samanthakillins
Exploring Dorothea Orem’s Self-Care Theory: Reestablishing Independence and Quality
of Life to Expand Personal Health of Patients
Samantha Killins
Trent-Fleming School of Nursing, Trent University
NURS1001: Nursing As a Profession
Professor Galea
October 16, 2024
Grade Received: 83%
Orem’s Self-care deficit theory of Nursing centers around the patient’s ability to maintain independence and a self-care framework that nurses utilize to provide better care for our patients. Astle et al., (2023) defines self-care as a patient having the means to care for themself, using knowledge, self-reliance, and awareness to achieve, maintain, and promote well-being (Martínez et al., 2021). Dorothea Orem developed this theory and was highly respected in her career in nursing, having won several awards, including the American Alumni Achievement Award of Nursing in 1980. Nine years prior to this, she published her theory of nursing, the Self-care Deficit Theory of Nursing (Petiprin, 2019). The development of this theory took place between 1959 and 2001, with continuous revision until her death on June 22, 2007 (Petiprin, 2019). This theory is considered one of the most significant in the field of nursing, defined by its broad and abstract frameworks, and its global reach (Astle et al., 2023. p 76). The framework established by Dorothea Orem is still encouraged by nurses working with patients during rehabilitation as it emphasizes that the patient is responsible for their recovery through their interaction with the environment, –specifically their beliefs, socio-cultural background, familial relationship and patient-healthcare provider relationships–to shape self-care/independence (Mohammadi et al., 2016).
With its patient-centric approach, the theory acknowledges the patient’s need for independence following a significant life change. Orem believed that when facilitated by nurses, self-care would improve the quality of life and rehabilitation process, catering to the patient’s physiological, psychological, and social needs. The theory is also implemented from the nurse disciplinary perspective, as nurses play a pivotal role in advocating for the patient’s self-care needs (Hartweg & Metcalfe, 2021). The nurse’s position is to stand in to fulfill self-care needs for the patient until the patient restores self-care independence with less assistance (Astle et al., 2023. 80). Orem’s theory observed other lifestyle factors such as diet, exercise and smoking and how they might affect the patient’s ability to care for themselves (Astle et al., 2023 pg. 80). The goals attributed are maintaining life-sustainable sources (food, water, and air), creating a balance, hazard prevention, functionality, well-being and social connections (Astle et al., 2023 pg. 80). Orem believed self-care or physiological function defects might arise when patients require physical intervention from nurses or family due to illness or disease- but that encouraging patients to improve their own self-care- will in turn improve patients’ cognitive and neurological function (Si et al., 2021). Creating self-agency in patients is desirable in increasing recovery and quality of life both physically and cognitively.
It has a positive outcome for patients with severe chronic diseases or conditions who must readapt to care for their essential needs or may require more knowledge to increase their living ability. The nurse is responsible for providing knowledge and care for the patient’s self-care needs. Typically, Orem’s Theory is used in primary care homes and for rehabilitation following a significant change in lifestyle/capacity (Petiprin, 2019). Zahra Khademian et al. (2020) researched the positive effects of implementing Orem’s Self-Care program into the care plan of hypertensive patients, which has increased their quality of life. The study spanned eight weeks; data was collected before, during and after the educational program based on Orem’s Theory. A similar study performed but with patients undergoing chemotherapy reported an increase in quality of life following the implementation of Orem’s self-care theory. Researchers pointed out that education of the patient and family is an essential component of self-care, and it has been shown to reduce the psychological and physiological side effects (Rakhshani et al., 2022). Chronically ill patients, such as those in the study of Nasiri, M. et al. (2022), found that implementing Orem’s Theory reduced anxiety and depression and improved quality of life. Those who may not benefit from Orem’s Theory are those who maintain high independence throughout their health change and patients with extreme loss of functionality/capacity, such as a quadriplegic or patient of a traumatic brain injury.
Reflection
I chose Orem’s Self-care theory because it aligns with my passion and perspectives for the nursing profession. The principal purpose of Orem’s Theory is to rehabilitate the patient to have independence and fulfill their self-care needs. The aspect that Orem emphasizes is that the nurse is temporarily stepping in to help the patient advocate for self-care, which is essential to me as everyone should feel they have autonomy and independence, especially concerning their physical being. Once the nurse establishes the responsibility to provide self-care to the patient, they become an advocate and format the way the patient will continue their care once they achieve rehabilitation. Exploring Orem’s theory allows us to understand why independence and autonomy are essential to patients’ overall well-being. Self-esteem, defined in Potter and Perry’s Canadian Fundamentals of Nursing, 7th Edition, is the overall emotional appraisal of self-worth, stemming from the person’s perception of their capabilities, competencies and body image (Astle et al., 2023 pg 459). Autonomy for patients is especially vital for those in long-term care homes, where independent self-care has improved recovery and quality of life (Moilanen et al., 2020). Patients in all stages deserve dignity and involvement in their care/needs.
