Dorothea Orem's Self-Care Requisites
Self-care Deficit is the key to Orem’s Self-Care Model because it identifies when and how much a nurse is needed in the care of the patient. Nursing care is needed if there is a problem that prevents a person from reaching their optimal health.
Orem believes there are three components to the Self-care nursing model, the compensatory system, the partial compensatory system and the educative-developmental system.
The Compensatory system is when the nurse provides total care for the patient. This patient cannot do anything for themselves including but not limited to activities of daily living and ambulation. This patient is totally dependent of the nurse for survival, such as an acute Stroke patient.
The second of Orem’s systems is the Partial Compensatory. The nurse must assist in the care of the patient but the patient and family can assist as well. A pneumonia patient, who is very short of breath, may require the nurse to monitor vital signs, oxygen saturations, assist in ADL’s and ambulation. The patient will be able to resume their own care when they are better but need the assistance and education a nurse can provide at this time.
The third of Orem’s systems is the Educative-developmental system. The patient has primary control over their health; the nurse assists with education and promoting safe health practices. The patient who has high cholesterol may fit into this category, diet, exercise regimen and medication is important education for this patient. The nurse would teach the patient how to properly maintain good health practices.
Restoring, promoting and maintaining health are the goals Dorothea Orem’s Self-care Model promotes. The model looks at the patient as a whole and how they interact with their environment. Self-care is an ever changing process through out the continuum of life and requires constant reassessment.
The advantages to Dorothea Orem’s Self-Care Theory when establishing a plan of care is the comprehensive assessment process which is used. Every aspect of the patients well-being is discussed, their character traits, social situation, environment, head to toe physical assessment using self-care requisites, behavioral characteristics and past medical history. Orem focuses on the patient; the need for nursing care is established by the patients self-care deficits found during the assessment process. Also, Orem scales down to actual nursing care requirements for the patient, separate from other health-care providers, creating autonomy for nursing as a profession.
The disadvantage to Dorothea Orem’s Self-Care Theory is how time consuming the process is for the nurse. Staffing ratios don’t allow for such an extensive initial plan of care. Nurses receive several admissions per twelve hour shifts; to scrutinize a patient this thoroughly would be impossible. It would take several days to know a patient as well as Orem suggests we should and with the short length of stay the luxury of time is not ours. The other disadvantage to Orem’s theory is complexity. Her theory is very long and detailed, the wording is difficult to understand, and recognizing how all the components fit together can only be accomplished after actually studying her process.
There are many places to find information about her theory and other nursing theories, look on the internet and at your local book store. I encourage you to read about some of them because the basis of the nursing profession started with these ideas and models and has grown into what it is today.
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