Orem's Theory Research Articles

Implementing cooperative care on an acute care medical unit.

Cooperative care is an approach to nursing care, based on Orem's self-care theory, that encourages patient self-care and family involvement in care giving. Patients and care partners (family members or friends) are taught by staff working on the unit. The model has been successfully implemented on acute care units at institutions across the nation. In March 1990, under the direction of our chief nurse, cooperative care was initiated at Dorn Veterans' Hospital as a part of a research project on a busy acute care medical unit. The model had already been piloted with success on the oncology unit of the institution. The purpose of this article is to describe patient, nursing, and pharmacy involvement during the implementation of cooperative care on a 40-bed acute care unit in a veteran population.

Empowerment support with adult female survivors of childhood incest: Part I—Theories and research

This report is concerned with the concept of empowerment support as a nursing intervention that facilitates the development of mastery, competence, self-worth, and control in the adult female survivor of childhood incest. Empowerment support has been derived from Orem's theory of nursing system. In that theory, empowerment support is encompassed in particular “methods of helping.” Theories and research that relate to incest trauma and empowerment support are discussed from an interdisciplinary perspective.

Guillain-Barré syndrome: giving the patient control.

The patient with Guillain-Barré syndrome (GBS) presents a complex clinical picture. Depending on the degree of paralysis, problems with communication can be significant. The patient's inability to express fears, needs and frustrations coupled with the lengthy recovery process makes GBS one of the most difficult diseases for nurses to manage. Nursing interventions, based on Orem's self-care theory, can ease the frustration and feelings of powerlessness a patient with GBS experiences.

Studies exploring self-care for the person coping with cancer treatment: a review.

Individuals living with an illness such as cancer and receiving chemotherapy must often meet a new set of demands, that are not amongst their usual repertoire of skills and knowledge. Little is known about how patients manage the illness of cancer and in particular what self-care actions they develop and perform to cope with the side-effects of treatment. This paper outlines Orem's theory of self-care and describes its utilization in the design of a number of research studies in the cancer patient population. In particular, work which has explored the role of self-care in relationship to the control of chemotherapy induced nausea and vomiting is reviewed. The role of manipulating food and fluid intake, exercise and sleep and diversionary activities are explored; self-care is considered a vital part of the battle against combating nausea and vomiting induced by chemotherapy and further studies are urged.

Self-care capabilities in black girls in anticipation of menarche.

Limited research exists on young girls' expectations of self-care related to menarche. No studies specifically focus on black girls. This study describes the self-care agency of a group of black premenarcheal girls with respect to menarche. Data were collected through audiotaped interviews from a standardized schedule of questions based on Orem's theory. A verified content analysis was conducted. Family system elements, sociocultural orientation, peers, and developmental state were determined to be important in conditioning the self-care agency in preparation for menarche. Girls had difficulty estimating what self-care should take place although there was some ability to acquire and retain knowledge from an authoritative and personal source. Menarche was viewed as an event involving self-care in the areas of two requisites: elimination and social interaction.

Pain assessment in children

Valid assessment of pain in children is foundational for both the nursing practice and research domains, yet few validated methods of pain measurement are currently available for young children. This article describes an innovative research approach used in the development of photographic instruments to measure pain intensity in young African-American and Hispanic children. The instruments were designed to enable children to participate actively in their own care and to do so in ways that are congruent with their developmental and cultural heritage. Conceptualization of the instruments, methodological development, and validation processes grounded in Orem's Self-Care Deficit Theory of Nursing are described. The authors discuss the ways in which the gaps between nursing theory, research, and practice are narrowed when development of instruments to measure clinical nursing phenomena are grounded in nursing theory, validated through research and utilized in practice settings.

Orem's General Theory of Nursing and Community Nursing

The purpose of this article is to examine the way in which theoretical concepts of community articulate with Orem's theory. Philosophical and theoretical perspectives of community are presented as the basis for developing a model for community nursing. The development of nursing theory and science related to the concept of community proceeds from an understanding of community and its articulations with nursing. Three basic models of community are identified and described: (a) atomistic/contractarian, (b) organic/functional, and (c) mutual/personal. Orem's theory can be legitimately viewed as having meaning for nursing when the community is viewed from any of the three models. It is not limited to the use of "aggregate" models. The distinction comes in the view of community consistent with the underlying philosophical view of the nature of person expressed or inherent in the nursing theory. A general model for the community as a unit of service, congruent with Orem's theory, is presented.

Contract learning for self-care activities

Chemotherapy presents a challenge to patients and their families because of altered abilities for self-care. The nurse investigator initiated a protocol study with five patients responding to a query, "What do you need to know?," related to chemotherapy. Evaluation was done during February and March 1989 in a private oncology/hematology clinic in Hawaii. This was an evaluative study designed to measure the effectiveness of a contract learning protocol. A descriptive case study approach was used to analyze findings. Orem's self-care deficit theory of nursing provided the theoretical framework for the protocol. Based on Orem's supportive educative system, the nurse utilized the three types of self-care requisites to develop a learning needs assessment tool. Contract learning reinforced management of self-care deficits with self-care activities. Four of the subjects were able to recognize symptoms, weigh options for actions, initiate self-care behaviors, and evaluate the effectiveness of self-care activities. Findings suggest that the protocol provides a systematic and comprehensive approach to patient's self-care deficits using adult learning principles.

Contract learning for self-care activities

Chemotherapy presents a challenge to patients and their families because of altered abilities for self-care. The nurse investigator initiated a protocol study with five patients responding to a query, “What do you need to know?,” related to chemotherapy. Evaluation was done during February and March 1989 in a private oncology/hematology clinic in Hawaii. This was an evaluative study designed to measure the effectiveness of a contract learning protocol. A descriptive case study approach was used to analyze findings. Orem's self-care deficit theory of nursing provided the theoretical framework for the protocol. Based on Orem's supportive educative system, the nurse utilized the three types of self-care requisites to develop a learning needs assessment tool. Contract learning reinforced management of self-care deficits with self-care activities. Four of the subjects were able to recognize symptoms, weigh options for actions, initiate self-care behaviors, and evaluate the effectiveness of self-care activities. Findings suggest that the protocol provides a systematic and comprehensive approach to patient's self-care deficits using adult learning principles.

Self-care deficit theory and nursing diagnosis: a test of conceptual fit.

Conceptual frameworks and nursing diagnoses represent recent additions to nursing's theoretical base, but their relationship and potential to interface has not been explored. This study describes the results of 130 registered nurse baccalaureate students' integration of current North American Nursing Diagnosis Association (NANDA) nursing diagnoses into major concepts of Orem's Self-Care Deficit Theory (SCDT). It identifies areas of agreement and difficulty inherent in this challenge, and suggests directions for needed theoretical work.

The Structure of Nursing Diagnosis from Orem's Theory

Nursing diagnosis is generally accepted as a legitimate part of the nursing process; however, there is no consensus on the form, structure, or meaning of diagnosis within the discipline. Some nursing theories and models provide the basis for deriving a structural model for nursing diagnoses. A general structural model for a classification schema for the perspective of Orem's general theory, the self-care deficit theory of nursing has been developed and described. Sample diagnostic statements for various levels within the schema are presented. The language of nursing diagnosis which is appropriate to the theoretical perspective is also described and examples are provided. Diagnostic statement models are identified. This work is the beginning of a formal classification system for nursing diagnosis from one nursing theoretical perspective.

Nursing Actions to Prevent and Alleviate Pain in Hospitalized Children

Nurses are confronted daily with the responsibility to care for hospitalized children in pain, yet the substantive knowledge base about that care and how effective it is remains extremely limited. Although there is initial evidence of effectiveness of several pharmacologic and nonpharmacologic pain relief approaches, little evidence of use or effectiveness in clinical nursing practice exists. To begin to address this knowledge deficit, two studies conceptualized within Orem's (1991) general theory of nursing were undertaken: one involving ethnographic interviews to determine what pain relief actions are taken by nurses with recognized expertise in caring for children in pain and another, follow-up survey to examine the frequency with which these actions are used by general nursing staff. Data about perceived effectiveness of the actions were also obtained. The results of these two studies of nursing actions to prevent and alleviate pain in hospitalized children document that nurses use a wide variety of creative methods to relieve pain. From interviews with the nurse experts both specific actions and action patterns and themes were identified. Furthermore, these patterns were congruent with methods of helping used by nurses as described by Orem. Results of this research currently serve as the basis for development and testing of nursing action protocols for alleviation of pain in hospitalized children.

