Nursing theories offer an organised and systemic way to express statements related to questions in nursing, providing nurses with the opportunity to describe, predict, explain and control phenomenon related to their practice. Dorothea Orem's general theory of nursing revolves around a person-centred model in which the nurse identifies self-care needs of his patient and then works as collaboratively as possible with the patient to meet those needs.
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Orem's general theory is comprised of three more-defined theories: the theory of self care, which defines the activities patients need to complete to achieve optimal health; the theory of self-care deficit, which specifies when nursing is needed for a patient who is incapable of meeting his self-care needs; and the theory of nursing systems, which describes how self-care needs will be met by the patient, nurse or both of them working together.
Depending upon the identified self-care deficits and her patient's abilities, a nurse may help by acting and doing for her patient, guiding her patient or others involved in her care, supporting her patient and/or her significant others, ensuring the environment encourages the patient to develop self-care abilities, and/or teaching the patient and others in her environment to meet self-care needs.
Orem's theory is a comprehensive approach to nursing practice that makes good sense in clinical practice, as well as educational, administrative and research settings. It fits well with today's patient- and family-centred philosophies of care in hospitals, long-term care, home health, community, behavioural health and ambulatory care facilities. With its focus on determining the right plan of care for each patient, the theory is easily incorporated into the nursing process of assessment, nursing diagnosis, planning, implementation and evaluation.
As an early theorist, Orem significantly impacted the development of professional nursing by laying the theoretical groundwork for collaborative nursing care that incorporates the abilities and disabilities of individual patients. Today's nurses use nursing diagnoses to describe patient problems, and Orem's self-care deficits are well-represented. For example, self-care deficit of bathing/hygiene is used for a patient who is unable to bathe himself. And a patient who is unable to get himself safely to the bathroom on time may have a nursing diagnosis of self-care deficit of toileting.
Although there is still a gap between many nursing theories and actual nursing practice at the bedside, Orem's self-care deficit theory has been widely adopted in a variety of clinical settings. It has particular appeal in settings like rehabilitation nursing, with its focus on addressing self-care deficits in patients with physical disability or chronic illness, and home health nursing, which is aimed at making patients as safe and independent as possible in their own homes.
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