The definition of nursing is to care for those who are injured and sick, carrying the skills to promote and maintain health (Merriam-Webster (n.d.). I chose to nurse as I want to live a life where I can ensure everyone is treated with equality and can have control over themselves when they feel they lack the most control. This relates to the theory as the purpose is to help advocate and stand up for patients’ role in self-care to improve patient outcomes. In practice, I can implement strategies within the Orem—framework to help patients participate in self-care. The capacity to consider the patient’s overall needs beyond physical medicine will allow me to be better as a practicing nurse, going above and beyond care to humanize patients through their quality-of-life needs. Within the adaptation and socialization into nursing, building our foundations of how we care for patients will allow for established solid morals and internal motivations. Being a nurse who follows Orem’s theory to care for patients as a whole will allow empathy and rehabilitation aid for your patients. Some students reported feeling a sense of belonging within their work settings when they implemented their knowledge of nursing practice theories (Zarshenas et al., 2014). Clear internal motivations for care will also clarify why you are caring for patients in a specific way; for example, following self-care theory would be why helping patients take care of themselves improves their rehabilitation ability.
Analysis
I found this theory especially hard to critique as it aligns with most nursing responsibilities and roles. My main criticism of Orem’s theory is that it pays little attention to the variability of patient’s needs, primarily focusing on physical needs. It neglects specific dynamics of health and well-being that humans will adapt to in response to a change in stimulus or environment. Orem’s model focuses on returning patients to their original capability rather than adapting to the new dynamic. For example, a patient who has paralysis in their lower limbs may struggle to be independent of a caregiver and may develop mental health disorders due to extreme change in loss of function. The theory lacks individualization for those who may not be able to physically or mentally care for themselves, expecting that they will only have a positive quality of life if they can be completely independent of care.
Another limitation that may arise from Orem’s theory is that some patients may completely reject the nurse performing their self-care tasks, regardless of whether or not they are unable to themselves, such as dependent patients leaving against medical advice. In some cases, people will reject their prognosis and may feel shame in asking for help with tasks associated with self-care. This is apparent in older patients who refuse help, as evidenced in the Moilanen et al., (2020) study, where some did not accept nurses care out of fear of losing independence, even if the care was beneficial. The outcome of a patient having limited independence requires more hands-on care, which may cause the patient’s psychological health to decline.
I would adapt this theory to accommodate the patient’s needs on an individual level instead of based on the broad stages of Orem’s current self-care model. Some patients may require more or less hands-on aid, and others may even become too dependent on the nurse if their plan is not individualized to accommodate their prior lifestyle. An example of an individualized care plan would be showing low mobility patients how to use assistive devices to increase independence based on their mobility needs. Orem’s theory is still widely encouraged in healthcare systems and continues to expand in the Middle East, Europe, and Asia (Hartweg & Metcalfe, 2021).
There are considerable strengths associated with this theory, such as promoting independence and rehabilitation. Orem’s theory is easily applied to nursing as it is relatively simple, helping patients and students understand. There is a minimal chance of error as it has defined purposes. It provides a foundation of what aspects the nurse needs to focus on to improve the patient’s quality of life. For example, a dependent patient who has just had surgery and cannot shower may greatly benefit from having their nurse brush their hair, help them wash their face and clean up their hair. These simple self-care items will allow the patient to focus on their healing process, and they will not feel as though they have lost all sense of self. Orem’s theory will help us understand the power of knowledge and information on our patients and why ensuring we use straightforward language may benefit their understanding.
I will implement this theory into my daily practice in my future nursing career. This means I will make myself an extension of the patient if they struggle to keep up with their self-care and become a provider to increase their quality of life while in my care. Understanding the importance of independence and autonomy for patients to help them drastically improve their ability to improve will guide my movements regarding their care. Encouraging the patient and families to seek self-care strategies to maintain balance in recovery and adaptation. In conclusion, Dorothea Orem’s model of self-care can greatly improve patient outcomes of quality of life and improvement when applied to our plan for care.
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