Dorothea. Ou Lin is one of the famous American nursing theorists. Her self-care theory emphasizes the self-care needs of nursing objects, including three theories: self-care theory, self-care defect theory and nursing system theory. This theory is widely used to guide clinical nursing practice, which is summarized as follows.
Main concepts and contents of 1 Orem's self-care theory
The self-care body in self-care theory refers to the person who can complete self-care activities; The general self-care needs refer to all activities that people take to meet their own self-care needs, including general self-care needs, self-care needs for growth and development, and self-care needs when they are in poor health; The theory of self-care defect means that when the self-care ability of the self-care body is less than the self-care need, the defect will appear; Nursing system theory expounds the nursing activities when people have self-care defects, including full compensation system (patients have no self-care ability and their self-care needs are fully met by nurses), partial compensation system (patients have the ability to meet some self-care needs, but the other part needs to be met by nurses) and auxiliary education system (self-care needs can be met by patients themselves, but they need to be consulted, guided and educated by nurses).
Orem theory holds that everyone has the ability to take care of themselves, and nursing intervention should focus on guiding their ability to take care of themselves. The goal of nursing practice is to help patients make full preparations, realize self-care and improve prognosis and quality of life. As a nurse, we can establish a good relationship of trust between nurses and patients, let patients control their illness by participating in decision-making, and encourage patients to share their successful treatment experience.
Application of Orem's self-care theory in clinical nursing practice.
2. Application of1Orem self-care theory in the field of surgical nursing
Orem's self-care theory is widely used in nursing practice such as gastrointestinal surgery, neurosurgery and traumatic orthopedics. Liu Guangying and others used Orem's self-care theory to intervene 48 patients with esophageal cancer in perioperative period with different nursing systems at different times. The results show that the awareness rate of health education content is high, the self-training of respiratory function before operation, the self-management ability of sputum excretion and thoracic drainage tube after operation are obviously improved, the hospitalization days are obviously shortened, and the postoperative complications are obviously reduced. Yang et al. applied Orem self-care theory to 46 patients with intracranial hematoma and limb dysfunction after severe craniocerebral injury. On the basis of holistic nursing, different nursing systems were adopted for nursing. Results Except for 2 deaths, the self-care ability of other patients was obviously improved. 40 patients can wash and eat by themselves. Wu Sufang provided 34 patients with lumbar discectomy with three basic methods: complete compensation, partial compensation and support education to meet their self-care needs. The results show that the treatment and nursing effect of patients is obviously improved, the hospitalization days and complications are reduced, and the nursing satisfaction is improved. Chen Yuwei et al. intervened in 40 patients with otosclerosis after laser-assisted stapes implantation by using the education system of complete compensation, partial compensation and support. The results showed that the scores of anxiety and depression were improved after operation, and the patients could get out of bed early without complications, shorten the hospitalization days and reduce the medical expenses. Jiang et al. applied Orem's self-care theory to completely and partially compensate 23 patients after total knee replacement, and supported the education system nursing. Follow-up for 6 months showed that 65438 cases were excellent and 7 cases were good according to the knee joint scoring standard of American Special Surgery Hospital (HSS). Patients can walk without crutches, go up and down stairs and take care of themselves completely.
2.2 the application of self-care theory in the field of internal medicine nursing
Orem's self-care theory is also widely used in nursing practice in neurology, respiratory medicine, gastroenterology and endocrinology. Yang Haiyan and others integrated Orem self-care model into the whole routine nursing process of 10 1 stroke patients, and chose the most suitable nursing system among the total compensation, partial compensation and support education systems to meet the self-care needs. Results: The incidence of complications and nosocomial infection caused by nursing was significantly reduced, and the ability of daily activities was significantly improved. Shi et al. carried out Orem self-care theory practice on 3 10 family sickbed patients and their caregivers during the rehabilitation period of cerebrovascular accident. The results show that patients and their caregivers have improved their psychological barriers, significantly improved their rehabilitation skills, and reduced their dependence on professional nursing. The difference was statistically significant. Wang Chunlan used Orem's self-care theory to give full compensation, partial compensation and supportive education and nursing to 30 patients with bronchial asthma. The lung function and quality of life of patients were significantly improved. Cao Xiaoying intervened in 20 patients with liver cirrhosis by using the nursing system theory of Orem's self-care theory, and found that the liver function, drowsiness, systemic symptoms and emotional scores of patients were higher than those of the control group, among which the emotional scores were significantly different, which achieved the effect that ordinary care could not achieve. On the basis of routine nursing, Zhang Yan used Orem's self-care theory to make an individualized rehabilitation health education plan, and provided a knowledge-based auxiliary education system and partial compensation system for nursing. The results show that patients are better than the control group in actively monitoring blood sugar, insulin treatment compliance, diet control, foot care, self-discipline exercise and glycosylated hemoglobin control, which shows that Orem theory can make patients voluntarily carry out activities to maintain and improve their health through self-care transfer.
