Nurse Practitioner Models of Care Essay

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Nurse Practitioner Models of Care -- Dorothea Orem

The objective of this work in writing is to choose a model of nursing care. The model chosen is that of Dorothea Orem. Orem's 'Self-Care Deficit Theory' is a general theory of nursing and one of the most utilized models in nursing in contemporary times.

Dorothea Orem - Background

Dorothea Orem was born in 1914 in Baltimore, Maryland. Orem earned her nursing diploma in the earlier part of the 1930s from Providence Hospital School of Nursing, Washington, D.C. As well as receiving three honorary doctorates and an Alumni Achievement Award for Nursing Theory in 1980 from Catholic University of America. (Bridge, Cabell, and Herring, paraphrased) Orem gained experience early in her nursing career in various hospital clinical settings as a staff nurse.

The work of Bridge, Cabell, and Herring (nd) states that Orem recalls from early in her career while serving as director of nursing service at a hospital in Detroit, Michigan that "she was asked a substantive question and didn't have an answer because she 'had no conceptualization of nursing'." (p.2) Orem is reported to have related that while working at Indiana University she found that there was difficulty in the articulation of nurses to the administrators of the hospital in regards to their needs "in the face of demands made upon them regarding such issues as length of stay, scheduling admissions and discharges…" (Bridge, Cabell, and Herring, nd, p. 2)

According to Orem, she had recognized a need "to look for the uniqueness of nursing. Specifically she was looking to answer questions such as 'What is Nursing?', 'What is the domain and what are the boundaries of nursing a field of practice and a field of knowledge?' And 'What condition exists when judgments are made that people need nursing?' (Bridge, Cabell, and Herring, nd, p. 2) The International Orem Society is reported to have stated is as follows: "What do nurses encounter in their world as they design and produce nursing for others? What meaning can and should nurses attach to persons, things, events, conditions, and circumstances they encounter?" (Bridge, Cabell, and Herring, nd, p.2)

II. Orem's Theory of Nursing

It is reported that Orem (1978) stated that the task "…required identification of the domain and boundaries of nursing as a science and an art." (Bridge, Cabell, and Herring ) Following having reflected upon her own experiences in nursing Orem is reported to have said that the answer came as a "…flash of insight, an understanding that the reason why individuals could benefit from nursing was the existence of…self-care limitations." (Orem, 1978 cited in: Bridge, Cabell, and Herring, nd, p.2)

Four concepts are used by Orem to explain the nursing metaparadigms. Those four are: (1) human beings; (2) environment; (3) health; and (4) nursing. Orem stated that a human being or 'humanity' as "an integrated whole composed of internal physical, psychological and social nature with varying degrees of self-care ability." (Chinn & Kramer, 2004, cited in, p.4) A human being is stated by Orem to have the ability to "reflect, symbolize and use symbols." (Bridge, Cabell, and Herring, nd, p.2) Orem uses the terms "individual, patient, multiperson unit, self-care agent, dependent-care agent" when she referred to humans. (Fawcett, 2005 in: Bridge, Cabell, and Herring, nd, p.2)

When addressing the concept of health Orem states that health and healthy "are terms used to describe living things…[it is when]they are structurally and functionally whole or sound…includes that which make a person human, operating in conjunction with physiological and psychophyisiological mechanisms and material structure (biologic life) and in relation to an interacting with other human beings (interpersonal and social life." (Bridge, Cabell, and Herring, nd, p. 4) Health is defined by Orem as "a state of physical, mental and social well-being, and not merely by the absence of disease or infirmity." (Foster and Bennett, 2001 in Bridge, Cabell, and Herring, nd,, p.4-5)

III. Nursing and the Environment

Nursing is viewed by Orem as "an art through which the practitioner of nursing gives specialized assistance to persons with disabilities of such a character that greater than ordinary assistance is necessary to meet daily needs for self-care and to intelligently participate in the medical care they are receiving from the physician." (Bridge, Cabell, and Herring, nd, p. 5) According to Orem, the environment is "…encompassed by two dimensions-physical, chemical and biologic features and socioeconomic features.

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Physical, chemical, and biologic features include things such as atmosphere, pollutants, weather conditions, pets, infectious organisms and the like. Socioeconomic features of the environment focus on the family and the community and include such things as gender and age roles, cultural roles, and cultural prescriptions of authority." (, p. 5) Orem notes that these two dimensions may interact with one another and emphasizes the "…potential contribution of environment to a person's development, stating that "It is the total environment, not any single part of it that makes it developmental" (Orem, 2001, p. 58, cited in Fawcett, 2005 in: Bridge, Cabell, and Herring, nd, p. 6) From Orem's view the environment is a "prevailing internal and external conditions in some time and place frame of reference." (Fawcett, 2005 cited in: Bridge, Cabell, and Herring, nd, p. 6) Orem's Self-Care Deficit Theory is a 'Conceptual Framework for Nursing" as follows:

R = relationships

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