Dorothea Orem – Self-Care Model

The rapid development of technology in the last decade has contributed to the emergence of numerous innovations that increased the quality of care available to patients worldwide. Specifically, the implementation of innovative equipment, medicine, and treatment techniques has provided medical practitioners with the ability to effectively treat the majority of existing illnesses and alleviate the conditions of chronically and terminally ill individuals. However, the current healthcare system has certain drawbacks that limit the effectiveness of care and produce a negative influence on patient outcomes. Specifically, one of the most problematic issues in the modern clinical environment is the lack of self-care knowledge and skills among patients, which contributes to the gradual deterioration of their health and a significant increase in hospitalization and readmission rates (Felix, Seaberg, Bursac, Thostenson, & Stewart, 2015). This problem is especially topical to family practice because family nurse practitioners have to deal with a large number of individuals with chronic health conditions who require sufficient care on a constant basis. The presented information clearly indicates the necessity to implement positive change aimed at promoting self-care in the clinical environment. Therefore, this paper will describe the Self-Care Model by Dorothea Orem, determine how it could be applied to promote self-care in the family practice and discuss potential barriers to its implementation.

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Key Principles of Dorothea Orem’s Self-Care Model

Dorothea Orem’s Self-Care Model is one of the general theories of nursing that focuses on promoting self-care in the clinical environment. Specifically, the theory emphasizes the importance of self-reliance and personal responsibility in addressing the healthcare needs of individuals and families and defines nursing as interactions between two or more persons, including a nursing specialist, aimed at improving these capacities (Hagran & Fakharany, 2015). The approach identifies three types of self-care requisites: universal, developmental, and health deviation. The first one refers to the factors that are essential for ensuring the proper functioning of the human body, such as sufficient consumption of food, water, and air, provision of necessary care related to elimination processes, a healthy balance between physical activity and rest, adequate socialization, and the avoidance of potential risks and hazards (Hagran & Fakharany, 2015). On the other hand, developmental requisites are associated with processes caused by a variety of events and conditions, such as adjusting to a new environment or body changes. Lastly, health deviation requisites occur due to illnesses and injuries that negatively influence the functioning of the human being and hinder one’s self-care abilities temporarily or permanently (Silva, et al., 2009). They include receiving necessary medical assistance, understanding and accepting specific health conditions and their impact and consequences, carrying out prescribed treatment and regulating its uncomfortable effects, and learning to lead a productive life under the given circumstances.

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Most importantly, the model utilizes the principle of health care deficit to determine when nursing interventions are required to address the mentioned requisites and offers effective solutions. Specifically, the approach implies that nursing is needed when individuals have significantly limited self-care capabilities that prevent them from ensuring sufficient self-care on a constant basis. In such cases, the appropriate nursing interventions include the provision of necessary care, guidance, support, and education as well as the establishment of an environment that could promote personal development and satisfy future demands in the long-term (Hagran & Fakharany, 2015). The model also identifies three nursing systems that could be utilized to address the health care deficits of individuals: wholly compensatory, partly compensatory, and supportive-education.

Rationale for Selecting Dorothea Orem’s Self-Care Model

The lack of self-care knowledge and skills represents one of the most problematic issues in the modern clinical environment due to changing demographics. Specifically, the overall aging of populations worldwide in the last decades has contributed to the significant increase in the number of patients with chronic health conditions. According to research conducted by the World Health Organization, approximately 60% of individuals over 45 years old suffer from one or more chronic disease and it is expected that chronic conditions will account for 73% of deaths and 60% of disability by 2020, becoming the greatest challenge to be addressed by healthcare systems (Capelli, 2016, p. 28). These issues are especially relevant for developed countries, including the United States, and they could contribute to a significant increase in patient loads in family practice, which could adversely affect nurse-to-patient ratios and the quality of care available to patients and lead to a major increase in hospitalization and readmission rates. The presented information suggests that family nurse practitioners should focus on promoting of self-care in the clinical environment to address the needs of individuals with chronic health conditions more effectively and improve patient outcomes. Therefore, the implementation of Dorothea Orem’s Self-Care Model could allow achieving this important goal and ensuring the effective functioning of the healthcare system in the long-term.

Implementation Plan

Applying the model in practice would involve organizing educational classes on self-care for patients and their families. However, the key to introducing positive policy change in the clinical environment is establishing effective communication and productive collaboration between all involved parties. Therefore, the first step in implementing Dorothea Orem’s Self-Care Model in family practice would involve creating a clear vision statement illustrating the benefits of the innovation and sharing it with all involved stakeholders, including colleagues, patients, and the management by disseminating sufficient supporting evidence acquired through empirical research (Chun-Mei & Zhang, 2017). Specifically, it could be shared with the staff during group meetings in the form of presentations while patients could receive such information via e-mails, hospital website, and printed materials. Most importantly, it would be necessary to receive approval from the management. In order to achieve this goal, the management should be provided with sufficient data illustrating the financial long-term benefits of implementing the mentioned model in the clinical environment. Upon receiving the approval, it would be necessary to prepare education materials on self-care for different categories of patients and design comfortable schedules for patient admittance based on their feedback. The last step would involve informing patients and their families about the new program and its benefits and providing reminders on a regular basis.

Potential Barriers and Proposed Solutions

The most common barriers to implementing positive policy change in the healthcare environment include the fear of change among the staff and patients and toxic behaviors exercised by personnel. Specifically, the staff and patients could express significant concern about the efficiency of proposed innovations while the management could focus on evaluating the costs of their implementation. Additionally, some members of the staff could actively oppose the utilization of Dorothea Orem’s Self-Care Model in practice and resort to such toxic behaviors as passive hostility and team sabotage due to the desire to preserve personal authority and maintain familiar and conservative practices (Holloway & Kusy, 2014). The first issue could be addressed by explaining positive influence of self-care education on treatment efficiency, patient outcomes, and cost savings to all involved parties and establishing productive collaboration between them. However, overcoming toxic behaviors in the clinical environment would require utilizing crisis management. Specifically, it would be necessary to consolidate team efforts on persuading the opposition to accept the proposed change and act as a mediator between the sides to facilitate and hasten the process of finding mutually beneficial consensus (Edmonson, Sumagasay, Cueman, & Chappell, 2016).

Conclusion

To conclude, the lack of self-care knowledge and skills among patients negatively influences the effectiveness of treatment and patient outcomes and contributes to increasing hospitalization and readmission rates. This situation is especially relevant for family practice due to the overall aging of populations and the increasing number of patients with chronic health conditions who require constant care. Utilizing the principles of Dorothea Orem’s Self-Care model in the clinical environment could assist in promoting self-care among patients and addressing their needs more effectively. Therefore, it could be helpful to organize educational classes on self-care for patients and their families. The implementation process would involve creating a vision statement, supporting it with evidence-based data, disseminating information about the benefits of the proposed change to all involved parties, receiving approval from the management, preparing educational materials, and creating comfortable schedules for patient attendance. Potential obstacles to the introduction of this program could include the fear of change and toxic behaviors in the workplace. However, these issues could be addressed by establishing effective communication and productive collaboration between the staff, patients, and the management and using crisis leadership to find mutual understanding with the opposition.