Successors' Stories

ER Nurses in Action with Orem’s Self-care Deficit Theory
by: Maria  Lauremelch C. Piedad, RN

The theory of self-care deficit is the core of Orem's grand theory of nursing that takes into consideration several other concepts of human beings, health, nursing and society.  The overall purpose of Orem's theory is not just to view the person as a whole, but to utilize nursing knowledge to restore and maintain the patient's optimal health.
The nursing system designed by the nurse is based on the self-care needs and abilities of the patient to perform self-care activities. If there is a self-care deficit between what the individual can do and what needs to  be done to maintain optimum functioning, then nursing care is needed.  Orem defined self-care as the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health and well-being. When self-care is effectively performed, it helps to maintain structural integrity and human functioning, and it contributes to human development. The primary role of the nurse is also to teach and to provide educational support to the patient.
The comprehensive development of the self-care concepts enhances the usefulness of the Self-care Deficit Nursing theory as a guide to nursing practice situations involving individuals across the life span that are experiencing health or illness, and to nurse-client situations aimed at health promotion, health restoration, or health maintenance.
A starting point on my actual experience as an ER nurse Orem’s theory on self-care portrays our ability to care for patients who are incapable of or limited in the provision of continuous effective self-care. I remember our home visit patient, an 18 years old female who was recently diagnose having DM type 1 was receiving an insulin injection BID before meals.  During my first visit with the patient I started with building rapport to gain her trust and ask about her history because interaction and communication will help me identify the needs and problems of the patient thus it will guide me to what aspect I’m going to focus.  This diabetic patient are able to meet all her basic self-care needs; however, she would require teaching as to what foods need to be eaten to maintain blood glucose level.  Additionally, because she is on insulin injection, I teach the patient how to give self-injections, the amount to draw in to the syringe by following the sliding scale her doctor prescribed, where on her body the insulin shot needs to be injected, and how to properly dispose of used needles. After a week of home visit the patient learned the proper technique of giving insulin injection to herself and was able to overcome her fear through nurses constant health teaching and educational support.

How I loved OREM!
by: Maynadine Beronia
I wish I had more time in a day, in a typical day in my workplace. It seems that the duties I have to do is so endless – admissions, pre-op care, vital signs and intake and output monitoring, post care, wound dressings, discharge education etc. Oh my! Where have all my time gone? Of course, it is thru delivering patient care!
My encounter of patients from different walks of life utilizes the approach of theory of nursing system by Orem. Wholly compensatory approach can be seen as I do all activities for my elderly patient with post craniotomy and is unconscious. She is not able to perform simple things and how much more complicated ones. So, most of my time is dedicated for suctioning, turning, feeding, measuring urine output, oral care, etc. This scene makes me wanna shout as “DARNA!”, so I can do all the tasks at once, but hey, says my brain, keep in contact with reality, this patient needs you, so you got to have a normal functioning brain.
Oooopppsss! I cant wait to see my other patients. Another scenario is a patient who is bed bound due to fracture on right humerus. As her nurse, assisting her for elimination is one of my “must do” task since she is not capable of going to the toilet. But some self care abilities are carried out by the patient herself such as feeding, grooming and others. Not much to do with her but still have to hang out with her.
Before the day ends, the supportive-educative nursing approach can be seen as I care for a newly diagnosed diabetic patient. Although I am assigned in a surgical female ward, diabetes is common in UAE. It entails my teaching ability to be a resource person regarding her nutritional needs, the need to monitor blood sugar in the hospital and at home, and even explaining pharmacological interventions for diabetes. This particular situation always reminds me that I should have recorded a tape or a video for this topic. I am pretty sure DORA’s videos approach will be the best! Haha!
Hail to Orem’s theory! Truly, you are indeed the technology that is mostly useful in our profession.

