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Dorothea Orem's Theory of Self-care Deficit
Consider a client, Mr. Simpson, a thirty-six-year-old male who was involved in a motor automobile accident two months ago. His automobile collided with a truck on the freeway and instantly caught on fire. Mr. Simpson was rescued from the wreckage, but his wife died at the scene. He suffered second degree burns to the left side of his face and chest, and his left arm. He also has spinal cord injury, resulting in paraplegia and bowel and bladder incontinence. He presents to the outpatient rehabilitation clinic for his first adhere to-up check out since being discharged from the hospital. Macy is his nurse and in her initial assessment Mr. Simpson reveals that he is angry, depressed, grieving for his wife and frustrated since he unable to use his legs. He tells Macy that he wishes he had died in the accident alternatively of his wife since now he is a burden to his household. He also states that he can't bear to look at his reflection simply because the scars on his face are a continuous reminder of the accident and its tragic consequences. Mr. Simpson asks Macy how he can move on with his life given the hopelessness of his scenario.
Dorothea Orem’s theory of self-care deficit is a grand theory, comprised of four constituent theories, which collectively function to establish and define the connection in between caregiver and care recipient. The initial constituent theory is the self-care theory which encompasses activities that an person should initiate and execute for themselves to achieve and keep great wellness and nicely-becoming as effectively as optimum functioning. These self-care acts consist of enough intake of food and water, upkeep of healthier elimination processes, adequate and acceptable socialization, avoidance of hazards, in search of and obtaining health-related care, and studying to reside with pathologies. An person have to be able to make decisions to execute self-care as properly as possess the capabilities to execute these acts. In the clinical situation, Mr. Simpson is unable to execute some of these self-care acts simply because of his limited mobility and his present state of grief and depression. Nonetheless, Orem states that self-care can be discovered and as a result taught.
The second theory is the theory of dependent care and it requires performing self-care for an individual when they can no longer do so for themselves. In this instance Orem states that nursing may possibly be necessary as a type of dependent care. Dependent care may involve performing for others, guiding other people, supporting an additional, and offering education.
The third constituent theory is the theory of self-care deficit. This addresses the question of why nursing care may be required. It highlights that nursing care is needed when an individual’s self-care wants exceed their personal capabilities. In this way, a self-care deficit happens, and nursing care is one particular measure of compensating for this deficit. In Mr. Simpson’s situation, a deficit exists exactly where he is unable to meet his own self-care wants both physically and emotionally.
The theory of nursing systems is the fourth constituent theory of Orem’s self-care deficit theory and it describes how self-care demands are met by the patient, the nurse, or each. This theory focuses on how the nurse assists with patient care primarily based on assessments of person patient needs. It explains how deficits in self-care requirements are met by the nurse, based on the specific self-care limitations of the patient. According to Orem, nursing care can be wholly compensatory, partially compensatory, or supportive-educative. It is evident that self-care deficits exist in Mr. Simpson’s life and he is turning to his nurse Macy for support and guidance. The theory of self-care deficit can be applied to Mr. Simpson’s case as nicely as to an extensive array of nursing scenarios. For example, a study by Wilson and Gramling (2013) demonstrates the use of the self-care deficit theory in burn nursing and identified that massive burns, that is, involving higher than twenty-five % of total physique surface area, requires total nursing care, such that the patient with substantial burns would demand wholly compensatory nursing care.
Dorothea Orem’s theory of self-care deficit encompasses and types the basic framework that guides nursing practice. In this context, the nurse performs as an agent of care, using the nursing method to compensate for self-care deficits in individuals. The nurse very first assesses the patient, gathering relevant date about self-care requirements and deciding if these wants are getting met. Next, a nursing diagnosis is made as properly as a strategy for the delivery of care. The program may possibly be wholly or partly compensatory or supportive-educative. The program is then implemented to meet patient care requirements by using the nursing system. Evaluation of patient outcomes is accomplished often to assess if and how self-care requirements are being fulfilled and to make alterations to the plan as necessary. These actions are cohesive with the common objective of satisfying self-care requirements and compensating for self-care deficits.
The theory of self-care deficits may be utilized in any nursing care setting. A study by Felipe et al. (2014) examined the nursing process according to the model of self-care in a cardiac bedridden patient and concluded that Orem’s self-care deficit theory is “applicable, of simple understanding, and therefore viable to every day nursing care of a bedridden patient.” Further, in a study by Aline et al. (2007), a detailed investigation of nursing care for an ostomy patient was carried out, following the progress of the patient as care is delivered according to Dorothea Orem’s self-care deficit theory. Researchers discovered that “by indicates of nursing interventions primarily based on the supportive-educative program, we contributed to the improvement of the patient’s self-care capacity.” In the case of Mr. Simpson, nurse Macy in her initial assessment realized that many self-care deficits existed. Mr. Simpson was not fully mobile due to his paraplegia, and his left arm not entirely healed from the burn wounds he sustained. This coupled with the fact that he lacked technical understanding about how to maximize the use of his wheelchair, further restricted his mobility. Macy formulated the very first nursing diagnosis as impaired physical mobility connected to spinal cord injury. The subsequent nursing diagnosis she produced was primarily based on her assessment of Mr. Simpson’s bowel and bladder incontinence combined with his immobility. She determined that he was at danger for impaired skin integrity.
In her assessment, Macy also determines that Mr. Simpson feels hopeless and depressed. He is also grieving the loss of his wife. The nursing diagnoses of threat for self-harm associated to hopelessness secondary to becoming paraplegic, and ineffective coping associated to the death of his spouse had been created. Mr. Simpson also has difficulty seeking at his reflection simply because of the scars on his face, so Macy made the nursing diagnosis of disturbed body image related to burn scars. He is also unaware of sources that are obtainable to assist him function and cope, and he lacks understanding about the functional features of his wheelchair. Primarily based on this, another nursing diagnosis is deficient understanding related to unfamiliarity with physical and informational sources.
All through this situation, it is demonstrated that thorough assessment, self-care deficits are identified, and numerous nursing diagnoses are made. Familiarity with the theory of self-care deficit enabled Macy to recognize these self-care deficits and formulate interventions that are distinct to Mr. Simpson. These include encouraging him to verbalize his feelings, discussing his issues, educating him about modified strategies of performing self-care with impaired mobility, teaching him numerous coping mechanisms, as nicely as discussing the which means of loss and alterations. Macy can now refer Mr. Simpson to the acceptable resources for assistance, in addition to delivering precise data and discussing concerns honestly relating to his prognosis and treatment.
Dorothea Orem’s theory of self-care deficit has verified to be a grand theory with vast applicability and simplicity of use. This theory can be applied to all varieties of nursing practice exactly where the focus is on establishing a therapeutic partnership among caregiver and care recipient. Expertise of the ideas of this theory is certain to advantage all these who practice its principles.
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