APPLICATION OF OREM'S SELF-CARE DEFICIT THEORY IN NURSING PRACTICE

INTRODUCTION

• The history of professional nursing begins with Florence nightingale.

• Later in last century nursing began with a strong emphasis on practice.

• Following that came the curriculum era which addressed the questions about what the nursing students should study in order to achieve the required standard of nursing.

• As more and more nurses began to pursue higher degrees in nursing, there emerged the research era.

• Later graduate education and masters education was given much importance.

• The development of the theory era was a natural outgrowth of the research era.

• With an increased number of researches it became obvious that the research without theory produced isolated information; however research and theory produced the nursing sciences.

• Within the contemporary phase there is an emphasis on theory use and theory based nursing practice and lead to the continued development of the theories.

OBJECTIVES

• to assess the patient condition by the various methods explained by the nursing theory

• to identify the needs of the patient

• to demonstrate an effective communication and interaction with the patient.

• to select a theory for the application according to the need of the patient

• to apply the theory to solve the identified problems of the patient

• to evaluate the extent to which the process was fruitful.

Areas	Patient details
Name Age Sex Education Occupation Marital status Religion Diagnosis Theory applied	Mrs. X 56 years Female No formal education House hold Married Hindu Rheumatoid arthritis Orem’s theory of self care deficit.

OREM’S THEORY OF SELF CARE DEFICIT

• The self care deficit theory proposed by Orem is a combination of three theories, i.e. theory of self care, theory of self care deficit and the theory of nursing systems.

• In the theory of self care, she explains self care as the activities carried out by the individual to maintain their own health.

• The self care agency is the acquired ability to perform the self care and this will be affected by the basic conditioning factors such as age, gender, health care system, family system etc.

• Therapeutic self-care demand is the totality of the self care measures required.

• The self care is carried out to fulfill the self-care requisites.

• There are mainly 3 types of self care requisites such as universal, developmental and health deviation self care requisites.

• Whenever there is an inadequacy of any of these self care requisite, the person will be in need of self care or will have a deficit in self care.

• The deficit is identified by the nurse through the thorough assessment of the patient.

• Once the need is identified, the nurse has to select required nursing systems to provide care: wholly compensatory, partly compensatory or supportive and educative system.

• The 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 the nursing systems are to be evaluated to get an idea about whether the mutually planned goals are met or not.

• Thus the theory could be successfully applied into the nursing practice.

For Mrs. X….

• She 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.

• Patient 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

1. BASIC CONDITIONING FACTORS

Age	56 year
Gender	Female
Health state	Disability due to health condition, therapeutic self care demand
Development state	Ego integrity vs despair
Sociocultural orientation	No formal education, Indian, Hindu
Health care system	Institutional health care
Family system	Married, husband working
Patterns of living	At home with partner
Environment	Rural area, items for ADL not in easy reach, no special precautions to prevent injuries
resources	Husband, daughter, sister’s son

2. UNIVERSAL SELF-CARE REQUISITES:

Air	Breaths without difficulty, no pallor cyanosis
Water	Fluid intake is sufficient. Edema present over ankles. Turgor normal for the age
Food	Hb – 9.6gm%, BMI = 14.Food intake is not adequate or the diet is not nutritious.
Elimination	Voids and eliminates bowel without difficulty.
Activity/ rest	Frequent rest is required due to pain. Pain not completely relieved, Activity level ha s come down. Deformity of the joint secondary to the disease process and use of the joints.
Social interaction	Communicates well with neighbors and calls the daughter by phone Need for medical care is communicated to the daughter.
Prevention of hazards	Need instruction on care of joints and prevention of falls.  Need instruction on improvement of nutritional status. Prefer to walk bare foot.
Promotion of normalcy	Has good relation with daughter

3. DEVELOPMENTAL SELF-CARE REQUISITES:

Maintenance of  developmental environment	Able to feed self , Difficult to perform the dressing, toileting etc
Prevention/management of the conditions threatening the normal development	Feels that the problems are due to her own behaviours and discusses the problems with husband and daughter.

4. HEALTH DEVIATION SELF CARE REQUISITES

Adherence to medical regimen	Reports the problems to the physician when in the hospital. Cooperates with the medication, Not much aware about the use and side effects of medicines
Awareness of potential problem associated with the regimen	Not aware about the actual disease process.   Not compliant with the diet and prevention of hazards. Not aware about the side effects of the medications
Modification of self image to incorporates changes in health status	Has adapted to limitation in mobility.   The adoption of new ways for activities leads to deformities and progression of the disease.
Adjustment of lifestyle to accommodate changes in the health status and medical regimen.	Adjusted with the deformities. Pain tolerance not achieved

5. MEDICAL PROBLEM AND PLAN:  

o      Physician’s perspective of the condition:

          Diagnosed with rheumatoid arthritis and is on the following medications:

 T. Valus SR OD

T. Pan 40 mg OD

 T. Tramazac 50 mg OD

 T. Recofix Forte BD

 T. Shelcal BD

 Syp. Heamup 2tsp TID

Medical Diagnosis: Rheumatoid arthritis

Medical Treatment: Medication and physical therapy.

AREAS AND PRIORITY ACCORDING TO OREM’S THEORY OF SELF-CARE DEFICIT: IMPORTANT FOR PRIORITIZING THE NURSING DIAGNOSIS.

1. Air

2. Water

3. Food

4. Elimination

5. Activity/ Rest

6. Solitude/ Interaction

7. Prevention of hazards

8. Promotion of normalcy

9. Maintain a developmental environment.

10.  Prevent or manage the developmental threats

11. Maintenance of health status

12. Awareness and management of the disease process.

13. Adherence to the medical regimen

14. Awareness of potential problem.

15.  modify self image

16. Adjust life style to accommodate health status changes and MR

Nursing care plan according to Orem’s theory of self care deficit

Nursing diagnosis  ( diagnostic operations )

Outcome and plan (Prescriptive operations)