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Origin: Dorothea Orem developed her theory of Self-Care Deficit while working in general hospitals in her state in order to improve the quality of care.

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The Self-Care Deficit Theory developed as a result of Dorothea E. Orem working toward her goal of improving the quality of nursing in general hospitals in her state. The model interrelates concepts in such a way as to create a different way of looking at a particular phenomenon. The theory is relatively simple, but generalizable to apply to a wide variety of patients. It can be used by nurses to guide and improve practice, but it must be consistent with other validated theories, laws and principles.

The major assumptions of Orem's Self-Care Deficit Theory are:

People should be self-reliant, and responsible for their care, as well as others in their family who need care.

People are distinct individuals.

Nursing is a form of action. It is an interaction between two or more people.

Successfully meeting universal and development self-care requisites is an important component of primary care prevention and ill health.

A person's knowledge of potential health problems is needed for promoting self-care behaviors.

Self-care and dependent care are behaviors learned within a socio-cultural context.

Orem's theory is comprised of three related parts: theory of self-care; theory of self-care deficit; and theory of nursing system.

The theory of self-care includes self-care, which is the practice of activities that an individual initiates and performs on his or her own behalf to maintain life, health, and well-being; self-care agency, which is a human ability that is "the ability for engaging in self-care," conditioned by age, developmental state, life experience, socio-cultural orientation, health, and available resources; therapeutic self-care demand, which is the total self-care actions to be performed over a specific duration to meet self-care requisites by using valid methods and related sets of operations and actions; and self-care requisites, which include the categories of universal, developmental, and health deviation self-care requisites.

Universal self-care requisites are associated with life processes, as well as the maintenance of the integrity of human structure and functioning. Orem identifies these requisites, also called activities of daily living, or ADLs, as:

1. the maintenance of sufficient intake of air, food, and water

2. provision of care associated with the elimination process

3. a balance between activities and rest, as well as between solitude and social interaction

4. the prevention of hazards to human life and well-being

5. the promotion of human functioning

Developmental self-care requisites are associated with developmental processes. They are generally derived from a condition or associated with an event.

Health deviation self-care is required in conditions of illness, injury, or disease. These include:

1. Seeking and securing appropriate medical assistance

2. Being aware of and attending to the effects and results of pathologic conditions

3. Effectively carrying out medically prescribed measures

4. Modifying self-concepts to accept onseself as being in a particular state of health and in specific forms of health care

5. Learning to live with the effects of pathologic conditions.

The second part of the theory, self-care deficit, specifies when nursing is needed. According to Orem, nursing is required when an adult is incapable or limited in the provision of continuous, effective self-care. The theory identifies five methods of helping: acting for and doing for others; guiding others; supporting another; providing an environment promoting personal development in relation to meet future demands; and teaching another.

The theory of nursing systems describes how the patient's self-care needs will be met by the nurse, the patient, or by both. Orem identifies three classifications of nursing system to meet the self-care requisites of the patient: wholly compensatory system, partly compensatory system, and supportive-educative system.

Orem recognized that specialized technologies are usually developed by members of the health care industry. The theory identifies two categories of technologies.

The first is social or interpersonal. In this category, communication is adjusted to age and health status. The nurse helps maintain interpersonal, intra-group, or inter-group relations for the coordination of efforts. The nurse should also maintain a therapeutic relationship in light of pscyhosocial modes of functioning in health and disease. In this category, human assistance adapted to human needs, actions, abilities, and limitations is given by the nurse.

The second is regulatory technologies, which maintain and promote life processes. This category regulates psycho- and physiological modes of functioning in health and disease. Nurses should promote human growth and development, as well as regulating position and movement in space.

Orem's approach to the nursing process provides a method to determine the self-care deficits and then to define the roles of patient or nurse to meet the self-care demands. The steps in the approach are thought of uas the technical component of the nursing process. Orem emphasizes that the technological component "must be coordinated with interpersonal and social pressures within nursing situations.