Self‐care agency as a function of patient—environmental factors among nursing home residents

The relationship between environmental and personal factors on self-appraised self-care agency of nursing home residents was examined. Data were collected from 83 nursing home residents in relation to self-care abilities, environmental constraints, and selected demographic factors. Race and previous occupation were related to self-care agency with residents who were black or previously self-employed evidencing higher scores. In addition, residents who viewed the home as overly restrictive or fostering dependence had lower perceptions of their self-care abilities. The results are discussed in terms of Orem's theory of self-care, social learning theory, and implications for restructuring care within nursing homes.

Health promotion self‐care within Orem's general theory of nursing

The growing emphasis on health promotion by society and the increasing utilization of Orem's general theory of nursing to guide practice, education and research create a need to clarify health promotion activity within the model. The concept of health promotion self-care is developed after an analysis of statements by Pender and Orem for their logical congruence. Further in-depth analysis of Orem's model facilitates the placement of the new concept within its current structure. The potential strength of the model for guiding health promotion practice is discussed, as well as areas for needed development.

SELF-CARE for the Elderly Diabetic

Diabetes is a chronic disease; its successful management is largely dependent on the elderly individual's compliance with the treatment regimen. Teaching efforts for elderly clients with diabetes should be tailored to meet the many age-related conditions that affect learning abilities. These include prior experience with the disease, sensory perceptual changes, short-term memory loss, and lack of formal education. Orem's theory of self-care provides an appropriate framework for nurses who work with elderly diabetic clients. For these clients, nursing goals are geared toward having the older person remain as independent and healthy as possible.

Application of Orem's Self-Care Deficit Theory to the Pediatric Chronically Ill Population

The conditions under which children with long-term chronic health problems are cared for have changed dramatically in the past decade. These children are more often living longer and being cared for at home by their families and nursing supports. An effective tool allowing nurses to systematically assess, plan, implement, and evaluate the care needs of these children is a nursing theory. Orem's (1985) self- or dependent-care deficit theory is a useful basis from which the care of the chronically ill pediatric population can be planned. Attention is given to a caring relationship in which there is a dependent person in need of care and an individual who serves as that dependent person's agent of care. This article discusses several of the major concepts of the self- or dependent-care deficit theory and how it can be applied to guide clinical nursing practice aimed at meeting the care demands of the pediatric chronically ill population and their families.

Health and illness self-care in adolescents with IDDM

Orem's theory suggests that different self-care actions are necessary to meet requisites related to health (universal self-care) and illness (health-deviation self-care). The authors differentiate these types of self-care, propose hypotheses relating these concepts to other concepts in Orem's theory, and test them in a sample of adolescents with diabetes mellitus. As predicted, universal self-care is significantly related to a measure of the global health state, and health-deviation self-care is related to control of pathology. The findings provide direction for additional research and theory development.

An interpretation of family within Orem's general theory of nursing.

This article offers an interpretation of family from the perspective of Orem's theory of nursing. The family is conceptualized within this theory from three perspectives: (a) as a factor that conditions an individual's requirements for care and ability to provide care for self; (b) as a dependent-care unit; and (c) as a unit of service. The meaning of these perspectives to the nurse is examined. The different assessment questions are identified. The family is seen as having functions related to the members' development of self-care agency and the establishment of appropriate dependent care systems in such a way as to promote the health of the entire family.

Expanded nursing care for contraceptive use

Nursing actions to promote contraceptive self-care are described. Orem's self-care theory was used to develop assessment tools and to plan nursing actions.

Solving the Orem Mystery: An Educational Strategy

Three years ago Orem's Self-Care Deficit Theory was introduced in five pilot units at the Toronto General Hospital. To augment the existing implementation program and to introduce the basic concepts of the theory to staff from nonproject units, the clinical nurse specialist group developed a multimedia exhibit showing the theory in action. The theory was interpreted within the framework of the nursing process. A case study approach was developed so that a global perspective of the actual application of the model could be readily visualized. This article describes the activities involved in producing a self-learning educational presentation that can be put to a variety of uses, such as orientation of new staff and a review for current project unit staff, and that can also be revised and augmented as use of the theory becomes more sophisticated.