Middle Range Theory on Pressure Ulcers (Orem’s Self-care Model)

Middle Range Theory on Pressure Ulcers (Orem’s Self-care Model)

Despite the insistence of the healthcare filed for quality care, pressure ulcers remain a significant hindrance to this phenomenon for the critically sick persons. Central to this barrier for these individuals is their inability to perform self-protective activities independently. A case in point of such activities is self-turning on the bed that is necessary for preventing bedsores. Persons at highest risks of developing this condition are comatose individuals and those with hip fractures. Given the inevitability of this challenge in healthcare facilities, there is a dire need for seeking opportunities for implementing popular and indisputable theories that will improve the situation for the better. A befitting example of such proven nursing theories is Orem’s self-care model that provides a foundation for the best preventive practice in the contemporary modern world. According to Orem, one only helps a sick person up to the limit of his/her point of inability to perform his/her self-protective activities.

In essence, this discussion’s central focus is on the Orem’s self-care theory as a foundation of best practices that prevents bedsores in healthcare settings with a high number of critically ill persons. At the heart of this analysis are several themes that will help illustrate the effectiveness of this challenge to the prevention of this health problem. The themes include a brief overview of the problem of decubitus ulcers, the origin of the self-care theory, its previous application and its appropriateness to the prevention of the pressure ulcers.

Problem Summary

Currently, in the USA, pressure sores poses a significant challenge for health facilities striving to provide high-quality care. That is the case given the healthcare burden emanating from this unwanted healthcare problem. A case in point, Pickham, Ballew, Ebong, Shinn, Lough, & Mayer, (2016) estimated that 2.5 million individuals fall victims of this pressure sores every year. Worsening the situation further is the cost incurred in the management of patients developing this condition. The USA government spends close to 11 billion US dollars every year to treat pressure ulcers patients. Central to this cost is extended hospital stay and pressure ulcer-related complications that are expensive to treat. Based on this current situation, it is beyond question that there is dire need of addressing this problem.

Orem’s Theory of Self-Care Origin

Primarily, comprehension of Orem’s self-care model origin is of the essence to the appreciation of its appropriateness to the health challenge in question. The origination of self-care concept goes back to mid-twentieth century when Dorothea Orem developed the self-care concept and its assumptions. In this model, she recognizes three basic self-care strategies that frame the mainstays of this middle-range theory. They incorporate the wholly compensatory, partly compensatory and supportive education care systems. Central to a fully compensatory system, the nurse assumes full liability for guaranteeing he/she addresses the patient’s needs in totality. A comatose patient is a befitting case of such patients (Meleis, 2011). Contrary to this, the partly compensatory model is helpful in conditions where a patient can meet some of his/her needs. As indicated by Orem, the nurse’s responsibility in such a situation is helping the sick person up to his/her level of functionality (Meleis, 2011). Finally, an implication for the need of using supportive education self-care strategy the point at which a patient can address his/her issues but only needs sufficient information to upgrade his/her knowledge about these matters. Evidently, by using the three self-care strategies, a nurse is sure of dwelling with Orem’s self-care standards.

Previous Application of Orem’s Self-care Theory

Over the years, Orem’s self-care model has continuously informed nursing practice.  Since its conception, Orem’s self-care model has been a valuable tool in the achievement of nursing interventions. Virtually, almost all nursing activities are products of this theory since their existence is due to the nursing process. That is the case since the nursing process expects a nurse to assess the patient, diagnose his/her problems, plan for appropriate actions, intervene and evaluate for appropriateness of the interventions. Each step of the nursing process is similar as the self-care foundations, which looks to establish a self-care deficit as well as a suitable self-care nursing system for the address of this deficiency.  Upon identification of the self-care deficit and appropriate self-care nursing system, a nurse can then intervene and assess the adequacy of her interventions (Meleis, 2011). Clearly, this demonstrates that nurses have used self-care from time immemorial to inform their practice even though they might be unconscious of the dependability of the same.

