Orem自理理论selfcaretheory

Orem 自理理论（ theory of self care ）,教学内容,一、Orem简介二、Orem自理模式的主要概念三、Orem 的三种护理系统四、Orem理论的护理程序五、Orem理论中四个基本概念,Dorothea E. Orem 简介,1914年出生教育背景 1930年毕业于护校获护理大专 1939年获护理学学士学位 1945年获护理教育硕士学位 1976年获Georgetown等大学荣誉博士学位工作经历临床护士、护士长、实习带教老师、护理部主任、护理教育咨询专家、护理研究者,理论发展的动力,Orem是在50年代开始发展自我照顾理论框架的。那时正是护理教育比其他专业如医学、心理学和社会学更注重概念模式的时期，因此，Orem被称为发展独特的护理知识体系的先锋。发展的原动力是为实践性的护理教育项目发展课程。自我照顾理论框架的进一步发展源于“护理知识体系缺乏有组织的框架及相信护理概念对形成这种框架会有帮助”。,If you give a man a fish he will have a single meal； If you teach him how to fish he will eat all his life,Orem自护模式的产生发展,自护模式的雏形：“护理是为人提供自我照顾帮助的职业” 职业护理教育课程设置指南，1959年自护概念的阐明： 护理的希望，1962年个体的自护、自护需要与自护能力的阐明 Nursing: concepts of practice ，1971年,Orem自护模式的产生发展,家庭、社区和群体的自护、自护需要与自护能力 护理：实践的概念第二版，1980年自护理论、自护不足理论和护理系统理论 护理：实践的概念第三版，1985年自护不足理论的应用 护理：实践的概念第四版，1991年自护模式在多领域应用的综合阐明 护理：实践的概念第五版，1995年,Orem自理模式的主要概念,自理理论（the theory of self-care)自理缺陷理论(the theory of self-care deficit)护理系统理论(the theory of nursing system),一.自理理论(the theory of self-care),包括：自理（self-care)自理能力 (self-care agency)自理体 (self-care agent)治疗性自理需要 (therapeutic self-care demand)自理需要 (self-care requisites),自理（self-care),个体为维持自身的结构完整和功能正常，维持正常的生长发育过程，所采取的一系列自发的调节行为。practice of activities that individual initiates and perform on their own behalf in maintaining life ,health and well being 有效的自理活动能对人的结构整体性及其功能和发展作出贡献,Self-care Definition,Self-care comprises those activities performed independently by an individual to promote and maintain personal well-being throughout life.,自理能力 (self-care agency),是人所具有的从事自我照顾的能力 the individuals ability to perform self-care activities与年龄、发展情况、生活经历、社会文化、健康状况以及可得到的条件相关正常情况下，成人能主动照顾自己；婴儿、儿童、老年人、病人、残疾人的自理需要要通过部分或全部的帮助才能满足,自理能力 (self-care agency),包括10方面的内容重视和警惕危害因素控制和利用机体控制体位认识疾病和预防复发对疾病的态度对健康问题的判断学习和运用与疾病治疗和康复相关的知识和技能与医务人员的有效沟通和配合安排自我照顾行为寻求支持和帮助,自理体 (self-care agent),指能完成自理活动的人Self-care Agent - person who provides the self-careDependent Care Agent - person other than the individual who provides the care (such as a parent)正常情况下，成人的自理体是其本身儿童、病人或残疾人等的自理体部分是自己、部分为健康服务者或照顾者,治疗性自理需要 (therapeutic self-care demand),在特定时期内，自我照顾的需要是人处在他们自身的情况或情景中所执行的自我照顾活动totality of self care actions to be performed for some duration in order to meet self care requisites by using valid methods and related sets of operations and actions每个人都是需要的人与人之间是不一样的一个人处在不同的时间、地点是不一样的有内在因素和外在因素的影响,自理需要 (self-care requisites),为满足自护需要而采取的所有活动 action directed towards provision of self care.包括：一般的自理需要(universal self-care requisites)成长发展的自理需要(development self-care requisites)健康不佳时的自理需要(health deviation self-care requisites),Orems Self-care Requisites (also called Self-care Needs),Definition: the actions or measures used to provide self-careConsists of THREE categories:Universal - requisites/needs that are common to all individualsDevelopmental - needs resulting from maturation or develop due to a condition or eventHealth Deviation - needs resulting from illness, injury & disease or its treatment,一般的自理需要(universal self-care requisites),是与生命过程和维持人的结构和功能的整体性有联系的，对所有人在生命周期的各发展阶段都是需要的一些直接提供自我照顾的活动。包括：摄取足够的空气、水和食物与排泄有关的调节和控制维持活动和休息的平衡满足社会交往的需要，即独处和与人共处的平衡防止发生危险和避免对生命、健康和幸福有害的因素促进自我发展的需要：在社会群体中发挥个人潜能，短处被理解以及满足正常的个人欲望等,成长发展的自理需要(development self-care requisites),是指在一般发展过程中的特殊需要，包括：与发展过程中某一阶段有关的自理需要婴幼儿期的牙齿护理及预防接种，良好饮食和排泄习惯老年人要避免过硬食物等与发展过程中可能会发生的生活事件有关的调节需要失学、失业、失去亲人、接受新工作等,健康不佳时的自理需要(health deviation self-care requisites),是指在疾病、损伤、和特殊病理变化等情况下或在诊疗过程中产生的自理需要。