APPLICATION OF OREM'S SELF-CARE
DEFICIT THEORY IN NURSING PRACTICE
This page was
last updated on
16-03-09
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INTRODUCTION
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The history of professional nursing begins
with Florence nightingale.
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Later in last century nursing began with a
strong emphasis on practice.
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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.
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As more and more nurses began to pursue
higher degrees in nursing, there emerged the
research era.
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Later graduate education and masters
education was given much importance.
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The development of the theory era was a
natural outgrowth of the research era.
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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
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to assess the patient condition by the
various methods explained by the nursing theory
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to identify the needs of the patient
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to demonstrate an effective communication
and interaction with the patient.
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to select a theory for the application
according to the need of the patient
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to apply the theory to solve the identified
problems of the patient
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to evaluate the extent to which the process
was fruitful.
Areas
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Patient details
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Name
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Age
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Sex
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Education
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Occupation
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Marital status
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Religion
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Diagnosis
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Theory applied
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OREM’S THEORY OF SELF CARE DEFICIT
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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.
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In the theory of self care, she explains
self care as the activities carried out by the
individual to maintain their own health.
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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.
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Therapeutic self-care demand is the totality
of the self care measures required.
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The self care is carried out to
fulfill the self-care requisites.
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There are mainly 3 types of
self care requisites such as universal,
developmental and health deviation self care
requisites.
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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.
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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.
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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….
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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.
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She has these complaints since 5 years and has taken
treatment from local hospital.
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The symptoms were not reducing and came to
--MC, Hospital for
further management.
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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
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Age |
56 year |
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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.
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Air
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Water
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Food
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Elimination
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Activity/ Rest
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Solitude/ Interaction
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Prevention of hazards
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Promotion of normalcy
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Maintain a developmental
environment.
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Prevent or manage the
developmental threats
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Maintenance of health status
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Awareness and management of
the disease process.
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Adherence to the medical
regimen
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Awareness of potential
problem.
-
modify self image
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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)
|
Implementation
(control operations)
|
Evaluation
(regulatory operations )
|
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Based on self care deficits
|
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Outcome
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Nursing goal and
objectives
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Design of nursing system
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Appropriate method of
helping
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Nurse- patient actions to
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Promote patient as self care agent
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Meet self care needs
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Decrease the self care deficit.
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1. Effectiveness of the
nurse patient action to
-Promote patient as self
care agent
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Meet self care needs
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Decrease the self care deficit.
2. Effectiveness of the
selected nursing system to meet the needs.
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Thus in the patient Mrs. X the
areas that need assistance were…
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Air
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Water
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Food
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Elimination
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Activity/ Rest(2)
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Solitude/ Interaction
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Prevention of hazards(2)
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Promotion of normalcy
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Maintain a developmental
environment.
-
Prevent or manage the
developmental threats
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Maintenance of health status
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Awareness and management of
the disease process.
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Adherence to the medical
regimen
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Awareness of potential
problem.
-
modify self image
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Adjust life style to
accommodate health status changes and medical
regimen
APPLYING THE OREM’S THEORY OF
SELF-CARE DEFICIT, A NURSING CARE PLAN FOR MRS. X
COULD BE PREPARED AS FOLLOWS …
Therapeutic self care
demand: deficient area: food
Adequacy of self care agency: Inadequate
NURSING DIAGNOSIS
Inability to maintain the ideal
nutrition related to inadequate intake and knowledge
deficit
OUTCOMES AND PLAN
a. Outcome:
improved nutrition
Maintenance of a balanced diet with
adequate iron supplementation.
b. Nursing Goals and
objectives
Goal: to achieve optimal
levels of nutrition.
Objectives:
Mrs. X will:
- state the importance of
maintaining a balanced diet.
- List the food items rich in
iron , that are available in the locality.
c. Design of the nursing
system:
supportive educative
d. Method of helping:
guidance
support
Teaching
Providing developmental environment
IMPLEMENTATION
Mutually planned and
identified the objectives and the patient were made
to understand about the required changes in the
behaviour to have the requisites met.
EVALUATION
Mrs. X understood the importance of
maintaining an optimum nutrition.
She told that she will select the iron
rich diet for her food.
She listed the foods that are rich in
iron and that are locally available.
