CHAPTER I

INTRODUCTION

A. Background

Nursing is a professional discipline that applies many forms knowledge

and critical thinking skills in each situation the client through the use of a nursing
model in the nursing process. We believe that nurses must practice critical
thinking skills and apply the nursing model on each - each component of nursing.
Models that present varying levels of specification. Even so, each - each model
can be used in nursing practice. And each model also gives a different perspective.

Along with the experience of the nurse that they integrate and processing
increase their experience with the use of nursing models, the model became the
basic framework and internalized practice. Therefore the expert nurse who has
developed his skills are no longer thinking about each model and concept in
nursing, but intuitively apply the model and the concept against their actions a day
- a day in the practice of nursing (the nursing process: application of conceptual
models, ed4 paula j.christensen , RN, Phd & Jeanet K.Weaney, RN, PhD in 1195,
by Mosby-year bookinc). One model that applied the nurse in the hospital in a day
of action - the one of which was developed by Dorothea E. Orem. The
introduction of the theory is the theory of self-care deficit which consists of self-
care theory and the theory of nusingsystem.Model concept introduced by the
Orem stressed that every individual has the ability to care for himself and his
family members.

View of the theory of Orem in the order of nursing services addressed to

the needs of individuals in nursing action independent and set in their needs.

B. Aims Of Paper

1. To give the basic concepts self care theory and its application in order
nursing care in health care (hospital).
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2. Improving knowledge and understanding of the concept of the theory of
Orem nurse.

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 CHAPTER II
THEORITICAL STUDY

A. Theory of Dorothea Orem (Theory of Self Care)

Nursing self (selfcare )according to Orem's is an implementation of the activities

initiated and carried out by individuals themselves to meet the need to sustain life,
health and well-being according to circumstances, whether healthy or sick"
(Orem's 1980). Basically, it is believed that all human beings have needs self care
and they have the right to get the needs of it self, unless incapacitated.

Model Orem's, said there are several requirements of self care or are
mentioned as the purpose of self care (sefl care requisite), namely:

1. Universal (Universal self-care requisites)

Needs were generally required by humans during its life cycle such as the
physiological and psychosocial include:

a. Balance air intake; maintenance in the air making

income balance water; maintenance water uptake
b. Equilibrium food intake; maintenance of the food consumed
c. Spending through the process of elimination; maintenance elimination
process needs
d. Maintenance a balance between activity and rest;
e. Maintenance of balance between leisure time and social interaction;
f. Prevention of the risk of life, human functioning and well-being.
g. Improved functioning and development during the life of the social groups
in accordance with the potentials, limitations, interests and norms.

It is needed in humans for growth and development, adaptation to the

environment, and other useful for survival.

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 2. Development of self care requisites

Needs related to human growth and development processes, conditions,

events that occurred during the variation stages in the life cycle (eg, a premature
baby and pregnancy), and events that may adversely affect the development. It is
useful to enhance the development process throughout the life cycle.

3. Health deviation self-care requisites

Needs associated with genetic or hereditary, damage to human structures,

damage or deviation way, the structure of the norm, the deviation of the function
or role with influence, medical diagnostics and management of scalable along
with impact, and integrity that can disrupt a person's ability to perform self-care

4. Conditioning Factor
a. Age ( age) can be divided into infant / child - children, youth (young
adults) and old.
b. Gender (Sex) is divided into male - male and female

c. Socio-Cultural; Keeping the therapeutic relationship in psychosocial

functioning are related to health and disease; providing humanitarian
assistance tailored to human needs, abilities and limitations action;
maintaining personal relations between intrapersonal and intergroup
relations.
d. Environment; component - environmental components, including the
conditions and factors - factors related to the environment.
e. Health Status; in performing nursing care we must pay attention to the
relationship physiological mechanisms, psychological and material
structure in relation to other human interaction.
f. Lifestyle

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B. Theory of Self Care Deficit
People can take advantage of treatment because they are subject to
restrictions on health or derivative relationship health that makes them unable
to make continuous self-care or dependent care or make the result of
ineffective or treatment not complete.

Methods help undertaken in the implementation of nursing care nurse

in service Hospital.

The nurse helps clients to use the system and through the five-aid method that
includes:

a. Acting or do something for a client

provides direct services in the form of nursing actions
b. Teach clients
Teaching clients about procedures and other aspects of the actions that
clients can perform maintenance themselves independently
c. Directing clients
Provide direction and facilitate the ability of clients to meet their needs
independently
d. Supports client
gives a boost physically and psychologically so that clients can develop
their potential so that clients can perform self-care.
e. provide an environment for clients to grow and develop.

C. Theory of nursing systems

System-nursing system was formed when the nurses use their ability to write,
designing, and providing care for the patient (as an individual or a group) to
undertake special efforts in deploying the system and the system. These efforts
or system which regulates the ability of individuals to practice with relation to
care independently and meets the requirements of self-care for the individual
teraupetik. Basic system according to Orem self-care deficit are:

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1. Compensatory Wholly

1. Conduct self-care to patients as a therapeutic.

2. Actions carried out as compensation nurse in the patient's inability

to care for themselves.

3. Support and protect patients.

4. Overall aid, needed for clients who are not able to control and
monitor the environment and does not respond to stimuli.

2. Partially Compensatory

Help majority, needed for clients who have limited mobility due to
illness or accident.

a. Nurses take several steps care patient (partial support).

b. Nurses compensate for limitations of patient care (nurses perform

actions that can not be done the patient).

c. Nurse Helps correct the patient's needs - absolutely necessary.

d. The nurse and the client set the necessary self-care (self-agency).

e. Patients do some self-care measures that can be done.

f. Patients receiving care and support from nurses.

3. Supportive Education

Educational support required by clients that need to be learned, to be able to

perform self-care.
a. Patients perform self-care
b. patients and caregivers to cooperate in the implementation of self-care

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 conditioning Self
factors -
car
R R
e

R
Self- Self-
care care
agenc demam
y
ds <
deficit
conditioning
factors R R

Nursin
g
agenc
y

Gambar.2.1. Kerangka kerja konseptual untuk keperawatan. R = