Nursing Theory B – Orem

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Orem Background?
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-Local connection: worked at Detroit providence hospital -development of theoretical structure and organizing framework for nursing knowledge
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Orem’s Theory?
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Self-Care deficit Theory of Nursing
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The self care deficit theory (sometimes abbreviated as SCDT) was based on ?
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-Orem’s experiences in nursing practice, and was an attempt to develop a theoretical structure and organizing framework for nursing knowledge. -The SCDT attempts to answer the questions… Why does a person need nursing care? And, what do nurses do and what are the outcomes of nursing care?
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What type of philosophy is it based on?
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It is based on a moderate realism philosophy -There is natural law (it’s knowledge, which exists only in the mind of the person), or the laws of nature which shape the universe, and the knowledge of the person. -there is more to the world than what the person knows.
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What setting is SCDNT applicable to?
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All settings
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main assumption in the SCDNT ?
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that people need nurses when they can’t care for themselves in the necessary quality or quantity needed
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Other assumptions of Orem’s theory?
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-Humans require continuous deliberate inputs to themselves and environments to function and maintain life -Human agency (acting deliberately) exercised in caring for self and others based on identified needs -Limits in caring for self and others -Human agency used in determining ways and means to identity needs and how to meet them -Groups of people provide care for members of the group who have limitations in meeting needs
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Concern over Orem theory?
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That it is not as applicable to cultures who do not value self care and reliance as much as the culture in the United States does. -Orem does take this into consideration, that some cultures have the preference of groups providing care for members of the group who are unable to, instead of an individual such as a nurse providing care for those not able to care for themselves. -But the criticism does remain that the entire notion of “self care” is a very Western culture concept that is not universally accepted.
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Self care
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practice of activities that individual initiates and perform on their own behalf in maintaining life ,health and well being -“human regulatory function individuals must, with deliberation, perform themselves or have performed for them to maintain life, health, development, and well being.” This action system must be learned and be in line with bodily needs.
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Self care agency
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is a human ability which is “the ability for engaging in self care” -conditioned by age developmental state, life experience sociocultural orientation health and available resources -Self care agency seems logical when one considers the differences in the ability to care for self across the lifespan, from the very young to the very old and everyone in between, as well as those that face developmental or health challenges, or lack the resources to perform self care
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therapeutic self care design
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“totality of self care actions to be performed for some duration in order to meet self care requisites by using valid methods and related sets of operations and actions” . It is basically what people need to have done for them in order to meet their self care demands.
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Self care requisites
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action directed towards provision of self care. Life processes, developmental, & health deviation What we do to care for ourselves
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3 interrelated theories of Orem’s theory
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Theory of Self Care Why and how people care for themselves Theory of Self Care Deficit Limitations hinder ability to know what is needed or to engage in self care. Ability to provide care <demands of care needed. Theory of Nursing Systems Actions by nurses to meet health limitations of self care or dependant care. Actions deliberate, intentional and include prescribing, diagnosis, regulation
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Theory of self care
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the why and how people care for themselves -Self care is human regulatory function performed by individuals or is performed for them -Purpose is to maintain life, keep essential functions going, maintain integrity of functions and development of person necessary for life -Self care actions learned, purposeful, contributes to human integrity, function and development -care is across the domains of holistic health – that is the bio-psycho-social and spiritual arenas.
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Universal Self Care Needs
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-Life processes Air, food, water, shelter, elimination Balance between rest/activity, solitude and interaction, prevent hazards, promote human functioning, develop social groups -Developmental needs (through out life span) Relationship, job, changes due to aging or maturation) -Health deviation (deviations in function or structure) Disease, genetic deviation, require medical assistance/care, learning to live with disease, comply with tx, modifying self concept to accept state of health
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Capabilities of Self Care 3 Levels
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progressive process. This does a nice job of showing the developmental aspects of self care. 1. estimative – knowledge and thinking 2. Transitional- decision making 3. Productive Operations- doing self care
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Capabilities of Self Care explain
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At the first level, one must become cognizant of self-care needs. This begins as intra-uterine experiences with sensations of warmth, sound, and movement and continues throughout a life time with developing awareness, experience and failure – in the form of minor to major physical and psychological injuries which are sustained as part of the developmental and physical growth processes. -Some of the development is internal with physical and psychological maturation such as mobility, reasoning, decision making and skill. -The level of productive operations is achieved when adulthood is reached and the individual is able to both mentally and physically problem-solve effectively. -The levels achieved in this model are not absolute as physical and mental capabilities as well as temporary conditions such as illness or psychological distress can all affect the level of functioning at any given point in time.
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Basic conditioning factors?
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Age, gender developmental state health state socio-cultural orientation health care system factors family system factors pattern of living environmental factors resource availability and adequacy +List incomplete..new factors to be added when identified *influence self-care and self-care agency and are items that the nurse can assess when determining an individual’s self care and self care agency.
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Theory of Self-Care Deficit
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major concepts within this theory is the idea of self-care agency and deficit
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Self Care Agency
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-Learned ability or power to perform self-care that is described as knowledge, skill and motivation for self-care action. (Agency – the actions that an agent engages in ) -When the agency is less than the demand for self-care, a deficit -or specifically a self-care deficit exists.
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Self-Care Deficit
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The relationship between a person’s therapeutic self care demand and their self-care agency When the agency is less than the demand for self-care, a deficit -or specifically a self-care deficit exists. Nurse steps in to help
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Theory of Nursing Systems
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Therapeutic self-care requisites and actions or systems involved in self care *relationships that must be brought about and maintained for nursing to be produced -theory identifies the various levels at which nursing intervention can occur -Orem identifies that a relationship between the patient and the nurse is essential -Contractual or interpersonal relations -The nurse compensates in proportion to the degree of deficit experienced by the patient/client Wholly Compensatory Partially Compensatory Supportive Educative
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Wholly compensatory
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Nurse does all self care, patient unable to care for self
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Partially compensatory
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Nurse and patient engage in meeting self-care needs
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Supportive educative
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Assistance in decision making, behavior control, learning knowledge, and skills. Can perform some self-care with assistance
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Nursing agency (NA)
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specialized abilities of nurses for diagnosis, prescribing, and producing nursing care that results in meeting the individual therapeutic self-care demand or increased self-care agency.
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Collaborative Nursing Operations (Nursing Process for Orem)
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-Diagnosis—establish therapeutic relationship, diagnose self-care deficits -Prescription—calculate ideal therapeutic self-care demand; design and prioritize therapeutic self-care demands -Regulation—design regulatory nursing care system, plan regulatory operations, produce/perform regulatory care -Control—observe and appraise regulatory operations
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Deficiency in 8 universal self-care requisites
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-Maintenance of sufficient intake of air, food, water -Provision of care associated with elimination processes -Maintenance of balance between activity and rest, solitude and social interaction -Prevention of hazards to human life, functioning and well-being -Promoting of human functioning, development within social groups, being essentially human/normalcy
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Deficiency in 3 developmental self-care requisites [maturational and situational]
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-Maintenance of Developmental Environment -Prevention/Management of conditions threatening normal development -Engagement in self-development
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Examples of Helping Methods preformed by nurses
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Acting for or doing for another Guiding and directing Providing physical and psychological support Providing and maintaining an environment that supports personal development Teaching
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metaparadigms – Environment
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-Environmental factors, elements, conditions and developmental environment. -Included under nursing therapeutics -Nursing therapeutics: deliberate, systematic, purposeful action by nurse or others. Includes acting or doing for others, guiding, supporting, providing developmental environment, teaching . Helps to meet self-care needs
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metaparadigms – Person
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-Can reflect, symbolize and use symbols -Total being with universal developmental needs and capable of continuous self-care -Capability to meet universal, developmental and health-deviation self-care requisites
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metaparadigms – health
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Describes a way of living. Holistic Structurally or functionally whole or sound Includes physical, psychological, social
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metaparadigms – Nursing
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-Focus of nursing is identification of self care requisites, design methods/actions to meet the requisites, and “the totality of the demands for self-care action” -Art, science, helping service to maintain or change conditions in themselves or environment
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Diagram on slide connecting all of Orem’s conceptual thoughts
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-The basic conditioning factors (age, gender, developmental state, developmental state, health state, socio-cultural, orientation, health care system factors, family system factors, pattern of living, environmental factors, resource availability and adequacy) are the form the framework. -Working from left to right, when the self care agency (or ability to care for self) is less than the therapeutic self care demands (what the person needs), nursing agency enters into the picture because there is a self care deficit. -Working from the center top, the person has self care needs, and the ability to care for themselves (self care agency). This self care agency has a relationship with the therapeutic self care demand, as well as the person, and therapeutic self care demand is in relationship with the person and their self care. -Note that the nursing agency also has a relationship with the self care agency and the therapeutic self-care demand—all three of Orem’s subtheories work together and in relationship with each other to assist the person in meeting their self care needs, especially when there is a self care deficit.