The self care deficit in terms of food
will be decreased with the initiation of the
nutritional intake.
The supportive educative system was
useful for Mrs. X
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Therapeutic self care demand:
deficient area: Activity
Adequacy of self care
agency: Inadequate
NURSING DIAGNOSIS
Self-care deficit: dressing,
toileting related to restricted joint movement,
secondary to the inflammatory process in the joints.
OUTCOMES AND PLAN
a. Outcome:
- improved self-care
- maintain the ability to
perform the toileting and dressing with modification
as required.
b.
Nursing Goals and
objectives
Goal: to achieve optimal
levels of ability for self care.
Objectives: Mrs. X will:
-perform the dressing
activities within limitations
-utilize the alternative measures available for
improving the toileting
-perform the other activities
of daily living with minimal assistance.
c. Design of the nursing
system:
Partly compensatory
d. Method of helping:
Guidance:
Assess the various
hindering factors for self care and how to tackle
them.
Support:
Provide all the articles needed for
self care, near to the patient and ask the family
members also to give the articles near to her.
Provide passive exercises and make to
perform active exercises so as to promote the
mobility of the joint.
Make the patient use commodes or
stools to perform toileting and insist on avoidance
of squatting position
Provide assistance whenever needed for
the self care activities
Provide encouragement and positive
reinforcement for minor improvement in the activity
level.
Initiate the pain relieving measures
always before the patient go for any of the
activities of daily living
Make the patient to use loose fitting
clothes which will be easy to wear and remove.
Teaching:
Teach the family members the
limitation in the activity level the patient has and
the cooperation required
Promoting a developmental
environment:
Teach the family and help them to
practice how to help the patient according to her
nee ds
IMPLEMENTATION
Mutually planned and identified
the objectives and the patient was made to
understand about the required changes in the
behaviour to have the requisites met.
EVALUATION
Patient was performing some of the
activities and she practiced toileting using a
commode in the hospital.
She verbalized an improved comfort and
self care ability.
She performed the dressing activities
with minimal assistance
Patient verbalized that she will
perform the activities as instructed to get her ADL
done.
The partly compensatory system was
useful for Mrs. X
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Therapeutic self care demand:
deficient area: Pain control
Adequacy of self care
agency: Inadequate
NURSING DIAGNOSIS
OUTCOMES AND PLAN
a. Outcome:
b.
Nursing Goals and
objectives
Goal: to achieve
reduction in the pain.
Objectives: Mrs. X will:
describe the total plan of
pharmacological and non pharmacological pain relief
demonstrate a reduction in the pain
behaviours
verbalize a reduction in the pain
scale score from 7 – 4
c. Design of the nursing
system: supportive educative
d. method of helping:
Guidance:
Explore the past experience of pain
and methods used to manage them.
Ask the client to report the
intensity, location, severity, associated and
aggravating factors.
Support:
Provide rest to the joints and avoid
excessive manipulations
provide hot and cold
application to have better mobility.
Encourage exercises to the joints by
immersing in the warm water.
Administer T. Ultracet and Tab
Diclofecac as prescribed.
Provide diversion and psychological
support to the patient
Teaching:
Teach the non – pharmacological
method to the patient once the pain is a little
reduced.
Providing the developmental
environment:
Discuss with the patient the
necessity to maintain a pain diary with all
information regarding episodes of pain and refer to
that periodically
Enquire from the health team,
the need for opioid analgesics or other analgesics
and get a prescription for the patient.
IMPLEMENTATION
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EVALUATION
Patient still has pain over the joints
and she agreed that she will use the measures for
pain relief that is told to her.
The pain scale score was 6 after the
measures were provided to the patient.
She demonstrated slight reduction in
the pain behaviours.
The supportive educative system was
useful for Mrs. X
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Therapeutic self care
demand: deficient area: prevention of hazards.
Adequacy of self care agency:
Inadequate
NURSING DIAGNOSIS
Potential for fall and fractures related to
rheumatoid arthritis.
OUTCOMES AND PLAN
a. Outcome:
Absence of falls and injury to
the patient
b. Nursing Goals and
objectives
Goal: prevent the falls
and injury and to maintain a good body mechanics.
objectives: Mrs. X will:
-remain free from injury as evidenced by:
-absence of signs and symptoms
of fall or injury
- explaining the methods to
prevent the injury.
c. Design of the nursing
system: supportive educative
d. method of helping:
Support
Never leave the client alone in the
unit
Assess the patients gait, activities
and the mental status for any confusion or
disorientation
Encourage the patient to use
supportive devices as required.