2.3Orem self-care theory in the field of obstetric and pediatric nursing application
Cheng applied Orem's self-care theory to 120 patients after gynecological surgery, and adopted different compensation systems according to different nursing needs and self-care ability. Results 1 patient had no complications, and the satisfaction rate was 100%. After 6 months of follow-up, the patient's physiological function recovered well, and his satisfaction with his current life reached 93%. Orem's self-care theory is very practical, which can enhance patients' awareness of active participation, give full play to patients' self-care ability, assume self-care responsibility as soon as possible, and promote early recovery. Cai Ruwen applied Orem's self-care theory to 100 parturients after cesarean section, and flexibly applied the education system of complete compensation, partial compensation and support to the whole process after cesarean section. After operation, the time of anal exhaust was obviously shortened, the time of getting out of bed was advanced, and the milk yield was obviously increased 2 ~ 3 days after delivery, which promoted the early recovery after operation and the success of breastfeeding. Orem nursing mode is adopted in Liu Baozhen, and different nursing systems are adopted at different stages. Two hours after delivery, she chose the full compensation system and sent it to the baby-friendly area on 1 and the next day. On the third day after delivery, she used the auxiliary education system for nursing. The results showed that the satisfaction of puerperal women and their families with health care knowledge, neonatal nursing skills and nursing work was significantly improved. Yanwu also applies Orem's self-care theory to the rehabilitation nursing of children with cerebral palsy, and makes dynamic individualized rehabilitation plans for different groups of people and gives rehabilitation guidance. The three major nursing systems provide different degrees of help. Thus, children's self-care ability is significantly improved, and self-care is realized to a great extent, which lays a good foundation for children's family training and long-term persistence, and achieves the purpose of reducing the disability rate and reducing the burden on families and society.
2.4Orem self-care theory in the field of psychiatric nursing application
Helping patients to establish self-care mode is one of the important basic nursing contents of mental illness. Zhao Gendi applied Orem's self-care theory to 95 patients with schizophrenia, providing full compensation, partial compensation and supporting education and nursing to meet their self-care needs. The results show that 88.4% patients can keep themselves clean, 93.7% patients can keep their clothes clean, 57.9% patients can make their own beds, 78.9% patients take medicine actively, and 76.8% patients actively participate in recreational activities, which meets the self-care needs of patients. Li Xiujuan applied Orem's self-care theory to 28 patients with mental disorder caused by epilepsy, and adopted different nursing systems for personalized health education. The results showed that the qualified rate of basic nursing reached 65438 0.00%, the nursing complications and accidents were significantly lower than those of the control group, the awareness rate of drug knowledge and medication compliance were significantly higher than those of the control group, and the satisfaction rate of nursing effect reached 99.0%. Orem self-care theory can reduce the recurrence rate, disability rate and quality of life of patients with mental disorders caused by epilepsy.
2.5 application in the field of PICC technology
Peripherally guided central venous catheterization (PICC) is a kind of deep venous catheterization introduced to China in the late 1990s. Because of its high success rate, simple operation, long indwelling time and few complications, PICC has become the best intravenous medication for cancer chemotherapy patients. Because chemotherapy is carried out in multiple cycles, a considerable number of patients need to go home to rest after completing 1 cycle chemotherapy, but catheter maintenance such as catheter opening and dressing change has become a problem that they can't solve when they take the catheter home. If the tube is extubated after discharge, the success rate of intubation will gradually decrease with the increase of intubation times, which will inevitably affect patients' choice of PICC and eventually hinder the development of PICC technology. The oncology department of our hospital used the auxiliary education system in Orem's self-care theory to give practical guidance to 8 1 PICC discharged patients. The results showed that the incidence of common complications of PICC, such as catheter blockage and prolapse, local infection and related blood flow infection, was not statistically significant compared with the control group, the maintenance cost was significantly lower than that of the control group, and the nursing satisfaction was higher than that of the control group. It is considered that it is feasible to use Orem's self-care theory to guide patients and their families to self-maintain PICC, which not only solves the inconvenience caused by their return to hospital for maintenance.
3 outlook
To sum up, Orem's self-care theory plays an extremely important role in improving patients' self-care ability, reducing complications, improving quality of life, shortening hospitalization time, reducing medical expenses, reducing family burden, strengthening nurse-patient relationship, and promoting the development of holistic nursing and quality nursing services. With the rapid development of computer network technology, it will become a reality to guide patients to meet their self-care needs through online video "remote control". Orem's self-care theory provides scientific theoretical basis for nurses to solve nursing problems. More and more patients will enjoy medical services in hospitals without leaving home. WHO pointed out that in this century, individuals, families and society are playing an important role in meeting health needs, and self-care will become the development trend.
[Editor: Xiang Qiu]