Guest Author - Colleen Moore, RN
Dorothea Orem explains Universal Self-Care Requisites as all the things that are need by individuals, at all stages of life, to be able to care for ones self. Orem uses the self-care requisites as a basis for assessment the nursing process. To state it in an easy way to understand, she takes all the elements that need to be right for an individual to function wholly and independently and then works backward, identifying self-care deficits. Each component of the assessment is broken up into two parts, the health habits and the review of systems.
Air is the first of the self-care requisites. The assessment of air involves more than just the respiratory function. Orem believes that the inadequate air supply will result in the appearance of the skin, hair and nails. Obviously, the respiratory and cardiac function will need to be physically assessed but Orem wants you to think about how air effects the entire well-being of an individual. This is when the nurse should assess the patient’s lab values, such as CBC, Hgb and Hct since these labs reflect circulatory oxygenation of the patient. Does the patient have a history of smoking or asthma? This would be a good time to ask these questions.
Water is the next of the self-care requisites. The nurse would assess for a fluid overload or deficit. Skin turgor, edema, lung sound would be all part of the physical assessment for any deficits. Does the patient have a history of CHF or urinary retention? Has the patient had any significant weight gain or loss that was not planned? Important questions to ask while assessing water self-care requisites.
Food is another self-care requisite that Orem recognizes. The examiner would assess dietary needs, obesity, and malnutrition. A significant weight loss or gain is important. It is vital to obtain a dietary history, is it healthy or poor? Many times economic status has a lot to do with dietary habits. A physical examine would include the abdomen, bowel habits, the patient’s mouth; the tongue for thickness, the teeth for erosion and breakage, the gums for bleeding and swelling and the breath for halitosis. Does the patient have a history of ETOH, ulcers or gastro-intestinal bleeding?
Elimination is the next requisite. What is the patient’s elimination pattern? Is there a history of blood in the stool? Does the patient have chronic constipation or diarrhea? Has the patient had bowel surgery or removal of their gallbladder? Physical assessment would include bowel sounds, pelvic tenderness, and bloating. Dietary habits would be important to assess at this point, too.
Activity and rest requisites are the next requisites that Orem examines. Physical assessment would include mentation and activities of daily living. Does the patient have a steady gaite? Does the patient live alone? Neurological assessment should be done at this time. Review sleep patterns, muscle tone, and peripheral vascular disease.
Solitude and social interaction are addressed next. Is the patient isolated or do they have family and friends who visit? This is the time to assess for depression and suicidal ideations. Assess for hearing problems, sight problems and physical limitations. This is a good time to discuss menstruation and PMS with female patients, along with pregnancy history. This is the place when you want to ask the patient about their sex life. Nurses need to remember just because someone is 85 years old that a sexual relationship and intimacy can be very important. We are all sexual beings, we need to remember that when we are treating our patients.
Hazards to human life, human functioning and human well-being is the e next requisite. This would include any bad behaviors such as alcohol and drug abuse. Also, difficulty ambulating in the home, living alone without transportation both can lead to hazards.
The last self-care requisite is normalcy. Normalcy is very difficult to interpret because we all have our own definition of what is normal. Orem feels this is how the individual reacts to illness, obsession or apathy or how the patient perceives their relationship to the world and others around them. Is the patient attention seeking, in counseling, deal appropriately with stress and anxiety?
As you may have noticed many of these Universal Self-Care requisites overlap in the assessment process. Dorothea Orem meant for that to happen because for an individual to be completely healthy all of these requisites must be fulfilled.
Next week will be the continuation of Dorothea Orem’s Self-Care Requisite Theory where we will discuss Self-Care Deficits and Developmental Self-Care Requisites.