Required in conditions of illness, injury, or disease与疾病或损伤有关与目前治疗有关,Seeking and securing appropriate medical assistance 寻求适当的医疗性帮助的需要Being aware of and attending to the effects and results of pathologic conditions 认识疾病的病理条件和状况的需要Effectively carrying out medically prescribed measures 有效执行医嘱Modifying self concepts in accepting oneself as being in a particular state of health and in specific forms of health care 调整自我概念，接受健康上的特殊改变和适应病人角色Learning to live with effects of pathologic conditions 学习带病生存，改变生活方式,基本条件因素,自理需要和自理能力的影响因素年龄性别生长发展阶段健康状况社会文化背景健康服务过程家庭系统生活方式或行为习惯环境因素资源及利用,二.自理缺陷理论(the theory of self-care deficit),是整个理论的核心是自理能力低于自理需要，有三种情况:自理能力有缺陷时或受限时个体的自理能力低于自理需要个人的自理能力不变，但自理的需要增加是需要护理之时，是护理的工作重心可以是现存的，也可以是潜在的,Orems Self-care Deficit Theory,Is the central focus of Orems Grand Theory of NursingSpecifies when nursing is needed.Nursing is required when an adult (or in the case of a dependent, the parent) is incapable or limited in the provision of continuous effective self care. Results when the Self-care Agency (patient) cant meet her/his self-care needs or administer self-careNursing meets these self-care needs through five methods of help,Five Methods of Nursing Help,Acting or doing for othersGuiding othersTeaching anotherSupporting anotherProviding an environment to promote the patients ability to meet current or future demands,三.护理系统理论(the theory of nursing systems),是人出现自护不足时护理活动的体现有三个分系统完全补偿系统（wholly compensatory nursing system)部分补偿系统 (partly compensatory nursing system)支持-教育系统 (supportive-educative system),Orems Nursing Systems Theory Describes.,Nursing responsibilities Roles of the nurse and patientRationales for the nurse-patient relationshipTypes of actions needed to meet the patients demands,Orems Nursing Systems Theory,Refers to a series of actions a nurse takes to meet a patients self-care needsIs determined by the patients self-care needsIs composed of THREE systems:Wholly compensatoryPartly compensatorySupportive-educative,Three Nursing Systems,Wholly Compensatory: a patients self-care agency is so limited that s/he depends on others for well-being Partly Compensatory: a pt can meet some self-care requisites but needs a nurse to help meet othersSupportive-educative: a pt can meet self-care requisites but needs help in decision-making, behavior control, or knowledge acquisition,完全补偿系统（wholly compensatory nursing system),是指病人处于不能参与需要自理的活动，需要护士提供全面的护理病人在精神上和体力上完全没有能力参与自理活动，如昏迷病人病人是清醒的，能观察、判断和作决定，但不能移动或操作如高位截瘫患者能进行身体活动，但不能做出合理的判断与决定如精神病人、老年痴呆者和智力障碍者,部分补偿系统 (partly compensatory nursing system),病人有能力满足一部分自理需要，需要护士的参与为别人做指导别人做支持别人做（心理上、身体上）提供一个环境教别人做,支持-教育系统 (supportive-educative system),病人能自己满足自理需要，但必须在护士的帮助下决策行为控制知识技能,三种护理系统示意图,完成病人的部分自理内容补偿病人自理的局限性必要时帮助病人,完成部分自理内容调整病人自理能力接受护士的照顾和协助,完成病人的治疗性自理补偿病人所不能进行的自理帮助和保护病人,完成自理内容调整病人锻炼和发展自理的能力,完全补偿系统,部分补偿系统,辅助-教育系统,护士的行为,护士的行为,护士的行为,病人的行为,病人的行为,举例,一个妇女从怀孕到分娩可能会处在不同的护理系统中早期辅助教育系统晚期部分补偿系统剖宫产全补偿恢复期部分补偿出院时辅助教育系统,Theory,Selfcare,Self Care deficit,Nursing system,Self care agency,Ten abilities,Self care requisites,UniversalDevelopmentHealth deviation,Wholly compensatoryPartly compensatorySupportive-educative