1
What is self-care

• Orem Defines Self-care as the practice of
  activities that individuals initiate and perform
  on their own behalf in maintaining life, health,
  and well-being

2
Orems Theory of Self Care

• Each person has a need for self care in order to
  maintain optimal health and wellness.
• Each person possesses the ability and
  responsibility to care for themselves and
  dependants.
• Theory is seperated into three conceptual
  theories which include self care, self care
  deficit and nursing system.

3
Theory of Self Care

• Self care is the ability to perform activities
  and meet personal needs with the goal of
  maintaining health and wellness of mind, body and
  spirit.
• Self care is a learned behavior influenced by the
  metaparadigm of person, environment, health and
  nursing.
• Three components universal self care needs,
  developmental self care needs, and health
  deviation.

4
Metaparadigm Concept

• Person An individual with physical and emotional
  requirements for development of self and
  maintenance of their well-being.
• Environment Clients surroundings which may
  affect their ability to perform their self-care
  activities.
• Health Structural and functional soundness and
  wholeness of the individual (Orem 1991).
• Nursing The acts of a specially trained and able
  individual to help a person or multiple people
  deal with their actual or potential self-care
  deficits.

5
Universal Self Care

• This includes activities which are essential to
  health and vitality.
• Eight elements identified these include air,
  water, food, elimination, activity and rest,
  solitude and social interactions, prevention of
  harm, and promotion of normality.

6
Developmental Self Care Need

• These include the interventions and teachings
  designed to return a person to or sustain a level
  of optimal health and well being.
• Examples can include such things as toilet
  training a child or learning healthy eating.

7
Health Deviation Self Care

• This encompasses the variations in self care
  which may occur as a result of disability,
  illness, or injury.
• In other words the person with a variation is
  meeting self care and maintaining health and
  wellness in a more individualize meaning.

8
Self-Care Deficit

• A self-care deficit exists when the self-care
  agency is not able to meet some or all the
  components of Therapeutic Self-Care Demand

9
Theory of Self Care Deficit

• Every mature person has the ability to meet self
  care needs, but when a person experiences the
  inability to do so due to limitations, thus
  exists a self care deficit.
• A person benefits from nursing intervention when
  a health situation inhibits their ability to
  perform self care or creates a situation where
  their abilities are not sufficient to maintain
  own health and wellness.
• Nursing action focuses on identification of
  limitation/deficit and implementing appropriate
  interventions to meet the needs of person.

10
Personal Nursing Philosophy

• Nursing is being able to intervene when the
  person is unable to care for themselves and teach
  them methods to help them move beyond their
  inability. This can include offering information,
  teaching and tools necessary for their well being.

11
Theory of Nursing Systems

• The ability of the nurse to aid the person in
  meeting current and potential self care demands.
• Focused on person
• Three support modalities identified in theory
  including total compensatory, partial
  compensatory, and educative/supportive
  compensatory.
• The clients ability for self care involvement
  will determine under which support modality they
  would be considered.

12
Support Modalities

• Total compensatory support encompasses total
  nurse care- client unable to do for themselves.
• Partial compensatory support involves both the
  nurse and the client sharing in the self care
  requirements.
• Educative/supportive compensatory support elicits
  the help of the nurse solely as a consultant,
  teacher or resource person. Client is responsible
  for their own self care.
• A person can fluctuate between support modalities
  at any given time throughout life.

13
Nurses Role

• The nurses role in helping the client to achieve
  or maintain a level of optimal health and
  wellness is to act as an advocate, redirector,
  support person and teacher, and to provide an
  environment conducive to therapeutic development.

14
Application of Theory To Nursing Process

• Orems theory of self-care is applied to many
  undergraduate nursing curricula.
• The nursing care plan is one example of how her
  theory of self-care can be applied to nursing
  process

15
Nursing Care Plan

• The nursing care plan includes assessment data
  pertaining to Gordons Functional Assessment, a
  NANDA nursing diagnosis, the identification of
  client expected outcomes, the nursing
  interventions and evaluation.

16
Nursing Theory in Practice

• The self-care aspect of Orems theory applies to
  the assessment and evaluation of the nursing
  process. Orem emphasizes the importance of how
  ones own self-care is important for maintaining
  life, health development and wellbeing.
• The only restriction to this method is that the
  nurse can only make assessments where there is
  direct contact between the nurse and the client
  and or the family.

17
Nursing Theory in Practice Contd

• The area of self-care deficit applies to the
  diagnosis area of the nursing care process.
• Although self-care deficit is an abstract
  concept, it does provide a guideline for the
  selection of methods for helping and
  understanding the patient roles in self-care.

18
Nursing Theory In Practice

• The third area of her theory, nursing systems,
  applies to the interventions of the nursing care.
  
