Orem model of nursing

1 Introduction
2 Central philosophy
3 Self care requisites
4 Self care defecits
5 Support modalities
6 Universal Self Care Requisites (SCRs)
7 Example nursing assessment
8 Related Links

Introduction

The Orem model of nursing was developed between 1959 and 2001 by Dorothea Orem and is also known as the 'Self Care' Model of Nursing. It is particularly widely used in rehabillitation and primary care settings where patients are generally encouraged to be as independent as possible.

Central philosophy

The Orem model is based upon the philosophy that all "patients wish to care for themselves".

Self care requisites

Self care requisites are groups of needs or requirements that Orem identified. They are classified as either:

Universal self care requisites – those needs that all people have
Developmental self care requisites – those needs that relate to development of the individual
Health deviation requisites – those needs that arise as a result of a patient's condition

Self care defecits

When an individual is unable to meet their own Self care requisites, a Self Care Defecit occurs. It is the job of the Registered Nurse to determine these defecits, and define a support modality.

Support modalities

Nurses are encouraged to rate their patient's dependencies for each of the self care defecits on the following scale:

Total Compensation
Partial Compensation
Educative/Supportive

Universal Self Care Requisites (SCRs)

The Universal self care requisites that all patients, regardless of age or health have are:

Air
Water
Food
Elimination
Activity and Rest
Solitude and Social Interaction
Hazard Prevention
Promotion of Normality

The nurse is encouraged to assign a support modality to each of the self care requisites.

Example nursing assessment

This patient is entirely ficticious and any likeness to any person, alive or dead, is purely coincidental.

'J' is a 50-year-old male who has just been diagnosed with type-two diabetes mellitus. He has a history of hypertension, and is a chronic smoker, smoking around 30 cigarettes daily.

AIR: Educative/Supportive – Provide education on the risks associated with smoking particularly for the diabetic patient.
WATER: Educative/Supportive – Ensure access to adequate hydration – risk of polydipsia due to hyperglycaemia.
FOOD: Partial Compensation – Education and provision of a diet that is suitable for his new diagnosis of diabetes, blood sugar monitoring prost-prandially.
ELIMINATION: Educative/Supportive – May require monitoring.
ACTIVITY AND REST: Educative/Supportive – Educate patient as to the benefits of cardiovascular exercise, especially for the diabetic
SOLITUDE AND SOCIAL INTERACTION: Partial Compensation – Nurses may provide social interaction as hospital admission will cause change is social behaviour and interactions.
HAZARD PREVENTION: Partial Compensation – Nurses will need to educate regarding the medication that he may be taking, and asminister this medication initially. Particularly relevant if J is taking insulin injections.
PROMOTE NORMALITY: Partial Compensation – Nurses will need to facilitate a return to normal lifestyle. This will involve advocating for the patient in a multi-disciplinary team, in order to achieve a medication regime that will fit with the patient's life.