Theory Evaluation: Orem
In evaluating Orem’s Self-Care Deficit Nursing Theory (SCDNT) based on the Synthesized Method for Theory Evaluation the nurse must first ask if the theory is compatible with standards of nursing care and nursing practice in today’s world. In simple terms, can Orem’s theory be applied to nursing interventions? I believe the theory can be applied to many clinical areas of nursing practice.
Nursing care plans are created from key parts of the theory and identify patient goals and the nursing interventions to achieve those goals. Orem’s SCDNT uses three systems to show how nursing care can be implemented to meet self-care needs of patients: wholly compensatory, partial compensatory, and health education (Dorothea Orem’s self-care theory, 2012).
Orem’s Theory combines the concepts of self care, self-care agency, therapeutic self-care demand, and self-care requisites, which are further broken down into universal self-care requisites, developmental self-care requisites, and health deviation self-care requisites. The self-care agency
concept described in Orem’s model includes considering several patient
factors including: age, gender, health status, developmental stage,
sociocultural orientation, health care setting, family system, support
system, environment, and current living situation (Dorothea Orem’s self-care theory, 2012).
Now let’s apply a case example to Orem’s Theory based on current nursing practice.
Based on the assessment from the self-care agency concept above our patient is a 20yo, female, post-partum via c-section, high school education, African-American, Baptist, acute setting, single, no significant other, father of baby not involved, mother, three younger siblings,
urban area, and has limited family support.
Universal Self-Care Requisites including: air, water, food, elimination,
activity/rest, social interaction, prevention of hazards and promotion of
basic human functioning (Application of Orem’s, 2011). In our case example, we would identify self-care needs of food, elimination, activity/rest, social support and preventions of hazards as they relate to the patient currently recovering from a c-section. This patient would be on a clear liquid diet, have urinary catheter in place, remain on bed rest, need social support after discharge and have post operative care needs as they relate to pain, nutrition, treatments to prevent blood clots and pneumonia after surgical procedures, and prevention of falls.
Developmental Self-Care Requisites involves identifying health and
environment problems created by illness (Application of Orem’s, 2011). Our patient is unable to bath, dress, urinate (due to catheter), eat (due to MD orders), unable to ambulate independently, and without social support after hospitalization. In addition, patient has many knowledge deficit areas that would benefit from nursing education such as post operative and post partum. Patient can identify learning needs and is willing to learn. Patient is unable to identify need for social support after
discharge.
Health Deviation Self-Care Requisites look at adherence, awareness, modification, and adjustment as it relates to patient coping to illness or self-care deficit (Application of Orem’s, 2011). Our patient utilizes the call button to voice concerns and is receptive to treatments such as pain medication. Patient is aware of self-care deficits related to nutrition, elimination, hygiene, activity and prevention of hazards. In this example the patient is unable to identify pain medication, side effects of treatment, and risk factors to not following instructions and maintaining activity limitations.
In our case study, the patient has multiple self-care needs that can be divided between the three nursing systems of wholly compensatory, partial compensatory, and health education. To simplify this means either the nurse meets the self-care needs of patient, the patient meets their own needs or the nurse and the patient work together to meet patient needs. All of this information relating to our case study can be developed into a nursing care plan based on Orem’s Self- Care Theory. Nurses working with post operative patients like in the above example can utilize Orem’s theory in many different aspects of patient care.
The second question would be is there supportive evidence that the theory has been used to develop nursing research and education? According to Orem (1995, 2001) her model of theory is used to develop nursing curriculum in numerous universities, colleges, and schools of nursing all over the country (as cited in McEwen & Wills, 2011, p. 135). The self-care theory has added to nursing knowledge and has created new hypotheses in nursing through research (Dorothea Orem’s self-care theory, 2012). Numerous research studies have been conducted based on Orem’s theory and research has been performed on the concepts of the theory as well (McEwen & Wills, 2011, p.134).
Nursing care plans are created from key parts of the theory and identify patient goals and the nursing interventions to achieve those goals. Orem’s SCDNT uses three systems to show how nursing care can be implemented to meet self-care needs of patients: wholly compensatory, partial compensatory, and health education (Dorothea Orem’s self-care theory, 2012).
Orem’s Theory combines the concepts of self care, self-care agency, therapeutic self-care demand, and self-care requisites, which are further broken down into universal self-care requisites, developmental self-care requisites, and health deviation self-care requisites. The self-care agency
concept described in Orem’s model includes considering several patient
factors including: age, gender, health status, developmental stage,
sociocultural orientation, health care setting, family system, support
system, environment, and current living situation (Dorothea Orem’s self-care theory, 2012).
Now let’s apply a case example to Orem’s Theory based on current nursing practice.
Based on the assessment from the self-care agency concept above our patient is a 20yo, female, post-partum via c-section, high school education, African-American, Baptist, acute setting, single, no significant other, father of baby not involved, mother, three younger siblings,
urban area, and has limited family support.
Universal Self-Care Requisites including: air, water, food, elimination,
activity/rest, social interaction, prevention of hazards and promotion of
basic human functioning (Application of Orem’s, 2011). In our case example, we would identify self-care needs of food, elimination, activity/rest, social support and preventions of hazards as they relate to the patient currently recovering from a c-section. This patient would be on a clear liquid diet, have urinary catheter in place, remain on bed rest, need social support after discharge and have post operative care needs as they relate to pain, nutrition, treatments to prevent blood clots and pneumonia after surgical procedures, and prevention of falls.
Developmental Self-Care Requisites involves identifying health and
environment problems created by illness (Application of Orem’s, 2011). Our patient is unable to bath, dress, urinate (due to catheter), eat (due to MD orders), unable to ambulate independently, and without social support after hospitalization. In addition, patient has many knowledge deficit areas that would benefit from nursing education such as post operative and post partum. Patient can identify learning needs and is willing to learn. Patient is unable to identify need for social support after
discharge.
Health Deviation Self-Care Requisites look at adherence, awareness, modification, and adjustment as it relates to patient coping to illness or self-care deficit (Application of Orem’s, 2011). Our patient utilizes the call button to voice concerns and is receptive to treatments such as pain medication. Patient is aware of self-care deficits related to nutrition, elimination, hygiene, activity and prevention of hazards. In this example the patient is unable to identify pain medication, side effects of treatment, and risk factors to not following instructions and maintaining activity limitations.
In our case study, the patient has multiple self-care needs that can be divided between the three nursing systems of wholly compensatory, partial compensatory, and health education. To simplify this means either the nurse meets the self-care needs of patient, the patient meets their own needs or the nurse and the patient work together to meet patient needs. All of this information relating to our case study can be developed into a nursing care plan based on Orem’s Self- Care Theory. Nurses working with post operative patients like in the above example can utilize Orem’s theory in many different aspects of patient care.
The second question would be is there supportive evidence that the theory has been used to develop nursing research and education? According to Orem (1995, 2001) her model of theory is used to develop nursing curriculum in numerous universities, colleges, and schools of nursing all over the country (as cited in McEwen & Wills, 2011, p. 135). The self-care theory has added to nursing knowledge and has created new hypotheses in nursing through research (Dorothea Orem’s self-care theory, 2012). Numerous research studies have been conducted based on Orem’s theory and research has been performed on the concepts of the theory as well (McEwen & Wills, 2011, p.134).