you will see how complex it is. According to Alshamsi (1995), Orem’s work is like a simple wall clock. From the outside, it seems as plain as it can be but once you look inside it, you will be surprised to see the intricacy of its work. This is the reason why most undergraduate students volunteered to report Orem’s theory not knowing how tricky it is to differentiate all the terminologies and how to apply this in a hospital/community setting. Mendoza, et al (2004) also noted that students find Orem’s work “easy to explain but difficult to define”. This means that generally, the concepts of Orem are easy enough to explain but once you go deeper to her theory, they find it hard to define and differentiate her numerous terminologies and hypothesis. Generality The Self care deficit theory is one of the Grand Theories of our generation. This means that it is one of the most complex and has the broadest scope of all the nursing theories present. Grand theories are usually difficult to test in a study or apply in a healthcare setting because it is too complex (dela Cruz, et al, 1991). Wide range theories are effective in an academic environment as its concepts are the building blocks of our practice. Almost all of our current practices are somehow developed from the grand theories. But applying a grand theory, like Orem’s, in a study exclusively will be extremely difficult to prove. Because of the complexity and the broadness of the theory, it gives the study a lot of variables to look at and a very wide scope to apply the study. Moustafa (1999) also noted that Orem’s theory is generally accorded to the physiological and sociological wellbeing of the person, undermining the importance of mental health. According to him, as general as it may look, Orem’s work is lacking some concepts which are vital to nursing care. He greatly stressed the lack mental health on this theory and the possible problems that may happen once Orem’s theory is applied in a healthcare setting. For example, a person who is a paranoid schizophrenic will not admit that he needs help regarding his self care demands. And without acceptance of the self care deficit, it will be difficult to care for the person if we are using Orem’s concepts.
APPLICATION TO PRACTICE Nica-Ann Santos ”Nurses work in life situations with others to bring about the conditions that are beneficial to persons nursed. Nursing demands the exercise of both the speculative and practical intelligence of nurses. In nursing practice situations, nurses must have accurate information and be knowing about existent conditions and circumstances of patients and about emerging changes in them. This knowledge is the concrete base for nurses’ development of creative practical insights of what can be done to bring about beneficial relationships or conditions that do not presently exist. Asking and answering the questions, ‘what is?’ and ‘what can be?’ are nurse’s point of departure in nursing practice situation.” (Orem, 1995, p. 155) The significance of the utilization of the Orem’s model in practice has been explicit since the publication of the first edition of Nursing: Concepts of Practice (Orem, 1971). Early use of the theory in nursing practice began with the work of the Nursing Development Conference Group (NDCG) (1973). The group initiated their adventure into theory-based nursing practice by integrating the developing concepts of the model into their clinical teaching of students. As the conceptualizations evolved, they were incorporated into nursing care.
Members of the NDCG were able to address the reality of theory-based nursing practice from their leadership positions that enabled control over nursing systems. Members of the NDCG valued their work in practice settings for supporting their conceptualizations and revealing the importance of the broad conceptualizations to structure practice. The Center for Experimentation and Development in Nursing at John Hopkins Hospital was one of the early sites for the development of the theory through practice in the Mississippi Methodist Hospital and Rehabilitation Center (Allison, 1989). The overall purpose of Orem’s theory is not just to view the person as a whole, but to utilize nursing knowledge to restore and maintain the patient’s optimal health. The theory of Self Care Deficit Nursing Theory when applied to nursing practice could identify the self care requisites of the patient in various aspects. This is helpful to provide care in a comprehensive manner. The application of this theory in the management of patients will reveal how well the method of nursing assistance (acting and doing for, guiding, teaching, supporting, providing a developmental environment) and the nursing systems used (wholly compensatory, partly compensatory or supportive-educative) could be used to solve the identified problems of the patient with self care deficit. The Nursing Process, when used systematically, could very well facilitate the application of this theory. The self care deficit is identified by the nurse through assessment of the patient. Dorothea Orem portrayed one of the very crucial skills of the nurses in the nursing practice and that is skilled observation, both of the patient and other elements of the nursing situation. Once the self care need is identified, the nurse has to select required nursing systems to provide: wholly compensatory, partly compensatory, or supportive-educative nursing system. The nursing care will be provided according to the degree of deficit the patient is presenting with. Once the care is provided, the nursing activities and the use of nursing systems are to be evaluated to get an idea about whether the mutually planned goals are met or not. Thus, this self care deficit nursing theory could be successfully applied into nursing practice. Below is an example of a nursing situation wherein the Self Care Deficit Theory was utilized in order to address the identified problems of the patient.
