Orem’s Self-Care Model in Management of Pressure Ulcers
Despite the health sector’s loud outcry for quality care, bedsores still pose a significant threat to this phenomenon for the critically ill patients. Such is the case due to their inability to accomplish their activities of daily living (ADLs) that are often self-protective. A befitting example is their failure to turn themselves on the bed, which is critical for avoiding bedsores. The most vulnerable to this fate include but not limited to patients in comatose state and with hip fractures. It is the realization of this undying problem that the nurses ought to devote its time in tackling this issue. Central to their efforts is the translation of proven nursing theories such as Orem’s self-care model to rescue this situation. Dorothea asserts that an individual should only assist a patient up to the level that he/she cannot accomplish his/her ADLs. In essence, this is in line with the prevention of this adverse healthcare outcome. The nurse has the responsibility of ensuring self-care is at the disposal of a patient that is at risk of pressure ulcers. Instances like this illustrate the appropriateness of this theory in handling such healthcare problems. Thus, the central theme in this discussion is the analysis of Dorothea Orem’s self-care ideologies and its application in halting this health care injustice.
First and most importantly, for one to appreciate the appropriateness of this theory, an understanding of Orem’s self-care model foundation is inevitable. The conception self-care model dates back to early 20th century when Dorothea Orem defined self-care and came up with assumptions. In her self-care model, she identifies three critical self-care strategies that form the pillars of this theory. They include wholly compensatory, partly compensatory and supportive education care systems. In the fully compensatory system, the nurse takes full responsibility for ensuring he/she meets the patient’s needs entirely. A comatose patient is an example of such patients. On the contrary, the partly compensatory model is useful in circumstances where a patient can meet some of his/her needs. According to Orem, the nurse’s role in such a scenario is assisting the patient up to his/her level of functionality. Lastly, the indication of supportive education self-care strategy is when a patient can meet his/her needs but only lacks adequate knowledge to enhance this possibility (Meleis, 2011). Clearly, by utilizing the three self-care measures, a nurse is sure of abiding with Orem’s principles.
Close to that is the prior application of this theory in nursing practice. Since its inception, Orem’s self-care model has been a useful tool in the accomplishment of nursing interventions. Virtually, all nursing actions are formulations of this theory since they owe their existence to the nursing process. The systematic nursing process demands that in the management of a patient, a nurse must assess, diagnose, plan, intervene and evaluate. All these steps are in essence the same as the self-care foundations, which seeks to identify a self-care deficit and an appropriate self-care nursing system. Upon realization of the two, a nurse can then intervene and evaluate the effectiveness of her actions (Meleis, 2011). Evidently, this shows that self-care is always in use by nurses even when they are unconscious about the same.
Besides its application in the past, Dorothea’s theory can be a useful asset in the prevention of pressure sores in this new age. The existence of vast evidence of literature exploring this assertion is only but helpful in validating it. Baron et al., (2016) are of the opinion that refocusing to self-care is pivotal in preventing pressure sores. They propose that self-management is the way to go if indeed this menace is to be obliterated. In a self-management strategy, a nurse affords all the three self-care strategies proposed by Orem. Thus, scrutinizing the three self-care strategies is essential in illustrating the suitability of this theory in eradicating pressure sores.
To begin with, the relevance of using a wholly compensatory approach to prevent this problem is beyond doubt. Many patients that develop bedsores are predominantly those that are unable to meet their self-care needs. For instance, a comatose patient is unable to turn his/her body and thereby he/she develops this problem. In such cases, the patient is fully dependent on others to accomplish self-care activities. A dependence of that kind is the core element of a wholly compensatory paradigm, which demands that a nurse meets the patient’s need. Nursing actions like turning the patient two-hourly and four hourly pressure area care are appropriate in a wholly compensatory system (Berman,Snyder, Frandsen,& Kozier,2016). With such interventions in place, a nurse is on course to preventing pressure sores.
Moreover, one may also utilize this theory by adopting a partly compensatory nursing system. In this system, a nurse may continually support a post-operative patient as he/she makes an effort to ambulate. By so doing, the therapist encourages the patient to avoid prolonged bed, which is a major risk factor for bedsores. Additionally, one may adopt a supportive-educative strategy to evade this challenge. A case in point is the use of patient teaching to enhance patient’s decision-making capabilities. Consequently, the patient is free from this health risk since he/she is capable of deciding the suitable alternative for pressure sore prevention (Baron et al., 2016). Clearly, all these instances are proof enough of the indispensability of self-care model in the prevention of bedsores.
Finally, the consequences of utilization of the self-care theory in the prevention of bedsores are also noteworthy. Adoption of this approach in practice will result in ultimate prevention of pressure sores through the nursing process. Such is the case when an individual can establish the self-care needs of a patient and meet them using an appropriate nursing system. Similarly, a nurse’s fortunes will change because he/she will be utilizing evidence-based practice accorded by this model (Riegel, Jaarsma, & Strömberg, 2012). Evidently, with such an outcome, adoption of this theory in practice makes sense.
In conclusion, Orem’s self-care model is a valuable tool that nurses can rely on when managing pressure ulcers. It is beyond doubt that utilizing the three nursing systems that Orem postulates can be pivotal in eliminating this risk. Besides, the contribution of this theory to nursing practice can increase, if nurses can adopt it in their daily practice. Failure to embrace this model can only but exposes high-risk patients to harsh effects of pressure sores. Thus, it is high time that nurses take up this model if protecting such patients from pressure sores and related consequences 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.
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