Orem in the Operating Room
by: Melissa Junio
In my daily practice as a nurse in the Operating Room I acquired skills and executed my job confidently. Others thought my job was only a routine but one thing they failed to notice is the art and the science behind it. The Art and Technology imparted by Dorothea Orem in me.
Following Orem’s belief, our goal as a nurse is to perform services directed to our patient for them to maintain self-care, including structural integrity, functioning and development.  Orem viewed nursing as a community service, an art and a technology.
Inside the Operating Room assisting the Surgeon during the Operation requires training, the application of that so called knowledge in a systematic, logical and efficient way will later develop into skills. The application of the facts that you learned in an artistic way is the idea of Orem in me. Since in the Operating Room behind every nurse’s action should always have an underlying principle. An example that I can give to you is the draping of the patient during the operation. When we draped the patient it should always be systematic, aseptically and in sequence or else you will compromise the sterility of the area and yourself as well thus compromising the health of your patient.
There are a lot of things inside the Operating Room that will help you appreciate the art and technology in nursing concept of Orem, from cleaning the surgical room up to the Surgical Hand Scrubbing and Handling the instruments to the surgeon. Doing these things will be a routine-but a routine that accompanies the art and science of nursing thus resulting in quality and effective nursing service to our patient.

by: Mara Sumague
According to Orem, self-care is a requirement of every person. An individual must be responsible in taking care of himself/herself in order to maintain health. However, there are instances that an individual is incapable of self-care due to an illness or injury so a help from a health care provider is needed. Orem’s Self-care theory plays a significant part in nursing practice because it serves as a guide for nurses in rendering quality care to patients.
Orem’s theory is really useful in our profession. Her approaches help me in assisting patients with health deficits. For instance, I have an unconscious patient. Because he is unable to take care of himself, I have to do the feeding via nasogastic tube, turn him every two hours to prevent pressure sores, passive range of motion exercises, etc. I was able to apply the wholly compensatory approach in taking care of this patient.
Health education is also important in nursing care. This will help patients understand their condition and able to maintain health and continue to progress after being discharged from the hospital. For example, for patient who has Hypertension. The precipitating factors, signs and symptoms, and proper management will be discussed. Proper diet and blood pressure monitoring is also emphasized. This supportive-educative nursing approach is applicable not only to the patient but also to their relatives.
Health care service is based on the values of self-help and helping others. So when an individual experiences a deficit in health, without a doubt a nurse is always ready to assist him/her in order to attain, maintain, or restore health because NURSES CARE!

Orem’s Theory in Action
By: Mary Anne Paulette Tomas
Orem’s theory has proved its usefulness to the Nursing practice over the years. In all areas of specialty,  the Self –Care Deficit theory played an essential part in the understanding and proper planning of the nursing care to the clients regardless of race, age, and gender. It has been a great tool for all nurses throughout the world on how we, as nurses, should view nursing as an art and service to all patients. For example, in the Ward, categorizing the help that the patients if they are wholly compensatory, partly compensatory and supportive – educative has been a good way on how we develop the nursing care plan for that specific patient. Also, the theory talked about the nursing process and on what steps we should take in every part of the process. In the assessment part we determine the ability of the patient to fulfill self – care activities. Planning would rely on the level of the patient in terms of his / her category and also it focuses on the long term goal which is to make the patient be as in independent as possible in taking care of himself. Then we do the planned interventions and evaluate the response of the patient to those interventions.   Orem’s theory did not only consider nursing based on its intellectual aspect but she mentioned that it also has a practical aspect and that is what it makes caring for the patients effective. In the Operating Room, the nurses should not only be concerned with the technicalities but also on how to treat the patients the practical way.  Immediately post –op, the patients are incapable of fulfilling self – care needs that is why the nurses in this area should be able to address these needs as the patients slowly regain consciousness and eventually wake up from sedation. This theory serves as our mantra in giving quality health care to our patients regardless of the area we are in.

Orem in My Workplace
by: Merlyn Ocfemia
I was working as a private duty nurse here in St. Luke's Medical Center handling different cases and as well as ventilated patients. Patient Mrs. X.E. 69 y/o,case of squamous cell CA, with trache at room air, with PEG, voiding freely. Patient is unable to move on her own. Unable to do his activities of daily living. Unable to eat foods orally because of almost totally block of mass around her oral cavity.Nursing Diagnosis:1.Risk for Aspiration,2.Risk for pressure sore due to bed mobility. Planning and implementation for Ng.Dx #1: Put on high back rest during and after feeding through PEG, on strict aspiration precaution and suction secretions as needed. Planning and implementation for Ng. Dx.#2: Turn to sides every 2 hours to prevent bedsores, assisted in activities of daily living like bed bath,oral care,trache care and PEG care. Evaluation#1: No aspiration noted. Evaluation#2: No bedsores noted.