The nursing process in this model has three parts. First is the assessment, which collects data to determine the problem or concern that needs to be addressed. The next step is the diagnosis and creation of a nursing care plan. The third and final step of the nursing process is implementation and evaluation. The nurse sets the health care plan into motion to meet the goals set by the patient and his or her health care team, and, when finished, evaluate the nursing care by interpreting the results of the implementation of the plan.

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Orem's Self-Care Deficit Nursing Theory - Nursing Theory

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The Self-Care Deficit Theory developed as a result of Dorothea E. Orem working toward her goal of improving the quality of nursing in general hospitals in her state. The model interrelates concepts in such a way as to create a different way of looking at a particular phenomenon.

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In 1971 Nursing: Concepts in Practice was published by Orem, establishing her as a lead theorist in the field of Nursing.

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Dorothea Orem is a nurse theorist who pioneered the Self-Care Deficit Nursing Theory. Get to know the biography and works of Orem, including a discussion about the major concepts, subconcepts, nursing metaparadigm, and application of Self- Care Deficit Theory.

Dorothea Elizabeth Orem (July 15, 1914 - June 22, 2007) was one of America's foremost nursing theorists who developed the Self-Care Deficit Nursing Theory, also known as the Orem Model of Nursing.

Her theory defined Nursing as "The act of assisting others in the provision and management of self-care to maintain or improve human functioning at home level of effectiveness." It focuses on each individual's ability to perform self-care, defined as "the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being."

Dorothea Orem was born in July 15, 1914 in Baltimore, Maryland. Her father was a construction worker and her mother is a homemaker. She was the youngest among two daughters.

In the early 1930s, she earned her nursing diploma from the Providence Hospital School of Nursing in Washington, D.C. She went on to complete her Bachelor of Science in Nursing in 1939 and her Master's of Science in Nursing in 1945, both from the Catholic University of America in Washington, D.C.

Dorothea Orem attended Seton High School in Baltimore, and graduated in 1931. She received a diploma from the Providence Hospital School of Nursing in Washington, D.C. in 1934 and went on to the Catholic University of America to earn a B.S. in Nursing Education in 1939, and an M.S. in Nursing Education in 1945.

She had a distinguished career in nursing. She earned several Honorary Doctorate degrees. She was given Honorary Doctorates of Science from both Georgetown University in 1976 and Incarnate Word College in 1980. She was given an Honorary Doctorate of Humane Letters from Illinois Wesleyan University in 1988, and a Doctorate Honoris Causae from the University of Missouri in Columbia in 1998.

Dorothea Orem's Self-Care Deficit Theory focuses on each "individual's ability to perform self-care, defined as 'the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being.'" The Self-Care or Self-Care Deficit Theory of Nursing is composed of three interrelated theories: (1) the theory of self-care, (2) the self-care deficit theory, and (3) the theory of nursing systems, which is further classified into wholly compensatory, partial compensatory and supportive-educative. It is discussed further below.

Dorothea Orem occupied important nursing positions, like the directorship of both the nursing school and the department of nursing at Providence Hospital, Detroit from 1940 to 1949, where she also taught biological sciences and nursing from 1939 to 1941. At the Catholic University of America, Orem served as Assistant Professor from 1959 to 1964, Associate Professor from 1964 to 1970, and Dean of the School of Nursing from 1965 to 1966.

She also served as curriculum consultant to The Office of Education, United States Department of Health, Education and Welfare, Practical Nurse Section in 1958, 1959, and 1960, to the Division of Hospital and Institutional Services, The Indiana State Board of Health from 1949 to 1957, and to the Center for Experimentation and Development in Nursing, The Johns Hopkins Hospital, 1969-1971, and to the Director of Nursing, Wilmer Clinic, The Johns Hopkins Hospital, 1975-1976.