Mrs. X came to the hospital with complaints of pain over all the joints, stiffness which is more in the morning and reduces by the activities. She has these complaints since 5 years and has taken treatment from local hospital. The symptoms were not reducing and came to --MC, Hospital for further management. She was able to do the ADL by herself but the way she performed and the posture she used was making her prone to develop the complications of the disease. She also was malnourished and was not having awareness about the deficiencies and effects. Data Collection According To Orem’s Theory of Self Care Deficit
AREAS AND PRIORITY ACCORDING TO OREM’S THEORY OF SELF-CARE DEFICIT: IMPORTANT FOR PRIORITIZING THE NURSING DIAGNOSIS. Air Water Food Elimination Activity/ rest Solitude/ interaction Prevention of hazards Promotion of normalcy Maintain a developmental environment. Prevent or manage the developmental threats Maintenance of health status Awareness and management of the disease process. Adherence to the medical regimen Awareness of potential problem. Modify self image Adjust life style to accommodate health status changes and medical regimen
Thus in the patient Mrs. X the areas that need assistance were‌ Air Water Food Elimination Activity/ rest(2) Solitude/ interaction Prevention of hazards(2) Promotion of normalcy Maintain a developmental environment. Prevent or manage the developmental threats Maintenance of health status Awareness and management of the disease process. Adherence to the medical regimen Awareness of potential problem. Modify self image Adjust life style to accommodate health status changes and medical regimen
APPLICATION TO PROFESSION Rosinee Rosales
As a staff nurse in a medical ward in Riyadh Military Hospital, many of our patients have respiratory and heart problems. All of them present different health problems and needs, some of them are intubated and some of them are in comatose condition after cerebrovascular accident or cardiac arrest. These patients will not be able to verbalize their concerns and feelings. Orem’s concept of self-care specified different self-care requisites, being acquainted in these concepts, it’s easier for me to assess and recognize the needs of my patients and it will facilitate me in selecting particular nursing interventions based on their needs. Orem’s theory of nursing systems is also evident in my current practice. The concepts of wholly compensatory, partly compensatory, and supportive-educative systems are relevant to various interventions that I perform based on different needs and abilities of my patients thus it creates individualized nursing care. In the case of bedridden patients, wholly compensatory nursing system is appropriate to them, “the nurse is their hands and their feet”. Patients who had liver biopsy are not allowed to ambulate 24 hours after the procedure. In this event, partly compensatory nursing system can be applied. Supportive-educative nursing system is appropriate to patients who have diabetes mellitus, they should be taught to correct their diet and lifestyle and how to check their blood sugar and to administer insulin if needed. These are some of the things how Orem’s theory could be beneficial in my current nursing practice. Her contributions are indeed significant in our nursing profession.
APPLICATION TO EDUCATION Vonnalin Del Rio The theory was first articulated in 1950’s it was formalized and published in 1972 for the purpose of “laying out the structure of nursing knowledge and explicating the domains of nursing knowledge”. Orem’s theory has been useful in developing and guiding practice, research, and education. There are numbers of report in literature that her theory has been used as a basis for the curriculum. Ex. The Sinclair School of Nursing University of Missouri at Columbia has used SCDNT as a framework for their curriculum and teaching as well as some Nursing schools in the United States. Orem’s Self care deficit nursing theory is used at all levels of the curriculum as well as continuing education and elective undergraduate course which introduce students to Orem’s theory as described by Berbiglia & Saenz, (Tomey-Alligood, Nursing theorist and their work 5th Ed.). Orem’s theory is useful in designing curricula for preservice, graduate, and continuing nursing education. It can also give direction to nursing administration, and be used for guiding practice and research. It precisely indicates most of the skills, techniques and methods that an individual must learn to become a nurse practitioner. It “gives direction to nurse-specific outcomes related to knowing and meeting the therapeutic self-care demands, and establishing self-care and self-management systems” (McLaughlinRenpenning and Taylor, 2002).
APPLICATION TO RESEARCH Jenzer Mae Ambrocio The research related to or derived from Orem’s theory can be classified as relating to: (1) the development of research instruments for measuring the conceptual elements of the theory and (2) studies the test element of theory in specific populations. A number of instruments for research have been developed. The first instrument to measure the exercise the self-care agency (ESCA) was published in 1979. The SCDNT(Self-Care Deficit Nursing Theory) was the conceptual ground work for Kearney and Fleisher’s ESCA in 1979, DSCAI (Denye’s Self Care Agency Instrument) in 1980, and Hanson and Bickel’s Perception of Self Care Agency in 1981. The SCDNT was a pivotal construct in the design of the Self-As-Carer Inventory (SCI). This inventory permits individuals to express their perceived capacity to care for their self.
