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Dorothea Orem’s Self-Care Theory

According to Dortha Orem every human need to do some tasks in everyday life that are important for their survival these tasks called selfcare. Problem develop when that human is un-able to perform that task on its own or without any other person assistance, this is called self care deficit. Interestingly person doesn’t need nurse during selfcare but when deficit happen nurse intervene and try to correct that deficit by partially helping or fully performing that job if client is so dependent. She also put in prospective the people who taking care of individual at home or family perspective that she classifies as theory of dependent care.

This theory gives full picture of every-day living of well as well as sick clients and how dynamics of care giver effected by self-care deficit by a client. Theory has a beauty of simplicity and language easy to understand if we compare it to others theorist. This theory is comprehensible by providers that are not highly educated and even they can implement this in day to day practice.

Orem explains that universal self-care is activity of daily living that are utmost important for human functioning and integrity of structure. These ADL’s include air intake for breathing, water intake, removal of waste from body, balance between activities and rest and promotion of human optimal functioning, whenever health deviation occur self-care deficit happen. To recover from this illness client need to do some activities like going to get medical advice, carry that prescribed measures. If he/she is able to conduct those needs by themselves there is no need to interfere by nurse. But client is unable to do so nurse role to take part and help to complete task. Nurse can help a client in 5 different ways.

  1. Acting for or doing full job for patient
  2. Guiding client
  3. Supporting clients
  4. Nurturing an environment that promote personal development
  5. Teaching skills to client.

It is very easy to apply in day to day nursing interactions. For example a home care nurse that is taking care of a client that is good strength and can use restroom without assistance but nurse provide her bed pan and ask her to use it so nurse is doing opposite to guidelines of Orem as she is not letting patient independent and not letting her completing self-care. Similarly if she if another patient is not in good strength but still can wail with assistance if nurse hold her one side and take her to rest room she is following Orem theory as she is assisting the patient but not compromising her independence. Similarly if home health nurse sit with patient listen to her guide her and teach her to overcome her self-care deficit she is following Dorothea Orem guidelines.

According to a research published in Red Crescent journal that was conducted with patient of multiple sclerosis. Design of study was a single blind randomized clinical trial where the person that analyze was blinded to participants of study. This research involved a clinical trial. 63 patients with multiple sclerosis were selected based on nonrandom sampling, and then they were allocated to the two groups based on random allocation. In the intervention group, Orem’s model was applied during six sessions of forty five min to one hour in length, and this process continued for 1 month. The data were collected one week before and seven weeks after the end of the intervention using the Orem’s self-care model based assessment form and fatigue severity scale.

Study shows that sefore the intervention only 11.11% of the participants had a good knowledge of self-care. In addition to knowledge, self-care willingness and skills were observed in 76.19% and 4.76% of participants, respectively. After applying Orem’s theory fatigue and tiredness level decrease significantly between 2 groups that were controlled and experimental (P < 0.05).

Another study publish in July 2018 journal Nursing Science Quarterly also shows positive results after application of Orem’s theory. To conduct this experiment, trauma patients were divided into two groups one cared for regular nursing care and other went through Orem’s theory care. Study was focuses to check self- care knowledge, attitude, practices and respiratory condition of trauma patients. This Study used a quasi-experiment was conducted. Although self-care attitude, knowledge and attitude improved in both groups but in Orem’s group it was way better and more striking to examine if the application of Orem’s self-care model could improve self-care knowledge, attitudes. However, there were no differences in the improvement of the chest parameters between the two groups. Orem’s model was effective in improving self-care in patients with chest tube.

According to scenario described elder patient who is not able to read medication labels and also not able to open bottles. If we apply Orem’s theory for this elder we will start asking about his knowledge of medicine and why he is not able to perform this activity of self-care. Once nurse will figure out what is underlying problem she will intervene and come up with a solution to decrease self-care deficit. For example if he has eye sight problem nurse will schedule eyes exam and get optical for reading. If client is not educated maybe change lable of medication bottles so he can see color and when to take medicine. If patient has problem of opening bottle may be check their motor ability to perform task by hand, or if the client don’t know how to open bottle if it require specific technique. So nurse will teach that technique and ask patient to perform in-front of nurse so she can check teaching was successful.

Not only scenario described above but this theory can use in any nursing situation in which client has self-care deficit. Nurse can guide and assist during client stay in hospital and after they are discharge.

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