Modern Application of Orem’s Self-care Model and Practice Change

Other than its application before, Dorothea’s model can be a helpful resource in the countering of the challenge of pressure sores in the contemporary world. The presence of immense proof in the literature investigating this declaration is only but supportive in approving it. A case in point, Baron et al., (2016) are of the idea that refocusing to self-care is vital in preventing bedsores. They recommend that self-care is the approach of choice if indeed this danger is to become nonexistent. In a self-care technique, a nurse utilizes all the three self-care strategies. Thus, examining the three self-care strategies is paramount in showing the appropriateness of this model in annihilating decubitus ulcers.

That said, the suitability of utilizing a wholly compensatory approach to deal with this problem is beyond doubt. Numerous patients that are victims of developing bedsores are transcendently those that cannot meet their self-care needs. A typical example is an unconscious patient that cannot turn his/her body, which consequently subjects him/her to developing bed ulcers. In such cases, the sick person is entirely reliant on others for the achievement of self-care needs. Such reliance is the central component of a wholly compensatory system envisioned by Orem as a means of meeting the patient’s self-care needs. Berman, Snyder, Frandsen, and Kozier, (2016) identify interventions such as turning the patient two-hourly and pressure area care after every four hours are befitting in a wholly compensatory system for at-risk individuals like the comatose patients. Apparently, with interventions of this kind, a nurse is in the right direction to the prevention of pressure ulcers.

Additionally, an individual may as well use the self-care model in the management of a patient at-risk of developing bedsores by embracing a partly compensatory nursing system. An example of the utilization of this system is a nurse persistently supporting a post-operative patient as he/she tries to ambulate. Through this intervention, a nurse urges the patient to avoid immobility, which is a noteworthy predisposing factor to pressure ulcers (Baron et al., 2016).

Moreover, one may use a supportive-educative strategy to circumvent this healthcare challenge. According to Baron et al., (2016) a valid example is the utilization of patient education to improve an individual’s capacity to make good decisions. Consequently, the patient becomes risk-free because he/she has the capability of choosing the appropriate option for prevention of the bedsores. Evidently, all these instances are reason enough to suggest the appropriateness of self-care model in the aversion of decubitus ulcers.

Lastly, the benefits of usage of the self-care theory in the aversion of bedsores are also worth mention. The use of this approach in the nursing practice arena will bring about the total elimination of the risk of developing decubitus ulcers via the nursing process. That is for sure in the event a nurse can identify self-care needs of a sick person and address them by utilizing an appropriate nursing system. According to Riegel, Jaarsma, and Strömberg, (2012), health care outcomes will significantly change for the better because of the reliance of nurses on evidence-based practice informed by Orem’s self-care model. Clearly, with such a result, utilization of middle-range theory for prevention of bedsores practically speaking bodes well.


In closure, Orem’s self-care model is an essential tool that nurses can depend on when aiming to prevent pressure ulcers. It is certain that utilizing the three nursing systems hypothesized by Orem can be indispensable in eradicating this danger. Notwithstanding, the contribution of Orem’s theory to nursing can substantially increase if nurses can embrace it in their routine practice. In the absence of such, it exposes high-risk persons to harsh effects of pressure ulcers. As such, it is high time for nurses adopt this model if prevention of pressure sores and its related effects is a priority.


Baron, J., Swaine, J., Presseau, J., Aspinall, A., Jaglal, S., & White, B. et al. (2016). Self-management interventions to improve skin care for pressure ulcer prevention in people with spinal cord injuries: a systematic review protocol. Systematic Reviews, 5(1). http://dx.doi.org/10.1186/s13643-016-0323-4

Berman, A., Snyder, S., Frandsen, G., & Kozier, B. (2016). Kozier & Erb’s fundamentals of nursing: Concepts, process, and practice

Meleis, A. I. (2011). Theoretical nursing: Development and progress. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Pickham, D., Ballew, B., Ebong, K., Shinn, J., Lough, M., & Mayer, B. (2016). Evaluating optimal patient-turning procedures for reducing hospital-acquired pressure ulcers (LS-HAPU): study protocol for a randomized controlled trial. Trials17(1). http://dx.doi.org/10.1186/s13063-016-1313-5

Riegel, B., Jaarsma, T., & Strömberg, A. (2012). A Middle-Range Theory of Self-Care of Chronic Illness. Advances In Nursing Science, 35(3), 194-204. http://dx.doi.org/10.1097/ans.0b013e318261b1ba



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