She was a member of the group of nurse theorists who presented Patterns of Unitary Man (Humans), the initial framework for nursing diagnosis, to the North American Nursing Diagnosis Association in 1982.

Dorothea Orem helped publish the "Guidelines for Developing Curricula for the Education of Practical Nurses" in 1959.

In 1971 Orem published Nursing: Concepts of Practice, the work in which she outlines her theory of nursing, the Self-care Deficit Theory of Nursing. The success of this work and the theory it presents established Orem as a leading theorist of nursing practice and education.

She also served as chairperson of the Nursing Development Conference Group, and in 1973 edited that group's work in the book Concept Formalization in Nursing.

She authored many other papers and during the 1970s and 1980s spoke at numerous conferences and workshops around the world. The International Orem Society was founded to foster research and the continued development of Orem's theories of nursing.

The second edition of Nursing: Concept of Practice was published in 1980. Orem retired in 1984 but she continued to work on the third edition which was published in 1985; fourth edition of her book was completed in 1991. She continued to work on the conceptual development of Self-Care Deficit Nursing Theory.

Orem continued to be active in theory development. She completed the 6th edition of Nursing: Concepts of Practice, published by Mosby in January 2001.

Dorothea Orem was also given many awards during her career: the Catholic University of America Alumni Achievement Award for Nursing Theory in 1980, the Linda Richards Award from the National League for Nursing in 1991, and was named an Honorary Fellow of the American Academy of Nursing in 1992.

She also received accolades for her contributions to the field of nursing, including honorary degrees from Georgetown University, Incarnate Word College, Illinois Wesleyan University, and the University of Missouri-Columbia.

She was inducted into the American Academy of Nursing, and received awards from the National League for Nursing and the Sigma Theta Tau Nursing Honor Society.

Dorothea Orem died on June 22, 2007 in Savannah, Georgia, where she had spent the last 25 years of her life as a consultant and author. She was 92.

Dorothea Orem's Self-Care Deficit Theory

There are instances wherein patients are encouraged to bring out the best in them despite being ill for a period of time. This is very particular in rehabilitation settings, in which patients are entitled to be more independent after being cared for by physicians and nurses. Through these, the Self-Care Nursing Theory or the Orem Model of Nursing was developed by Dorothea Orem between 1959 and 2001. It is considered a grand nursing theory, which means the theory covers a broad scope with general concepts that can be applied to all instances of nursing.

Dorothea Orem's Self-Care Deficit Theory defined Nursing as "The act of assisting others in the provision and management of self-care to maintain or improve human functioning at home level of effectiveness." It focuses on each individual's ability to perform self-care, defined as "the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being."

"The condition that validates the existence of a requirement for nursing in an adult is the absence of the ability to maintain continuously that amount and quality of self-care which is therapeutic in sustaining life and health, in recovering from disease or injury, or in coping with their effects. With children, the condition is the inability of the parent (or guardian) to maintain continuously for the child the amount and quality of care that is therapeutic." (Orem, 1991)

The assumptions of Dorothea Orem's Self-Care Theory are: (1) In order to stay alive and remain functional, humans engage in constant communication and connect among themselves and their environment. (2) The power to act deliberately is exercised to identify needs and to make needed judgments. (3) Mature human beings experience privations in the form of action in care of self and others involving making life-sustaining and function-regulating actions. (4) Human agency is exercised in discovering, developing, and transmitting to others ways and means to identify needs for, and make inputs into, self and others. (5) Groups of human beings with structured relationships cluster tasks and allocate responsibilities for providing care to group members.

In this section are the definitions of the major concepts of Dorothea Orem's Self-Care Deficit Theory:

Nursing is an art through which the practitioner of nursing gives specialized assistance to persons with disabilities which makes more than ordinary assistance necessary to meet needs for self-care. The nurse also intelligently participates in the medical care the individual receives from the physician.

Humans are defined as "men, women, and children cared for either singly or as social units," and are the "material object" of nurses and others who provide direct care.

