Applying Dorothea Orem’s Self-Care Deficit Theory To Practice Dorothea Orem developed her self-care deficit theory of nursing under three interrelated theories known as the theory of self-care, theory of self-care deficit, and theory of nursing systems. Each of these theories explains concepts of basic conditioning factors to support her general theory. Orem’s theory suggests that all individuals have a need for self-care action on a continuous basis. When self-care can no longer be performed due to injury or illness the patient develops a self-care deficit and requires the assistance of the nurse to provide quality and quantity healthcare.
Orem’s interrelated theories can be applied to day to day practice on the stroke unit. The theory of self-care is the patient’s ability to perform their own self-care needs to maintain life, health, and well-being. Basic conditioning factors of self-care include age, gender, developmental state and environmental factors to name a few. Stroke patients may lose their entire ability to provide self-care depending on where the stroke occurred. Basic things such as eating or even speaking may be affected.
One of the first steps taken on the floor is a bedside swallow evaluation. This is very important because it determines if oral nutrition or medications can be given. Swallowing problems can increase risk of morbidity and mortality, as well as risk of aspiration pneumonia where food or fluids pass into the airway (Morris, 2009). Patients may be unable to receive necessary treatment if they have the inability to swallow and collaboration with the doctor is needed to determine whether or not other routes for nutrition or medication administration may be used.
The theory of self-care deficit is the main element of Orem’s general theory. The self-care-deficit theory is acquired when individuals are unable to perform basic needs to sustain health, life and well-being. Stroke patients may only be able to use one arm, or one leg which is known as hemiparesis. The nurse is therefore needed to assist with things such as oral care and nutrition. The nurse encourages the patient to use stronger or non-affected side to eat or perform oral care. Patients want to feel independent and it’s mportant that nurses support self-care. The theory of nursing systems is how the nurse determines what the needs are of the patient. On the stroke floor nurses are constantly performing neurological checks to determine whether or not any changes have occurred or to assess for any deficits. When a patient has a deficit such as dysphagia or difficulty swallowing, nurses must assist that patient by crushing pills, making sure the patient has the proper diet and ensure the patient is always sitting upright during oral intake to prevent aspiration.
Nurses are pivotal in ensuring that patients’ dysphagia needs are met and managed promptly and safely (Hughes, 2011). Dorothea Orem’s theory of self-care can be applied to clinical practice in many different ways. One area of practice Orem’s theory is used is on the stroke units as described above. Patient’s want to be independent and in charge of their own healthcare decisions. Stroke can be debilitating and patients may not be able to perform routine task such as eating or brushing teeth. Nurses must assist patient with these task and encourage patients to participate as much as possible.
Nurses play a very critical role in supporting and promoting independence in patient care. Allowing patients to be independent in their self-care and assisting when patients are unable to perform tasks will create positive patient outcomes and is the basis behind Orem’s self-care deficit theory. References Hughes, S. (2011, April 2011). Management of dysphagia in stroke patients. Nursing Older People, 23(3), 21-24. Morris, H. (2009). Assessment and management of dysphagia after stroke. Assessment and management of dysphagia after stroke, 11(8), 385-388.
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