Ross, B., & Cobb, K. (1990). Family nursing: A nursing process approach. Redwood City, CA: Addison-Wesley Nursing.

Dorothea Orem: Self Care Model

Dorothea Orem’s self-care model is based on the premise that the state of well-being in humans is maintained through self-care activities. In relation to health, Orem views people as being responsible for their own self-care. Self-care agency is "the complex acquired ability to meet one’s continuing requirements for care that regulates life processes, maintains or promotes integrity of human structure and functioning and human development, and promotes well-being" (Orem, 1985, p. 105). Individuals are also responsible for other individuals who are dependent on them, such as children or the elderly. Finally, each individual or client has the right to choose or not to choose in relation to his or her health (Orem, 1985).

Orem’s model involves two phases of self-care. The first phase is recognizing a problem (or problems) and making decisions to deal with the problems(s). The second phase involves the actions that are taken to carry out the self-care activities that serve to maintain well-being in the client. Self-care demands may originate in the individual or from others (Orem. 1985, p.89). Several factors influence the ability to participate in self-care activities. These include the client’s state of health, age, knowledge level, available resources, values and goals, and usual pattern of response to both external and internal stimuli (Orem, 1985).

There are three distinct categjories of self care activities (Orem, 1985^, p. 90). The first is universal self-care which consists of activities of daily living to meet basic human needs. Such activities include ingestion of food, water, and air: excretion of bodily wastes; rest and

recreation: prevention of hazards to life and well-being; promotion of human development and functioning: and the human desire to be considered normal (Orem. 1985). For the family, universal self-care requisites include maintenance of a balance between solitude and social interaction, promotion of normalcy, maintenance of a balance between rest and activity. and prevention of hazards (Orem, 1980. pp. 42-44).

The second categoxy of self-care requisites emphasizes human developmental processes. These self-care requisites focus on the need for appropriate living conditions that support life and promote developmental growth during various stages of the human life cycle. This includes prevention of situations or events that have a damaging effect on human growth and development (Orem, 1985. p. 90).

The third category of self-care requisites is called health deviation self-care. When this category is employed the primary purpose is to combat illness (Orem, 1985, p. 97). This may mean that the client has to adjust the ways in which universal needs are met, establish new self-care techniques, modify the self image. revise the daily routine, develop a different lifestyle, or find ways to cope with the effects of the illness (Foster and Janssens, 1980). Self-care requisites can arise not only from illness but also from medical care measures such as surgical procedures or pain and discomfort (Orem. 1985, p. 99)

Whenever the client’s ability to carry out the universal, developmental, or health deviation self-care activities is impaired or the client needs to be assisted in the achievement of a high level of wellness in any of the self-care systems, nursing intervention is indicated. According to Orem (1985, p. 143) specialized ability to nurse is termed "nursing agency." Orem (1985. p. 143) further describes this term:

Nursing agency is analogous to self care agency in that both are abilities for specialized types of deliberate actions. They differ in that nursing agency is developed and excercised for the benefit and well-being of others and self-care is developed and exercised for the benefit and well-being of oneself."

Helping individuals meet their own self-care demands is the ultimate goal of nursing agency. This goal involves helping the client accomplish therapeutic self-care; helping the client toward more responsible actions related to self-care; and helping the client’s family or other caregivers to administer the client’s care in a competent manner.

The nurse’s interventions involve an intellectual phase and a practical phase. In the intellectual phase, the nurse and the client work together (if possible) to identify the self-care deficit needs of the client and develop a plan for meeting the client’s needs. In the practical phase, the plan is implemented and evaluated. The nursing care plan may be directed toward (1) compensating for the client’s self-care deficits, (2) eliminating the client’s self-care deficit, and (3) preventing new self-care limitations (Foster and Janssens, 1985).

Applying Orem’s Model to Families

Using Orem’s self-care model as a theoretical framework, the following can serve as a guide for assessment of families:

After completion of the family assessment using Orem’s self-care deficit model, the nurse must reach conclusions about the family’s ability to meet its self-care needs. Self-care deficits are identified, and strategies are formulated with the family to assist them in meeting these needs. Nursing interventions are categorized into one of three systems (Foster and Janssens, 1985):

1. Wholly compensatory: Family is unable to carry out self-care activities for the family unit

2. Partly compensatory: Family and nurse share responsibility for carrying out self-care activities

3. Supportive/educative: Family carries out self-care activities with assistance from the nurse through guidance and teaching when needed

References

Foster, P., & Janssens, N. (1985). Nursing theories: the base for professional nursing. Englewood Cliffs, NJ. Prentice-Hall.

Orem, D. (1985). Nursing: Concepts of practice (2nd ed.). St. Louis: McGraw-Hill.