Provide a safe environment in the
hospital by avoiding sharp objects or wooden objects
on the way and slippery floor.
Involve the family members in
providing and maintaining a safe environment in the
home
Involve the family members to provide
support to the patient whenever necessary
Plan a balanced diet for the patient
with a mutual interaction
IMPLEMENTATION
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EVALUATION
Patient remained free from injury as
evidenced by absence of signs and symptoms.
Patient explained the various measures
that they will take to prevent the injury.
The supportive educative system was
useful for Mrs. X
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Therapeutic self care
demand: deficient area: prevention of hazards.
Adequacy of self care agency:
Inadequate
NURSING DIAGNOSIS:
Potential for impaired skin integrity related to
edema secondary to renal cysts.
OUTCOMES AND PLAN:
a. Outcome:
Maintenance of normal
skin integrity.
b. nursing Goals and
objectives
Goal: Maintain the skin
integrity and take measures to prevent skin
impairment.
Objectives:
Mrs. X will:
-
maintain a normal skin integrity
-
list the measures to prevent the loss
of skin integrity
-
identify the measures to relieve
edema.
c. Design of the nursing
system: supportive educative
d. method of helping:
Support:
Assess the skin regularly for any
excoriation or loss of integrity or colour changes.
Keep the skin clean always
Avoid stress or pressure over the area
of edema by providing extra cushions or padding
Monitor the lab values as well as the
patient for any signs and symptoms of renal failure.
Encourage the patient to use slippers
while walking and that should not be tight fitting.
Assess the edema for its degree,
pitting or non pitting and continue the assessment
daily.
Provide a leg end elevated position or
elevation of the leg on a pillow if no cardiac
abnormalities are identified.
Explain the patient the need for
taking care of the edematous parts
Explain the patient to report the
symptoms like decreased urine output, palpitations,
increased edema etc. to the health team
IMPLEMENTATION
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EVALUATION
Patient remained free from impaired
skin integrity
She listed the measures to prevent the
loss of skin integrity
She identified the measures to relieve
edema.
The supportive
educative system was useful for Mrs. x
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Therapeutic self care
demand: deficient area: awareness of the disease
process and management
Adequacy of self care agency:
Inadequate
NURSING
DIAGNOSIS
Potential for complications related to rheumatoid
arthritis secondary to knowledge deficit.
OUTCOMES AND PLAN
a. Outcome:
Absence of complications and improved
awareness about the disease process.
b. nursing Goals and
objectives
Goal: Improve the
knowledge of the patient about the disease process
and the complications.
Objectives: Mrs.
X will:
-verbalize the various
complication and their preventions
-verbalize the changes
occurring with the disease process and the treatment
available
-describe the actions and side
effects of the medications which she is using
c. Design of the nursing
system:
supportive educative
d. Methods of helping:
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Guidance
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Teaching
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Promoting a developmental
environment
IMPLEMENTATION
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EVALUATION
Patient got adequate information
regarding the disease
She verbalized what she understood
about the disease and its management.
Patient has cleared her doubts
regarding the medication actions and the side
effect
The supportive educative system was
useful for Mrs. X
EVALUATION OF THE APPLICATION OF SELF
CARE DEFICIT THEORY
The theory of self-care deficit when applied could
identify the self care requisites of Mrs. X from
various aspects. This was helpful to provide care in
a comprehensive manner. Patient was very
cooperative. the application of this theory revealed
how well the supportive and educative and partly
compensatory system could be used for solving the
problems in a patient with rheumatoid arthritis.
REFERENCES
1.
Alligood M R, Tomey A M. Nursing Theory:
Utilization &Application .3rd ed.
Missouri: Elsevier Mosby Publications; 2002.
2.
Tomey AM, Alligood. MR. Nursing theorists and
their work. (5th ed.). Mosby, Philadelphia, 2002
3.
George JB .Nursing Theories: The Base for
Professional Nursing Practice .5th
ed. New Jersey :Prentice Hall;2002.
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