• In order to help explain this concept, Orem also
  created three areas of how care can be
  administrated to a client depending on the
  physical and mental capabilities of the client.
• Wholly compensatory, partly compensatory and
  supportive-educative role

19
Case Study

• The wholly compensatory system accomplishes the
  clients therapeutic self-care, compensates for
  the clients inability to participate in their
  self-care, provides support and protects the
  client.
• Bedridden oncology patient arrives via ambulance
  for chemotherapy. Family insists upon keeping
  patient at home however, leaves patient alone
  with nurse in chemo clinic for treatment. Patient
  requires O2 at 2L/min, continuous tube feeding at
  90cc hour, Foley catheter, bedpan. Nurse in
  clinic administers chemo premeds and chemo
  changes dressing around g-tube due to leaking
  administers O2 at 2L empties Foley at end of
  treatment places patient on bed pan one time.

20
Case Study

• The partly compensatory system has a give and
  take system in between the nurse and the client.
  The nurse performs, compensates for limitations,
  regulates and assists the client as needed. The
  client participates in some self-care procedures,
  regulates and accepts care and assistance from
  the nurse.
• Pre-term labour patient regularly visits clinic
  for BP monitoring, etc. Patient on bed rest (at
  home), except for weekly visit to module. Nurse
  assists patient out of wheel chair into bathroom,
  assists with urine sample collection, and onto
  exam table. Nurse administers injection of
  terbutaline and educates patient regarding oral
  terbutaline.

21
Case Study

• The supportive-educative role indicates that the
  client is participating in most of their
  self-care, and the nurses role is simply to
  monitor and regulate the clients self-care.
• Newly diagnosed diabetic patient received
  diabetic care teaching while in hospital. Now,
  patient visits module and reports highly variable
  BS/chemstrip readings. Nurse suspects patient may
  be performing procedure incorrectly. Nurse
  assesses that patient has been cutting some of
  his chemstrips in half to save money. Nurse
  instructs patient that cutting strips exposes
  chemicals and inaccurate readings may result.
  Additionally, nurse assesses that patient's wife
  (who does family cooking) did not receive any
  nutritional education while patient was
  hospitalized. Nurse begins nutritional counseling
  and provides wife with referral to nutritional
  services department.

22
Personal Philosophy of Nursing

• Nursing is the art of caring, nurturing and
  healing. Nursing goes beyond simply caring for
  illness, disease or ailment it is caring for the
  person. Part of the person is caring enough to
  aid them return to a state of optimal health and
  wellness in mind, body and spirit. These are
  believe to be the basic aspects essential to a
  fundament nursing philosophy.

23
Orems Philosophy

• It is believed that Orems theory portrays the
  idea that nursing is the ability to care for
  another, especially when they are unable to care
  for themselves. This corresponds to our
  philosophy of caring for person with the goal of
  achieving optimal level of health and wellness.

24
Orems Self-Care Deficit Theory
Self Care Is Performed by Oneself for Oneself
Is Deliberate Is Learned Is a Behavior Has
Pattern and Sequence Has Purpose Has New Needs
as a Result of Injury, Disease, Illness Is
Continuous Can be Effective or Ineffective Can
be Therapeutic or Non-Therapeutic Is a Right and
Responsibility
25
Universal Self-Care Requisites

• Air
• Water
• Food
• Elimination
• Activity and Rest
• Solitude and Social Interaction
• Prevention/Protection from Hazards
• Sense of Normalcy

26
Developmental Self-Care Requisites

• Self-care requisites addressing conditions that
  promote development that are met by dependent
  care agents in the early stages of the human life
  cycle
• Self-care requisites addressing involvement in
  the self-care processes of development
• Self-care requisites addressing preventing or
  overcoming the effects of human conditions and
  life situations that can adversely affect human
  development

27
Health Deviation Self-Care Requisites

• 1. Seeks Medical Assistance
• 2. Aware and Attends to the Effects to the
  Illness
• 3. Carry Out Medically Prescribed measures
• 4. Aware, Attend, and Regulate Deleterious
  Effects of Prescribed Measures
• 5. Modify Self-Concept in Acceptance of a
  Particular State
• 6. Learn to Live with the effects of the Condition

28
Self-Care Agency

• Power Components
• 1. Attention Span and Vigilance
• 2. Control of Physical Energy
• 3. Control of Body Movement
• 4. Motivation for Action
• 5. Ability to Reason
• 6. Decision Making Skills
• 7. Knowledge
• 8. Repertoire of Skills
• 9. Ability to Order Self-Care Actions
• 10. Ability to Integrate Self-Care Actions into
  Patterns of Living

29
Basic Conditioning Factors

• Age
• Gender
• Developmental State
• Socio-cultural Orientation
• Health State
• Family Systems Factors
• Health Care System Factors
• Patterns of Living
• Environmental Factors
• Resources Available

30
Nursing Agency

• Helping Methods
• 1. Acting for or doing for another
• 2. Guiding or direction
• 3. Teaching
• 4. Providing physical or psychological support
• 5. Providing and maintaining an environment that
  supports development

31
Nursing Conditioning Factors

• Age
• Gender
• Physical and Constitutional Characteristics
• Health State
• Education
• Experience
• Maturity