The environment has physical, chemical and biological features. It includes the family, culture, and community.

Health is "being structurally and functionally whole or sound." Also, health is a state that encompasses both the health of individuals and of groups, and human health is the ability to reflect on one's self, to symbolize experience, and to communicate with others.

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.

Self-care agency is the human's ability or power to engage in self-care and is affected by basic conditioning factors.

Basic conditioning factors are age, gender, developmental state, health state, socio-cultural orientation, health care system factors, family system factors, patterns of living, environmental factors, and resource adequacy and availability.

Therapeutic Self-care Demand is the totality of "self-care actions to be performed for some duration in order to meet known self-care requisites by using valid methods and related sets of actions and operations."

Self-care Deficit 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.

Nursing Agency is a complex property or attribute of people educated and trained as nurses that enables them to act, to know, and to help others meet their therapeutic self-care demands by exercising or developing their own self-care agency.

Nursing System is the product of a series of relations between the persons: legitimate nurse and legitimate client. This system is activated when the client's therapeutic self-care demand exceeds available self-care agency, leading to the need for nursing.

The Self-Care or Self-Care Deficit Theory of Nursing is composed of three interrelated theories: (1) the theory of self-care, (2) the self-care deficit theory, and (3) the theory of nursing systems, which is further classified into wholly compensatory, partial compensatory and supportive-educative.

This theory focuses on the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health and well-being.

Self-Care Requisites

Self-care Requisites or requirements can be defined as actions directed toward the provision of self-care. It is presented in three categories:

Universal Self-Care Requisites

Universal self-care requisites are associated with life processes and the maintenance of the integrity of human structure and functioning.

The maintenance of a sufficient intake of air

The maintenance of a sufficient intake of water

The maintenance of a sufficient intake of food

The provision of care associated with elimination process and excrements

The maintenance of a balance between activity and rest

The maintenance of a balance between solitude and social interaction

The prevention of hazards to human life, human functioning, and human well-being

The promotion of human functioning and development within social groups in accord with human potential, known human limitations, and the human desire to be normal

Normalcy is used in the sense of that which is essentially human and that which is in accord with the genetic and constitutional characteristics and the talents of individuals.
Developmental self-care requisites
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 condition or associated with an event."
Health deviation self-care requisites
Health deviation self-care requisites are required in conditions of illness, injury, or disease or may result from medical measures required to diagnose and correct the condition.

Seeking and securing appropriate medical assistance

Being aware of and attending to the effects and results of pathologic conditions and states

Effectively carrying out medically prescribed diagnostic, therapeutic, and rehabilitative measures

Being aware of and attending to or regulating the discomforting or deleterious effects of prescribed medical measures

Modifying the self-concept (and self-image) in accepting oneself as being in a particular state of health and in need of specific forms of health care

Learning to live with the effects of pathologic conditions and states and the effects of medical diagnostic and treatment measures in a lifestyle that promotes continued personal development

This theory 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. Orem identified 5 methods of helping:

Acting for and doing for others

Guiding others

Supporting another

Providing an environment promoting personal development in relation to meet future demands

Teaching another

This theory is the product of a series of relations between the persons: legitimate nurse and legitimate client. This system is activated when the client's therapeutic self-care demand exceeds available self-care agency, leading to the need for nursing.

Wholly Compensatory Nursing System

This is represented by a situation in which the individual is unable "to engage in those self-care actions requiring self-directed and controlled ambulation and manipulative movement or the medical prescription to refrain from such activity... Persons with these limitations are socially dependent on others for their continued existence and well-being."

Example: care of a newborn, care of client recovering from surgery in a post- anesthesia care unit

Partial Compensatory Nursing System

This is represented by a situation in which "both nurse and perform care measures or other actions involving manipulative tasks or ambulation... [Either] the patient or the nurse may have a major role in the performance of care measures."