system,理论假设,人都具有不断得到他人照顾和照顾他人的需要，以维持人的生存和社会人际交往，保持人与环境的互动平衡和整体功能人的行为能力在自我照顾、照顾他人和满足需要中得到锻炼和提高人都会经历自理活动受限或生活承受力和功能调节力的缺乏，当人的自我照顾能力不能满足自理需要时产生自理不足并需要帮助人可以发现、发展和传递满足不同需要的途径，在为自己寻求照顾的同时也照顾他人，挖掘和发展自理能力社会团体有义务和责任为自理不足的人提供照顾,四、Orem理论的护理程序Orem对护理程序的定义 决定人为什么需要护理 规范一个护理系统 为提供特殊护理而制定护理计划 执行护理措施并对其结果进行评价,Orem将护理程序分为三个步骤 诊断与治疗 计划 执行和评价,Orems Nursing Process,Consists of 3 steps:Step 1: determine why a patient needs careStep 2: design a nursing system & plan the delivery of careStep 3: management of nursing systems - planning, initiating, & controlling nursing actions,（一）诊断与处治 收集资料 确定 患者为何需要护理 需要何种护理,对以下五个问题作出回答,患者现在的治疗性自护需要是什么？ 以后又是什么？2. 为满足治疗性自护需要， 患者是否存在自护缺陷？3. 自护缺陷是什么性质？ 原因是什么？,4. 为了达到治疗目的，是完全提供帮助而不让患者自护，还是让其自护？5. 患者的自护力量有哪些潜力？如何将自护知识、技能、愿望纳入自护计划中？,（二）计划 规划一个护理系统， 达到使患者恢复健康的目的 按三个系统进行构思 把治疗性自护需要的内容加以组织 选择有效补偿自护和克服自护缺陷的方法,Orem 认为可用下列五种方法帮助或协助病人替病人做指导病人如何做为病人提供身心支持提供促进发展的环境教育病人（知识和技能）,（三）执行和评价,Orem 理论对四个概念的陈述,人人有反映自己及其环境的能力人能总结并解释经验在思考、交往和工作时能使用象征性的语言和文学，能创造性地为自己及他人某幸福人是整体的人，包括生理的、心理的、人际间的和社会的等方面人不是通过本能，而是通过学习获得学习和发展的能力如不会学习就需要帮助,Orems Theory & Nursings Metaparadigm - PERSON,The recipient（接受者） of nursing careA being who functions biologically, symbolically（象征性地）, and socially Has the potential for learning & developmentIs subject to the forces of natureHas a capacity for self-knowledge Can engage in deliberate actions, interpret experiences, and perform beneficial actionsCan learn to meet self-care needs (requisites),Orems Theory & Nursings Metaparadigm - PERSON,Human beings are distinguished from other living beings by their capacity to:Reflect upon themselves and their environmentSymbolize what they experienceUse symbolic creations (ideas, words) in thinking, communicating, and guiding efforts to make things that are beneficial for themselves and/or for others,五.Orem 四个概念的陈述,健康同意WHO的健康定义：健康不只是没有疾病和衰弱，而是身体、精神和社会方面的完好状态各个方面是有联系的维持健康要以预防保健为主（一级预防），并辅以治疗疾病为目的的二级预防和以预防并发症为主要目的的三级预防,Orems Theory & Nursings Metaparadigm - HEALTH,Supports health promotion and health maintenanceSupports the premises of holistic health in that both RN and patient promote the individuals responsibility for self care,Orem 四个概念的陈述,环境是人以外的所有因素，包括物理的、心理的和社会的等方面与人组成统一整体人利用各种技能去控制环境或改变环境，以满足自理需要不能满足自理需要的人会从别人处得到帮助自我帮助和帮助他人都是对社会有价值的活动,Orems Theory & Nursings Metaparadigm - ENVIRONMENT,Environmental Conditions - external physical & psychosocial surroundingsDevelopmental Environment - promotion of personal development through motivation to establish appropriate goals & to adjust behavior to meet those goals Can positively or negatively impact a persons ability to provide self-care,Orem 四个概念的陈述,护理为了保持生命和健康，从疾病和损伤中得到恢复，以及对付所造成的影响而持续提供和安排的自我护理活动，这些自理活动是每个人所特殊需要的是艺术 是一种服务 是一种助人的方式而不是有形的商品。护理力量（对个人或集体提供护理的特殊能力）是为他人的利益和幸福的，而自理力量是为自己的利益和幸福而运用及发展的护理工作包括社会方面（角色）、人际关系（护患）及特殊的技能（行为）,Orems Theory & Nursings Metaparadigm - NURSING,A service geared towards helping the self and othersIs required when self-care demands exceed a patients self-care ability (agency)Promotes the patient as a self-care agentHas several components,Components of NURSING,NURSING ART: the theoretical base of nursing and other disciplines such as sciences, art, humanitiesNURSING PRUDENCE: the quality that enables the nurse to seek advice in new or difficult situations, to make corr