Orem’s Influence in My nursing Practice
By: Maria Gracia Josefina Imperial
I'm currently working as a Neuro-Surgical ICU nurse and for me this theory reflects a lot on my current working condition. Our unit caters different types of patient coming from every part of the hospital with a variety of illnesses but we mostly admit patients with head injuries. Mostly,these patients would usually stay on our care for weeks to months as they become chronic patients. In my opinion, Neuro cases require the most rehabilitative care of all. As they progress from critical phase, they all undergo the grueling rehabilitation phase that needs special attention and patience as much as during the critical time.
  As we help these patients go through this difficult time, we watch them regain their sense of functionality and independence. It is in this phase where Orem's general concept of nursing process applies. The theory of Nursing System which is categorized as wholly compensatory, partially compensatory and supportive-educative system greatly reflects the clinical concepts on these type of patients. The theory tackles about determining the patient’s health care needs and the nurse’s judgment in assisting the patient in a specific phase of his illness. It says that each health care team has its own role in assisting the patient to meet his needs. And in each phase, the role of the nurse differs and is subjected to changes according to the patient's progression. The theory promotes maximum use of the patient's ability that enhances their sense of integrity. It motivates the patient to meet specific health care demands with an equal level of assistance from the health care team, therefore meeting each others satisfaction. This approach highly promotes nurse-patient interaction that enhances work relationship. With the use of this theory we can clearly develop a plan of care that would be beneficial in the patient's timely recovery.

Thanks to Orem!
By: Maureen Joy Selga
Orem –based nursing practice has been extensively described in the care of patients of various ages with all kinds of health-deviation self care requites and developmental requisites (Parker, 2001, p. 186). Thus this helped me in providing care for various patients I’ve handled before in hospital areas I’ve been exposed to. Orem included skilled observation as one of the guidelines in nursing practice – observation not only of the patient but also of the other elements in nursing situation (Abaquin, 2000, p. 61). This is one important context of her theory which could always determine the plan of care given to the patient. In my experience, as I’ve rotated in the Intensive Care Unit, Heart & Vascular Institute and Hemodialysis Unit – where I am currently serving - of our institution, I’ve provided care to different ages with different needs. As of now, I’m mostly providing care under the supportive-educative system since I’m under the Out-Patient Department.  Most of our patients are working, some are home maker and few depend their self-care with another person. Generally, our patients are able to perform their daily activities of living and only needs support in managing their care. We routinely give seminars and forums at our Unit for the client’s disposal, usual topic includes Nutritional Diet and Medication Support for their current situation. We include health teaching in our daily routine in providing care since clients need continuous reminder and support. These are only few of what I can identify as being based on Orem’s Theory; as she clearly contented the identification of nursing focus that enhanced the productivity of nurse, our professional practice will continue to advance and enhance.

Orem’s Theory and the Community

By: Margaret Nicole Miranda

         Orem’s theory is based on the thought that man has the innate ability to care for himself. It is a behavior one has learned during childhood and eventually mastered in adulthood, with which he performs in order to maintain a state of well-being. As an individual faces his day-to-day interaction with life, there are instances where the demand for self-care overwhelms his ability to nurture on his own. He may seek help from an immediate family member, but to a certain point, if that provider of care still is not able to meet his needs, this is where a nurse enters.
         Mainly, my work in the community is to provide free routine immunizations for infants. Daily, parents would bring their offspring to the health center to have them vaccinated. I as the nurse, grab these opportunities to educate them with regards to the importance of vaccines so as to lessen the risks of acquiring early childhood diseases. Most of these folks are then able to bring their children to the center but certain populations are having difficulties of doing such due to financial restraints and other issues.     This is why we come up with regular outreach sessions, where I, along with my co-health workers, set out in the community to do door-to-door immunizations.