Example: Nurse can assist postoperative client to ambulate, Nurse can bring a meal tray for client who can feed himself

Supportive-Educative System

This is also known as supportive-developmental system, the person "is able to perform or can and should learn to perform required measures of externally or internally oriented therapeutic self-care but cannot do so without assistance."

Example: Nurse guides a mother how to breastfeed her baby, Counseling a psychiatric client on more adaptive coping strategies.

The Nursing Process presents a method in determining self-care deficits and to define the roles of persons or nurse to meet the self-care demands.

Diagnosis and prescription; determine why nursing is needed. Analyze and interpret by making a judgment regarding care.

Design of a nursing system and plan for delivery of care.

Production and management of nursing systems.

Step 1 - Collect Data in Six Areas

1. The person's health status

2. The physician's perspective of the person's health status

3. The person's perspective of his or health health

4. The health goals within the context of life history, lifestyle, and health status.

5. The person's requirements for self-care

6. The person's capacity to perform self-care

Step 2

The nurse designs a system that is wholly or partly compensatory or supportive-educative.

The two actions are: (1) Bringing out a good organization of the components of patients' therapeutic self-care demands. (2) Selection of combination of ways of helping that will be effective and efficient in compensating for/overcoming patient's self-care deficits.

Step 3

Nurse assists the patient or family in self-care matters to achieve identified and described health and health-related results. Collecting evidence in evaluating results achieved against results specified in the nursing system design.

Actions are directed by etiology component of nursing diagnosis.

There is a superb focus of Orem's work which is self-care. Even though there is a wide range of scope seen in the encompassing theory of nursing systems, Orem's goal of letting the readers view nursing care as a way to provide assistance to people was apparent in every concept presented.

From the definition of health which is sought to be rigid, it can now be refined by making it suitable to the general view of health as a dynamic and ever-changing state.

The role of the environment to the nurse-patient relationship, although defined by Orem was not discussed.

The role of nurses in maintaining health for the patient was set by Orem with great coherence in accordance with the life-sustaining needs of every individual.

Although Orem viewed the importance of the parents or guardian in providing for their dependents, the definition of self-care cannot be directly applied to those who need complete care or assistance with self-care activities such as the infants and the aged.

A major strength of Dorothea Orem's theory is that it is applicable for nursing by the beginning practitioner as well as the advanced clinicians.

Orem's theory provides a comprehensive basis for nursing practice. It has utility for professional nursing in the areas of nursing practice, nursing education and administration.

The terms self-care, nursing systems, and self-care deficit are easily understood by the beginning student nurse and can be explored in greater depth as the nurse gains more knowledge and experience.

She specifically defines when nursing is needed: Nursing is needed when the individual cannot maintain continuously that amount and quality of self-care necessary to sustain life and health, recover from disease or injury, or cope with their effects.

Her self-care approach is contemporary with the concepts of health promotion and health maintenance.

Three identifiable nursing systems were clearly delineated and are easily understood.

Orem's theory, in general, is viewed as a single whole thing while Orem defines a system as a single whole thing.

Orem's theory is simple yet complex. The use of self-care in multitudes of terms, such as self-care agency, self-care demand, self-care deficit, self-care requisites, and universal self-care, can be very confusing to the reader.

Orem's definition of health was confined in three static conditions which she refers to a "concrete nursing system," which connotes rigidity.

Throughout her work, there is limited acknowledgement of the individual's emotional needs.

Health is often viewed as dynamic and ever-changing.

Orem's theory is relatively simple, but generalizable to apply to a wide variety of patients. It explains the terms self-care, nursing systems, and self-care deficit which are very essential to students who plan to start their career in nursing.

Moreover, this theory signifies that all patients want to care for themselves, and they are able to recover more quickly and holistically by performing their own self-care as much as they're able. This theory is particularly used in rehabilitation and primary care or other settings in which patients are encouraged to be independent.

