Categories
Theorists

Dorothea E. Orem

Dorothea E. Orem
Dorothea E. Orem

Person/Client:

A unity who can be viewed as functioning biologically, symbolically, and socially and who initiates  and performs self-care activities on own behalf in maintaining life, health and well-being; self-care activities deal with air, water, food elimination, activity and rest, solitude and social interaction, prevention of hazards to life and well-being, and promotion of human functioning.

Environment:

The environment is linked to the individual, forming an integrated and interactive system.

Health:

Health is a state that is characterized by soundness or wholeness of developed human structures and of bodily and mental functioning. It includes physical, psychologic, interpersonal, and social aspects. Well-being is used in the sense of individual’s perceived condition of existence. Well-being is a state characterized by experiences of contentment, pleasure and certain kinds  of happiness; by spiritual experiences; by movement toward fulfillment of one’s ideal; and by continuing personalization. Well-being is associated with health, with success in  personal endeavors, and with sufficiency of resources.

Nursing:

A helping or assisting service to persons who are wholly or partly dependent-infants, children and adults – when they, their parents, guardians, or other adults responsible for their care are no longer able to give  or supervise their care.  A creative effort of one human being to help another human being. Nursing is deliberate action, a function of the practical intelligence of nurses, and action to bring about humanely desirable conditions in persons and their environments. It is distinguished from other human services and other forms of care by its focus on human beings.

Orem’s Self-Care Deficit Theory

Dorothy Orem’s self-care deficit theory, published first in 1971, has been widely accepted by the nursing community. It includes three related theories of self-care, self-care deficit, and nursing system. Self-care theory postulates that self-care and the self-care of dependents are learned behaviors that individuals initiate and perform on theri own behalf to maintian life, health, and well-being. The individual’s ability to perform self care is called self-care agency. Adults care for themselves, whereas infants, the aged, the ill, and the disabled require assistance with self-care activities.

These are three kinds of self-care requisites:

1. Universal requisites, common to all people, include the maintenance of air, water, food, elimination, activity and rest, solitude and social interaction; prevention of hazards to life and well-being; and the promotion of human functioning.

2. Developmental requisites are those associated with conditions that promote known developmental processes throughout the life cycle.

3. Health deviation requisites relates to defects and deviations from normal structure and integrity that impair an individual’s ability to perform self-care.

Self-care deficit theory asserts that people benefit from nursing because they have health-related limitations in providing self-care. Limitations may result from illness, injury, of form the effects of medical tests or treatments.Two variables affect these deficits: self-care agency (ability) and therapeutic self-care demands (the measures of care required to meet existing requisites). Self-care deficit results when self-care agency is not adequate to meet he known self-care demand.

Nursing system theory postulates that nursing systems form when nurses prescribe, design, and provide nursing that regulates the individual’s self-care capabilities and meets therapeutic self-care requirements. Three types of nursing systems are identified:

1. Wholly compensatory systems are required for individuals unable to control and monitor their environment and process information.

2. Partially compensatory systems are designed for individuals who are unable to perform some (but not all) self-care activities.

3. Supportive-educative (developmental) systems are designed for persons who need to learn to perform self-care measures ans need assistance to do so.

 

Reference:

Kozier, Barbara et.al Fundamentals of Nursing 5th edition

Addison-Wesley Publishing Company, Inc 1998 p.51

Categories
Theorists

Betty Neuman

Betty Neuman
Betty Neuman

Health Care System Model

(1972,1974,1980,

1982,1989)

Person/Client:

Open system consisting of a basic structure or central core of survival factors surrounded by concentric rings that are bounded by lines of resistance , a normal line of defense, and a flexible line of defense. The total person is a composite of physiologic, psychologic, sociocultural, and developmental variables.

Environment:

Both internal and external environments exists and a person maintains varying degrees of harmony and balance between them. It is all factors affecting and affected by the system.

Health:

Wellness is the condition in which all parts and sub-parts of an individual are in harmony with the whole system. Wholeness is based on interrelationships of variables that determine the resistance of an individual to any stressor. Illness indicates lack of harmony among the parts and sub-parts of the system of the individual. Health is viewed as a point along a continuum from wellness to illness; health is dynamic. Optimal wellness or stability indicates that all a person’s needs are being met. A reduced state of wellness is the result of unmet systemic needs. The individual is in a dynamic state of wellness-illness, in varying degrees, at any given time.

 

Neuman’s Health Care Systems Model

Betty Neuman’s systems model, first published in 1972, is based on the individuals relationship to stress, the reaction to it, and reconstitution factors that are dynamic in nature. Reconstitution is the state of adaptation to stressors.

Neuman views the client as an open system consisting of a basic structure or central core of energy sources surrounded by two concentric boundaries or rings referred to as lines of resistance. The two lines of resistance represent internal factors that help the client defend against a stressor. The inner or normal line of defense represents the person’s state of equilibrium of the state of adaptation developed and maintained over time  and considered normal for that person. The flexible line of defense is dynamic and can be rapidly altered over a short period of time. It is a protective buffer that prevents stressors from penetrating  the normal line of defense.

The nurse’s focus is all the variables affecting an individual’s response to stressors. Nursing interventions are carried out on three preventive levels:

1. Primary prevention identifies risk factors, attempts to eliminate the stressor, and focuses on protecting the normal line of defense and strengthening the flexible line of defense. A reaction has not yet occurred, but the degree of risk is known.

2. Secondary prevention relates to interventions or active treatment initiated after symptoms have occurred. The focus is to strengthen internal lines of resistance, reduce the reaction, and increase resistance factors.

3. Tertiary prevention refers to intervention following that in the secondary stage. It focuses on readaptation and stability and protects reconstitution or return to wellness follwing treatment. The nurse emphasizes educating the client in strengthening resistance to stressors and ways to help prevent recurrence of reaction or regression.

Betty Neuman’s model of nursing has been widely accepted by the nursing community, nationally and internationally. it is applicable to a variety of nursing practice settings involving individuals, families, groups, and communities.

Reference:

Kozier, Barbara et.al Fundamentals of Nursing 5th edition

Addison-Wesley Publishing Company, Inc.1998 p.49