CREDENTIAL AND BACKGROUND OF THEORIST 1914 Dorothea E

CREDENTIAL AND BACKGROUND OF THEORIST � 1914 - Dorothea E. Orem was born in Baltimore, Maryland � 1930 – She received her diploma in Nursing � 1939 – She received her Bachelor Science in Nursing Education � 1946 – She received Master of Science in Nursing Education both in Catholic University in America.

� 1976 – Honorary degree of Doctor of Science from George Town University � 1971 – First published Book in Nursing; Concepts of practice � 1984 – Retired and continues to work on SCDN Theory

OREM’S GENERAL THEORY OF NURSING ü ü ü THEORY OF SELF CARE DEFICIT THEORY OF NURSING SYSTEMS

Ø The theory of Self Care – which describes how people care for themselves. Ø The theory of self care deficit – describes how people can be helped through Nursing. Ø The theory of Nursing systems – describes the relationships that must be brought about and maintained for nursing to be produced and how self care Agency is developed.

SIX CONCEPTS � Self care agency � Therapeutic self care demand � Self care deficit � Nursing agency � Nursing system

THE THEORY OF SELF - CARE � Self care is performances (or) practice of activities, that individual initiate to perform on their own to maintain life, health, personal development and well being. � Self care requisites : - Actions to be performed for human functioning and development. ◦ The complexity of self care or dependent care system is increased due to health deviation requisites.

SELF CARE REQUISITES Actions to be performed for human functioning and development. 3 categories Universal Developmental Health deviation

UNIVERSAL SELFCARE REQUISITES: These needs are common to all. �The maintenance of a sufficient intake of air, water and food �The provision of care associated with elimination process �The maintenance of balance between activity and rest �Prevention of hazards to human life. �The maintenance of balance between solitude and social interaction.

DEVELOPMENTAL SELFCARE REQUISITES: � Conditions that promote development � Maintenance of maturational body changes (Aging). � Self development - New job, New family. � Prevention of life situations that can adversely affect human development. (Loss of spouse, change in Image)

HEALTH DEVIATION SELFCARE REQUISITES: These self care requisites exist for persons who are ill or injured, who have specific forms of pathological conditions or disorders, including defects and disabilities. � Physiological – care demand due to pathological conditions

� Injury to the integrated human functioning – MR, Comatose, Autism � Power of Agency are seriously impaired (CVA, Paraplegia)

THERAPEUTIC SELF CARE DEMAND: - It refers to self care activities required to meet the self care requisites. If the Selfcare Agency is unable to meet therapeutic care on their own, Nursing agency to carryout deliberate actions.

THEORY OF SELF - CARE DEFICIT Occurs when the self care capabilities within the selfcare agency are not adequate to meet the projected selfcare demand.

SELF CARE AGENCY: � What the individual can do? Self care agency is the human’s ability or power to regulate their own human functioning and development. � Self care abilities are influenced by age, life experience & socio cultural background.

NURSING AGENCY : � Nurse – helps others to meet their therapeutic self care demands, or developing their own Self Care Agency.

DEPENDENT CARE AGENCY : �A person who fulfills the responsibility to meet therapeutic self care demand of relevant others who are socially dependent or Family members. � Dependent care deficit : If relatives are unable to take care of the patients. (Institutionalizing MR/Cerebral palsy children)

OREM’S CONCEPTUAL FRAME WORK FOR NURSING PATIENT � Self care needs – abilities of the patient to perform self care activities. � If self care deficit – occurs, what individual can do is self care Agency. � What needs to be done to maintain optimum functioning is (self care demand). It is done by Nursing agency or dependent Agency.

SELF – CARE CF SELF – CARE AGENCY R < SELF – CARE DEMANDS CF DEFICIT CF NURSING AGENCY < = Deficit relationship, Current or Projected CF = Conditioning factors

THEORY OF NURSING SYSTEM � The nursing system is designed by the nurse. It is based on the self care needs or dependent care of the patient to perform self care activities if there is a self care deficit. (Selfcare Agency) � If there is deficit between, what individual can do (self care agency) and therapeutic self care demand then the Nursing Agency is required.

CLASSIFICATION OF NURSING SYSTEMS 3 Systems: - 1. WHOLLY COMPENSATORY 2. PARTLY COMPENSATORY 3. SUPPORTIVE EDUCATIVE

I. WHOLLY COMPENSATORY NURSING SYSTEM When the individual is unable to engage in those self care action required, self directed and controlled. eg: Ambulation and manipulative movement or medical prescription to restrict from such activity.

Sub types : - Unable to engage in any form of deliberate action (coma patient) They can observe, judge and decide but could not perform ambulatory and manipulative movement. (C 3 - C 4 vertebral fracture) (Paraplegia and Quadriplegia) Unable to attend to themselves, but able to perform some measures of selfcare with continuous guidance and supervision. (MR)

II. PARTLY COMPENSATORY NURSING SYSTEM Both nurse and patient performs care measures or other actions involving manipulative task or ambulation. e. g. Pt who had abdominal surgery.

III. SUPPORTIVE EDUCATIVE SYSTEM In this patient is able to perform or can and can learn to perform required measure of externally or internally oriented therapeutic self care, but cannot do so without assistance. Eg: Self administration of insulin injection. One or more of the 3 types of systems may be used with a single patient.

CLASSIFICATION OF NURSING SYSTEMS

Wholly Compensatory System Accomplishes patient’s Therapeutic self-care Nurse Action Compensates for patients inability to engage in selfcare Support and protects patients Patient’s action is limited Partly Compensatory System Performs some self-care measures for patients Compensates for self-care limitations of patients Nurse Action Assist patients as required Performs some self-care measures Regulates self-care agency Accepts care and assistance from nurse Supportive – Educative System Accomplishes self-care Nurse Action Regulates the exercise and development of self care agency Patient action

METAPARADIGM : 1. PERSON ◦ The patient is the recipient of nursing care. ◦ Human being who function biologically, psychologically and socially, has the potential for learning and development. ◦ If the person cannot learn self care measures, others must provide the care.

2. ENVIRONMENT ◦ Consist of environmental factors. (External, physical and psychological) ◦ Promote Normalcy – Create an environment that allows to function as normally as possible.

3. HEALTH Health state is characterized by soundness or wholeness of bodily structure and function, illness is its opposite.

Consist of physical, psychological, inter personal and social well being. According to Orem, these aspects are inseparable. Preventive health care includes promotion and maintenance of health, treatment of illness and prevention of complications.

4. NURSING ◦ Nursing is needed when the self care demands are greater than the self care abilities. ◦ The art of nursing is, “The quality of individual nurses to make analysis of the conditioning factors with in Nursing situations, for effective assistance for individual”. ◦ Nursing prudence is the quality that enables the nurse to seek advice in new or difficult situation, to make correct judgment, to decide to act in a particular manner and to take action.

� Nursing service as a helping service to human. She describe the ability of nursing agency is to maintain continuously the self care, when the adult/ children is unable to do. � Role of nurse and patients are complementary, working together to achieve self care. � Maintenance, Promotion, prescribing and providing, prevention, Teaching and NPR are the Nurses role.

THEORY APPLICATION � Orem’s theory can be applied in Clinical practice while taking care of patient with, � Organ Tx � CVA � Paraplegia � ICU Patients – Critically ill, unconscious, Fracture Patient, Post Operative Patient, Asthma, CCF. � Diabetic, HT, MI � Post Operative children, critically ill children (Cardiac, Neuro Surgery, B. Tx Patient ) � Caesarian pop

N / Care of patient with Colostomy Universal Self care requisites - Maintenance of Sufficient air - Ineffective airway clearance related to inability to clear tenacious secretions as manifested by abnormal breath sounds, low O 2 saturation

- Maintenance of sufficient intake of food -Imbalanced Nutrition: Less than - Maintenance of sufficient in take of water Deficient fluid volume related to excess fluid loss, less intake of fluids as manifested by ed urine output. -Elimination Bowel incontinence related to presence of colostomy as manifested by frequent change of colostomy bag. body requirement related to ed appetite as manifested by wt. loss.

- Activity and rest - Activity intolerance related to POP pain as manifested by inability to perform selfcare Activities. - Fatigue related to Nut. deficits as manifested by inability to perform ADL - Prevention of hazards - Risk for infection related to ed susceptibility to environmental pathogens.

- Maintenance of balance between solitude and social interaction. - Anxiety related to possible life style changes as manifested by agitation. - Social isolation related to diminished social relationships as manifested by feeling of uselessness. - Promotion of human functioning and development within social groups. Ineffective coping related to lifestyle changes stress as manifested by inability to express feelings of concerns.

Developmental Self care requisites : - Promote Development - Disturbed self esteem related to altered body image as manifested by verbalization of negative feelings regarding personal appearance. - Distributed body image related to presence of Ostomy. - Self development - Powerlessness related to sudden change in life style as manifested by verbalization of inability to cope with stress.

Health Deviation requisites : - Risk for impaired skin integrity r to irritation from fecal drainage around peri ostomal area. Therapeutic Self care demand - Risk for infection of the surgical wound / related to presence of colostomy. - Delayed Surgical recovery related to Pop complications.

Self Care Deficit - Self care deficit related to incision pain as manifested by inability to perform all activities of Daily living. - Selfcare deficit – bathing / hygiene Dressing / grooming Feeding Toileting

Wholly Compensatory System : Immediate POP period to first 2 days. Nurse Agency to meet the selfcare deficit and therapeutic care demands. ◦ Patient fully dependent. ◦ Pop Care – Airway, Fluid & Electrolyte, therapeutic care, Self care needs.

Partly Compensatory System : From 3 rd Pop day - 7 th Pop day ◦ Patient performs selfcare activities with assistance ◦ Ambulation, Self Sponge bath, grooming ◦ Accepts therapeutic care demands from Nurse Agency - Medications and Dressings.

Supportive – Educative System: Discharge phase � Ineffective therapeutic regimen management related to lack of Knowledge. � Knowledge deficit related to colostomy care. ◦ Ostomy selfcare ◦ Dietary & fluid intake guidelines ◦ Colostomy irrigation

◦ Follow up care ◦ Other Stoma problems ◦ Patient performs self care activities ◦ Learn to change colostomy bags ◦ Gain knowledge on home care

Wholly Compensatory System Airway – O 2 Fluid & electrolyte – IV fluids Nurse Action Therapeutic care, Vital signs, Medications, chest physio, inhalation S. Bath, Mouth care, Grooming, Catheter care, Surgical Dressing, Colostomy dressing Patient’s action is limited Positioning, Surgical aspesis Partly Compensatory System Assist in Ambulation Self Sponge bath, Brushing, Backcare, Grooming, Oral fluids Nurse Action Patient action Passive exercises Regulates self-care agency Vital signs, Medications, Surgical wound dressing, changing colostomy bags, Inhalation, suture removal Supportive Educative System Accomplishes self-care Self Care Agency developed Nurse Action Teaching – change of col. bag, Diet at home, Followup care. Demonstrate Changing col. bag Patient action