Though this theory greatly influences every patient's independence, the definition of self-care cannot be directly applied to those who need complete care or assistance with self-care activities such as the infants and the aged.

See Also

You may also like the following nursing theories study guides:

References

1. "Obituary: Dorothea Elizabeth Orem", Savannah Morning News, June 24, 2007, retrieved June 17, 2014

2. Taylor, Carol R.; Lillis, Carol; LeMone, Priscilla; Lynn, Pamela (2011). Fundamentals of Nursing. Philadelphia: Wolters Kluwer Health. p. 74. ISBN 978-0-7817-9383-4.

3. Orem, D. (1991). Nursing: Concepts of practice. (4th ed.). In George, J. (Ed.). Nursing theories: the base for professional nursing practice. Norwalk, Connecticut: Appleton & Lange.

4. Orem, D. (1995). Nursing: Concepts of practice. (5th ed.). In McEwen, M. and Wills, E. (Ed.). Theoretical basis for nursing. USA: Lippincott Williams & Wilkins.

5. Orem, D. (2001). Nursing: Concepts of practice. (6th ed.). In McEwen, M. and Wills, E. (Ed.). Theoretical basis for nursing. USA: Lippincott Williams & Wilkins.

6. Taylor, S.G. (2006). Dorothea E. Orem: Self-care deficit theory of nursing.

7. Meleis Ibrahim Afaf (1997), Theoretical Nursing: Development & Progress 3rd ed. Philadelphia, Lippincott.

References and sources for this study guide about Dorothea Orem:

External Links
With contributions by Wayne, G., Ramirez, Q.
Further Reading

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Dorothea Orem: Self Care Deficit Theory Study Guide

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Dorothea Orem is a nurse theorist who pioneered the Self-Care Deficit Nursing Theory. Get to know the biography and works of Orem, including a discussion about the major concepts, subconcepts, nursing metaparadigm, and application of Self- Care Deficit Theory.

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Purpose: The Theory of Self-Care Deficit assists in demonstrating when nursing is needed. Nursing is needed when an individual incapable or limited in their ability to provide self-care.
Scope: Grand Nursing Theory which is actually three interrelated theories:
-  Theory of Self-Care
- Self-Care Deficit Theory
- Theory of Nursing Systems (comprised of wholly compensatory, partially compensatory and supportive-educative)
Major Concepts: Three Categories of Self-Care Requisites:
- Universal
- Developmental
- Health Deviation

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Organizations of concepts and statements are defined by Orem in the context of her 3 steps to assessment of Self-Care Deficit in order to remain consistent.
1. Collect Data
2. Decide a Nursing Diagnosis and create a Care Plan
3. Implement and Evaluate Outcomes
Orem's defined assumptions:
- Communication and connection to people and environment are essential
- Patient's must have the ability to act deliberately to make choices
- Mature patient's make life-function decisions
- Human agency is needed to make decisions and identify needs
- Humans cluster tasks and give responsibilities to themselves and others

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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.

PATIENT PROFILE
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.

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 2. UNIVERSAL SELF-CARE REQUISITES

Breaths without difficulty, no pallor cyanosis

Fluid intake is sufficient. Edema present over ankles.
Turgor normal for the age

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.

3. DEVELOPMENTAL SELF-CARE REQUISITES

Maintenance of
developmental environment

Able to feed self , Difficult to perform the dressing, toileting etc

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
Physician's perspective of the condition: Diagnosed with rheumatoid arthritis and is on the following medications:

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.

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 MR

NURSING CARE PLAN ACCORDING TO OREM'S THEORY OF SELF CARE DEFICIT

Based on self care deficits

Outcome
Nursing goal and objectives
Design of nursing system
Appropriate method of helping

Nurse- patient actions to
- Promote patient as self care agent
- Meet self care needs
- Decrease the self care deficit.

1. Effectiveness of the nurse patient action to
-Promote patient as self care agent
- Meet self care needs
- Decrease the self care deficit.
2. Effectiveness of the selected nursing system to meet the needs.

