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Orem's Concept and Theoretical Statements in Nursing Plan of Care

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Orem's Concept and Theoretical Statements in Nursing Plan of Care

Case study is on Mary M., a 56 year old female, Caucasian, married with a daughter, who has Rheumatoid Arthritis, incapacitated in providing care for self and performing activities of daily living due to arthritic exacerbation and joint pains. Mary M. sought emergency room evaluation and was admitted to the medical unit for the management of her clinical problem.

Because conceptual frameworks and models guide the plan and implementation of care in a purposeful way (Hamric, Sprossa, & Hanson, 2004), Orem's self care deficit theory provided a theoretical framework to guide assistance of a client with Rheumatoid Arthritis to meet self management requirements (Orem, 2001).

The assessment and plan of care utilized Orem's four related concepts: self care, self care agency, therapeutic self-care demand and self care deficit; and two concepts that relate to nurses and their roles: Nursing agency and nursing system. In addition, the linking concepts called basic conditioning factors which include age, gender, developmental state, health state, sociocultural orientation, healthcare system elements, family system elements, patterns of living, environmental factors and resource availability (Orem, 2001). In coping with chronic illness progression and the expected outcomes will depend on and affects the responses of the family. A thorough assessment of Mary's family will help in the selection of appropriate nursing diagnosis, outcomes, and interventions (Kumar, 2007).

Orem's concept of self-care or actions initiated by an individual to maintain health, life, and well-being is usually initiated voluntarily. Placement in the family constellation affects the person's ability for self care. Self care is Mary's continuous contribution to her own continued health and well-being, and is human regulatory function performed deliberately to regulate health, functioning, and development (Banfield, 2008).

Self-care agency is the acquired ability to perform the self-care and be affected by the basic conditioning factors such as age, gender, and family systems (, 2010). Family members may affect the person's behavioral changes, treatment, and outcomes. If Mary perceives that she is powerless to control the cause of her disease, has environmental factors that negatively influence her self-management, and has low self-esteem, this may have a negative impact on self-care agency.

Therapeutic self-care demands refers to those actions that Mary should perform over time to maintain life, health, and well-being. This will include universal therapeutic self-care demands, e.g. water and food, developmental self-care demands, e.g. death of a loved one, and health deviation therapeutic self care demands which apply to Mary who has chronic disease such as Rheumatoid Arthritis (Orem, 2001).

The concept of self-care deficit refers to the relationship between self-care agency and the self-care demand. Whenever there is an inadequacy of any of these self care requisites, deficit in self-care occurs and is identified by the nurse through the assessment of the patient (, 2010). In the case of Mary, she has partial self-care deficit as she has some capabilities for meeting her self-care demands but needs assistance in meeting her health deviation.

Nursing agency is the expression of the purpose of nursing, which is to compensate for or to overcome known or emerging health-associated limitations of clients for self-care. When a nursing agency is activated, a nursing system is



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