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what distinguishes health services from one another?
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the helping services each provides
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Orem’s primary source of ideas?
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Her experience in nursing field
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Orem’s philosophical system of moderate realism?
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-the nature of reality, the nature of human beings, and the nature of nursing as a science and the ideas and positions associated with the philosophy of moderate realism. -there is a world that exists independent of the thoughts of the knower. the nature of our world is not determined by our thoughts, but it is possible to obtain knowledge about the world. -humans are dynamic, unitary beings who exists in environments , who possess free will
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four categories of postulate entities that reflect moderate realist position of Orem
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1. persons in space time localizations 2. attributes or properties of these persons 3. motion or change 4. products brought into being
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What view is central to the SCDNT
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person-as-agent deliberate action of person for self care
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what kind of knowledge is represented in SCDNT?
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speculatively practical nursing science: nursing practice sciences (wholly, partly, supportive) and foundational nursing sciences (the science of self care, the science of development and exercise, science of human assistance for persons with health associated self care deficits)
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two types of scientific knowledge needed for nursing?
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applied sciences basic non-nursing sciences
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Universal self-care requisties
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air food water provisions of care associated with elimination processes and excrements maintenance of balance between activity and rest balance between social and solitude preventions of hazards to human life promotion of human functioning and development
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developmental self care requisties
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1. provision of conditions that promote development 2. engagement in self development 3. prevention of or overcoming effects of human conditions and life situation that adversely affect human development
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health deviation self care requisites
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for persons who are ill or injured, who have pathological condition or disorders, and under medical diagnosis and treatment the complexity of self care or dependent care systems increases by the more health deviation requisites that must be met within a specific time frame.
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Orem provides a unique focus for nursing because in her works her expression of the form of nursing science is a PRACTICAL SCIENCE. Explain?
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this theory differentiates the focus of nursing from other disciplines *build off a body of knowledge based on nursing practices, rather than engaging in theory testing -practical nursing is knowledge is developed for the sake of the nursing practice
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therapeutic self care demands
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summation of care measure necessary at specific times or over a duration of time to meet all of an individuals known self care requisites -controlling and managing factors identified as requisites (sufficient air or water) -fulfilling the activity element of the requisite (maintenance, promotion, prevention, provision) 1. factors in a patient or environment that must be maintained to a certain range 2. has a degree of effectiveness derived from their choice of technologies and techniques to control patient and environment
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self care agency
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ability of person to meet health care needs
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dependent care agency
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acquired ability of person to know and meet health care needs
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self care deficit
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relation between therapeutic self care demands and self care agency in which self care abilities are not adequate for meeting health demands
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nursing agency
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comprises developed capabilities of persons educated as nurses that empower them to represent themselves as nurses and within the frame of a legitimate interpersonal relationship to act and help persons meet their own self care demands
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basic conditioning factors
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factors that condition or affect the value of the therapeutc self care demand and or the self care agency of an indiciual at particual times and under specific circumstances. -age -gender -developmental state -health state -pattern of living -healthcare system factors -family system factors -sociocultural -available resources -external environment

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