Orem’s Theory in Promoting Self Care to Wound and Ostomy Clients
By: Maria Khristina T. Simon, RN

     Every day I see clients with chronic wounds and clients with newly-formed stomas. They come to me through referrals from their doctors to teach them how to take care of it since they will be dealing with their stomas and/or wounds for months or even years. When I first see a client I always ask him if he can take care of his wound and/or stoma. If his condition does not provide him to do self care, I require him to have someone specifically a family member who is living with him to be taught how to do ostomy and/or wound care. Our mode of teaching is simple: Observe and learn then apply what you learn. Hands-on demonstration is required before we let them do wound and/or ostomy care at home. This will go on for as long as they can do the hands-on. Sometimes with the clients lack of confidence with their caregiver or themselves they opt to go in our clinic on a scheduled basis for wound and stoma care which is in contrast with promoting independence or self care. As I read and absorbed Orem's theory, I was able to appreciate more of what Nursing is. I was able to understand more of the client’s limitations in learning. Because of these limitations, clients develop inhibitions on self-care. From this I was able to form a more effective Patient Care Agreement that would make our clients do the self care themselves or their caregivers do it for him thus promoting independence. In addition, I was also able to develop teaching strategies for my clients - with more consideration of their limitations.

BY: Maria Diethers

As an undergrad student of nursing I was always given the most difficult cases because maybe I was most senior in the group, but on the positive side, maybe my Clinical Instructor believed in my capability to give good nursing care and maybe she saw me as a more responsible student that my younger groupmates.  Anyway, I want to relate the use of one of the concepts in Orem’s theory which the concept of Nursing Systems.  According to Orem, nursing systems are approaches nurses use to assist patients with deficits in self-care due to condition of health.  Nursing systems may be wholly compensatory, partially compensatory or supportive-educative.

So far this patient stands out among my more difficult ones because for one thing, it was my first exposure in the clinical area and the case I was given was a patient with gun-shot wound in the head due to suicide attempt.  Fortunately the bullet missed the temporal area of my patient’s head so his wound was not that deep.  But nonetheless, it was a bloody, head injury and when you are just a student nurse, you don’t have that much confidence to provide nursing care to such a “complicated” case.
My patient was conscious but bleeding profusely in the head.  He was already transferred from the emergency room to the male medical-surgical ward where I was assigned.  Now action time.  What would be my nursing care plan?  How can I help this person regain his balance and regain his self-care capabilities?  What questions should I ask my patient? He had nobody with him then, so this patient is really under the hospital’s and my care.

I later found out that he could effectively communicate and thus it was easier for me to render nursing care.  As his nurse, I acted on the areas where self-care deficits existed, but I allowed him to participate in other areas of care.  In so doing I was both using all the three nursing systems of Orem with the same patient.  First he was transferred from the stretcher to his own bed which used the wholly compensatory nursing system because my patient then could not ambulate per physician’s order.  His wound was dressed which was also a wholly compensatory one because I dressed his wound without his participation in it.  He was able to participate in decision-making though (partially compensatory) about informing his family members about his hospitalization, his diet and his mode of treatment.  He was willing to go into counseling and during his stay in the hospital he was able to express his feelings, on his emotional outbursts and his act of committing suicide.  Although it involved a lot of listening, my patient also accepted health teachings that I imparted to him during his stay in the hospital.  His being referred for counseling may allow the patient to perform this required measure of therapeutic self-care but cannot do without assistance (supportive-educative nursing system).

By: Mary Joyce Paz

During my RLE days, I was assigned at the male surgery ward in one of the private hospitals in Cavite. He is a post-operative patient who undergone appendectomy. He cannot dress himself, go to the bathroom by himself and he cannot move freely since he is in pain.
Applying Orem’s Self-Care Deficit theory, patient B.P., 18 years of age is having deficiencies in self-care. The theory explains that self-care are activities carried out by an individual to maintain their own health. Self-care is carried out to fulfill individual’s self-care requisites. An inadequacy in self care requisites makes a person in need of self care or will have a self care deficit.
As learned from my mentors back then as a student nurse, I was able to identify the deficit of patient B.P. through assessment. He is deficient in performing his activities of daily living within his own ability. Care was provided according to the degree of the patient’s deficit. According to Orem, the nurse may select required nursing systems to provide care wholly compensatory, partly compensatory or supportive-educative. Once the care is provided, nursing activities are evaluated to get an idea if the mutually planned goals are met or not.
Thus the Self Care Deficit theory was successfully applied into nursing practice! Thanks to Orem! J