McBride did a comparative analysis of three instruments designed to measure self care agency: (1) DSCAI (2) Kearney and Fleisher’s ESCA (3) Hanson and Bickel Perception of Self-care agency. To identify latent traits and their relationships, a common factor analysis and canonical correlation was performed. The results supported the multidimensionality of Orem’s concept of self care agency. The Apparaisal of Self-Care Agency (ASA) scale was develop to measure the core concept of Orem’s SCDNT. The research instrument used most frequently include the DSCAI, DSCPI, ASA, and SCI. Others include Maieutic Dimensions of Self Care Agency Scale (MDSCAS) and Moore and Gaffney’s DCA questionnare. Moore used the child and adolescent self care practice questionnare, the DSCAI and the ESCA when she measured the self-care practices of children and adolescents. McCaleb and Edgil used DSCPI to measure self-concept and self-care practices of healthy adolescents. To assess and teach self care to youths with diabetes mellitus, Frey and Fox used the DSCPI and Denyes’ Health Status Instrument with the Diabetes Self-Care Practice Instrument. For evaluation of hemodialysis patient program and support program, the ESCA was used. Whetstone and Reid also used the ESCA to measure health promotion in older adults and the perceived barriers. The ESCA and the ASA were used to assess basic conditioning factors and self care abilities related to the health of pregnant women and their infants. Source: Nursing Theorists and their Work 5th edition by Ann Marriner Tomey & Martha Alligood pp.198-199
SIGNIFICANCE OF THE THEORY to a SURGICAL NURSE: Vonnalin Del Rio Orem’s theory serves as a guide in my daily practice at the Surgery Ward where majority of the patients are experiencing changes in their physical structure for instance those who have undergone surgeries like BKA, ORIF, etc. most of them lack the ability, strength, and motivation to perform their daily self care activities, so as a nurse committed in their care I must understand how they feel, and provide them with therapeutic interventions by giving them proper assistance or guiding them in meeting their essential needs throughout their care until they recover.
SIGNIFICANCEtoOF THE THEORY a DIALYSIS NURSE: Allan Andan In line with Orem’s concept regarding fostering self-reliance and her insight that man is responsible for his/her self-care and wellbeing of his/her dependents, we educate patients or their relatives about the condition they are in and how to do peritoneal dialysis exchange and PD care themselves during their hospital stay.
SIGNIFICANCE OF THE THEORY to an OBSTETRIC NURSE: Nica-Ann Santos An obstetric nurse, functions to render assistance, whether wholly compensatory, partly compensatory or supportive educative nursing system to the client through the different pregnancy stages, from the initiation of pregnancy, to the stages of labor and delivery and up to the involution stage, wherein there may be inability or decreased ability to perform activities of daily living (ADLs).
SIGNIFICANCE OF THE THEORY to an OPTHALMOLOGY/SURGICAL NURSE: Monaliza Pineda Visually impaired patients have high demand when it comes to caring and dependence. At early stage, they have no capacity to function in their environment alone. They need someone to assist them and teach them to become familiar of their environment. As an ophthalmology nurse, Dorothea Orem’s theory plays an important role in my field of specialization. This is where we help our patient to become as independent as possible despite of the impairment. We teach them and involve their family to our teaching to help them function just like a normal individual. At early stage, we help them accept the disability by letting them express their sentiment and feeling. Afterwards, we give them the necessary options like surgery. In an operating room setting, patient has no control over their environment. As an operating room nurse, we ensure that the area and all the members of the team that will do the operation are kept sterile. To facilitate a good outcome of the operation, the nurse will do his/her part by maintaining the sterility of the area.
SIGNIFICANCE OF THE THEORY to an AMBULANCE NURSE: Wally Guevarra On my everyday encounters at work and during my eight years span as an ambulance nurse here in Dubai. I should say it is a lot of learning experience for me by handling variety of cases of medical and trauma cases. From a very simple minor injury of abrasion to a multiple injuries of long bone fractures, head injury and up to the extent of scattered brain tissues on the scene or what we called dead on spot. The TLC or the tender, love and care approach that we know, which really helps the patient. Because they know that they are well taken care of and you will gain the confidence of your patient. Then the health teachings that we are sharing to patient and family. Dorothea Orem’s theory states that when there is self-care deficit on the part of the patient, which is the potential risk for injury or complication due to knowledge deficit about his condition. Educating the patient will give information of what he has and avoid possible complications thus,the client self-care needs of necessary strength and knowledge is met.
SIGNIFICANCE OF THE THEORY to an EMERGENCY ROOM NURSE: Russel de Lara
An everyday walk in the mill within the confines of the Emergency Department, never has there been a day that people walking in would mind how they look, talk or present themselves. Self-care is something that no person would ask from anyone, because innately, we are organisms who would want to exert and imbibe independence. One in distress would not even mind to do their activities of daily living or satisfy most of their physiologic needs when their current concern is “a complaint.” For severely acute cases needing immediate attention, establishing the ABC’s is key. It is only after maintaining a patent airway and sufficient breathing and circulation that the client can be assessed for self-care abilities & competencies. Most of the time, during the acute stage, can we find ER or ED clients mostly if not unconscious, has altered levels of consciousness. It is during this time that they need wholly compensatory support. When they start to become more responsive, and like anyone of us, demand independence but after careful assessment, all that they may need is partly compensatory assistance. It is only when the physician deems them to be stable, and able for ward transfer, that we may provide supportive-educative support. Provision and assistance of the client’s satisfaction of self-care requisites is very fundamental and that sometimes, we nurses forget that the smallest things we do sometimes are manifestations of the application of these theories, that we have spent years trying to comprehend. Some, if not most, remember these, but just to remind us all, sometimes knowing that we are doing the most basic of things just makes the bigger picture look right.