The Orem's Model of Nursing

The nursing profession over time has developed methods and role expectations to not only ensure safety of the patient, healthcare team, and community, but based off of evident based practice has proven to provide optimal care. One of those methods developed is Self-Care Nursing Theory or the Orem Model by Dorothea Orem. Orem’s model includes self-care, agency, therapeutic self-care demand, self-care deficit, and nursing systems. “The core idea of her work was based on the theory of Self-Care. It is best described as patients as individuals, whose normal state is one of independence and ability to self-care in all daily activities of life is compromised. Orem suggested that, when this is compromised through illness or some other disability, nursing should intervene to promote self-care for the individual to be as autonomous as possible” (Snowden, 2010).

“An explicit relationship between nursing and self-care was first made by Orem in 1956. Since then, under her leadership and guidance, that connection has been developed into a general theory of self-care deficit theory. The theory explains why people require nursing care, the processes for the production of the required care, and a structure for the development of the sciences of self-care, the practical sciences of nursing, and the related knowledge associated with these sciences. Nurses possess knowledge and skills that any person can benefit from at some time, but are not required or even desirable, all the time” (Taylor, 2011).

Other factors included in Orem’s Self-Care model highlight that “Agent and agency apply to both the patient and the nurse. Orem defines agent as the person who engages in a course of action or has the power to do so. Therapeutic self-care demand refers to all actions on a patient should perform to meet self-care needs. A self-care deficit occurs when an individual is unable to meet his or her therapeutic self-care demand. As defined by Orem, nursing systems are action systems that represent actions taken by the nurse for or with self-care agent to promote life, health, and well-being. The goal of nurse agency is to know and meet a patient’s therapeutic self-care demands and to protect and to regulate the exercise and development of a patient’s self-care agency” (Barry, 2015).

Dorothea Orem states, “the goal of nursing is to render the patient or members of his/her family capable of meeting the patient’s self-care needs. The nurse’s roles in helping the patient to achieve or maintain a level of optimal health and wellness is to act as an advocate, redirector, support person and teacher, and provide an environment conductive to therapeutic development” (Snowden, 2010). Self-Care is well facilitated and maintained when the patient has necessary support from family and healthcare team to help them get back to taking care of themselves before their health was compromised. Providing accurate and adequate knowledge of patient’s illness, they can choose how to perform their daily activities and meet their personal needs.

In order to meet the needs of patients, “Orem outlines five premises of self-evident characteristics of human beings which are the guiding principles that underlie her process. It includes understanding that humans require deliberate inputs to themselves and their environment in order to remain alive and function in accord with natural human endowments. Human agency is exercised in discovering, developing and transmitting to others way and means to identify needs for and make inputs to the self and others. It is the power to act deliberately, is exercised in the form of care of the self and others in identifying needs for and in making needed inputs including experienced privations. Lastly, groups of human beings with structured relationships cluster tasks and allocate responsibilities for providing care.” (Snowden, 2010). Each of these needs contributed to the development of Orem’s model.

“The mid-1950s was a time when there was beginning to be a focus on planning nursing care. Orem became aware that the “point of departure for planning care had to be the patient” not the nurses tasks. There are developmental processes for humans to achieve their potential and self-ideal. They possess free will and are capable of maintaining an awareness of self and environment. The object of nursing includes the whole reality of human beings, singly and in social units. This includes individuals, dependent units, and multi-person units such as families and communities” (Taylor, 2011)

“Self-care has been one of the key domain concepts in nursing since 1959, with the development of Orem’s self-care model. Recently, self-care has become increasingly evident in health care, making even more sense in the face of the world economic crisis and the need for health care reform in Thailand. Self-care is an attempt to promote optimal health, prevent illness, detect symptoms at an early date, and manage both acute and chronic conditions of illness. Self- care decreases the dependence of an individual on others. Even with rapid progress in medicine and technology, self-care is necessary. If people can mobilize their own resources and actively participate in their own health care, they may exceed life expectancies and significantly improve their quality of life” (Renpenning, 2003).

“Self-care deficit nursing theory and the work of Dorothea Orem is having a worldwide impact on nursing despite language barriers. In Mexico, self-care deficit nursing theory has had an enormous influence on nursing education, research, and practice. This concept has been utilized as the basis for designing nursing care. In Germany, the self-care deficit nursing theory was recognized as valuable in nursing education. The majority of nursing schools after 1985 used an Activities of Daily Living based nursing model based off of Orem’s theories. Most, if not all, nursing schools systematically included Orem’s theory in the nursing curriculum and based their program on the self-care deficit nursing theory” (Renpenning, 2003).

In conclusion, “Orem’s theory is based on the notion that each person has a need for self-care in order to maintain optimal health and wellness.” The purpose of self-care is to maintain life, the essential physical, psychological and social functions; to maintain the integrity of functions and development of the person within the framework of conditions that are essential to life.” Orem’s self-care theory has been used and incorporated in teaching globally, to provide patients the best evidence based, patient-centered care for improving life expectancy and quality of life. (Renpenning, 2003).