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

APPLYING THE OREM'S THEORY OF SELF-CARE DEFICIT, A NURSING CARE PLAN FOR MRS. X COULD BE PREPARED AS FOLLOWS ...A. 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: b. Nursing Goals and objectives
Goal: to achieve optimal levels of nutrition.
c. Design of the nursing system: d. Method of helping: 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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B. 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: b. Nursing Goals and objectives
Goal: to achieve optimal levels of ability for self care.

c. Design of the nursing system: Partly compensatory
d. Method of helping:
1. Guidance:

Assess the various hindering factors for self care and how to tackle them.

2. 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.

3. Teaching:

Teach the family members the limitation in the activity level the patient has and the cooperation required

4. Promoting a developmental environment:

Teach the family and help them to practice how to help the patient according to her needs

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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C. THERAPEUTIC SELF CARE DEMAND: DEFICIENT AREA: PAIN CONTROL ADEQUACY OF SELF CARE AGENCY: INADEQUATE NURSING DIAGNOSIS

Ineffective pain control related to lack of utilization of pain relief measures

OUTCOMES AND PLAN a. Outcome: b. Nursing Goals and objectives
c. Design of the nursing system: supportive educative
d. method of helping:

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

Teach the non - pharmacological method to the patient once the pain is a little reduced.

IMPLEMENTATION EVALUATION
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D. 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

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:

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
EVALUATION
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E. 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.

Maintenance of normal skin integrity.

b. nursing Goals and objectives
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 EVALUATION
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F. THERAPEUTIC SELF CARE DEMAND: DEFICIENT AREA: AWARENESS OF THE DISEASE PROCESS AND MANAGEMENT
ADEQUACY OF SELF CARE AGENCY: INADEQUATE

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:
c. Design of the nursing system: d. Methods of helping: IMPLEMENTATION EVALUATION 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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Application of Orem's self-care deficit theory in nursing practice

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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.

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- Congruent to nursing standards and interventions by focusing on data collection, nursing diagnoses, care planning, implementation and evaluation and outcomes for care.
- One of the most frequently used theories of nursing since it's development in 1971.

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The authors in this study use Orem's theory to demonstrate that conditions that make women vulnerable to contraction of HIV/AIDS are linked to their self-care practices.

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This study demonstrates the usefulness of Orem's Theory in relation to the physical and mental health needs of those with schizophrenia. The authors point out how SCDNT is a useful strategy for nurses to assess the societies barriers for these patients and how to use these to advocate for change.

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(n.d.). Retrieved July 27, 2020, from http://currentnursing.com/nursing_theory/application_self_care_deficit_theory.html

Gonzalo, A. (2019, August 24). Dorothea Orem: Self Care Deficit Theory Study Guide. Retrieved July 27, 2020, from https://nurseslabs.com/dorothea-orems-self-care-theory/

Hagran, A. (2015). Journal of Middle East and North African Sciences [Scholarly project]. Retrieved July 26, 2020, from https://pdfs.semanticscholar.org/5761/17009ae992dc2e2ee652cb66c03020d633f2.pdf

Orem's Self-Care Deficit Nursing Theory. (2020, July 19). Retrieved July 27, 2020, from https://nursing-theory.org/theories-and-models/orem-self-care-deficit-theory.php

Santos, M. C., Nóbrega, M. M., Silva, A. O., & Bittencourt, G. K. (2018). Nursing diagnoses for elderly women vulnerable to HIV/AIDS. Revista Brasileira De Enfermagem, 71(Suppl 3), 1435-1444. doi:10.1590/0034-7167-2017-0086

Wazni, L., & Gifford, W. (2016). Addressing Physical Health Needs of Individuals With Schizophrenia Using Orem’s Theory. Journal of Holistic Nursing, 35(3), 271-279. doi:10.1177/0898010116658366