OREM’S SELF-CARE MODEL: A SUITABLE FRAMEWORK TO GUIDE INTELLECTUAL DISABILITY NURSING PRACTICE IN COMMUNITY SETTINGS

Orem’s self-care model focuses on individual and holistic care and offers a varied approach to nursing care, giving the client choices and involvement in decision making about his/her own health issues by Aileen Doran, RNMH, (BNS Student, Trinity College Dublin) Staff Nurse, St Vincent’s Hospital

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Many nursing models are prevalent in Irish nursing, such as Roper, Logan and Tierney’s (1990) activities of daily living (ADL) and Roy’s (1976) adaptation model. Dorothea Orem, a well-known and respected nurse theorist from the USA, developed the ‘self-care’ model of nursing during the 1960-80s. Orem does not claim that her model is a complete answer to her questions; it simply provides a framework in which to view nursing practice, education and management (Pearson, Vaughan and Fitzgerald 1996).

Orem’s model of self-care is used extensively in US nursing practice and it is selectively used in Ireland, often along with other models. The central theme of Orem’s framework (2001) is that people require nursing care when their needs for care exceed their own ability to meet them, i.e. when there is a ‘self-care deficit’. Using the nursing process, the client’s level of ability to self-care is assessed; problems are identified and goals are set for the re-establishment of self-care. Although not specifically devised for the learning disability setting, Orem’s model is transferable for use in many settings. Care planning in the learning disability setting involves guiding, supporting and teaching the person to deal with current and possible future problems. The last stage is an evaluation—an assessment is made as to whether or not the goals have been reached, or to what extent they have been reached.

The model focuses on individual and holistic care. It offers a more varied approach to nursing care, giving the client choices and involvement in making decision about his/her own health issues. This approach clearly differs from the traditional role of nurses acting on behalf of clients (Cavanagh 1991).

Orem’s model unifies the interpersonal relationships between client and nurse, a concept which was fostered by Peplau (1952). It is a useful framework in community-based residences for persons with intellectual disability because it involves the client in the entire nursing process. For example, a client with a self-care deficit in the ability to dress him/herself can be taught to achieve this skill using a supportive-educative nursing system which guides and supports the client to become independent in this area of self-care. The abilities of the client should be taken into consideration and evaluation will determine whether or not the skill has been achieved. The client’s level of ability will also dictate the length of time it may take him/her to gain self-care in this area. Some clients may only reach a certain stage in their efforts to achieve self-care; it is equally important to acknowledge this and to maintain the improvements made. [possible pull-quote, if needed—without ‘in this area’??] Using the self-care perspective encourages clients to become more aware of their self-care needs and how to meet them.

The implications of such individual responsibility have been called into question by Webber (1991), who stated that there is perhaps too much concentration on the responsibility of the individual within society and not enough on the social structures which contribute to health. This is of particular relevance in intellectual disability settings, where social models of health need to be considered.

The author has found that using Orem’s model of self-care is a useful framework to conceptualise nursing care within intellectual disability settings. It places emphasis on the individual need for self-care and pays particular attention to client education to maintain self-care. In the author’s own practice setting, the use of Orem’s model has greatly enhanced the self-care abilities of individual clients. In addition, the care plans guided by Orem’s framework are valuable in preventing possible future problems—particularly where clients have co-existing medical conditions that may require an altered lifestyle or medical/nursing interventions. The author recommends that Orem’s model should be used in other community-based residences and centres.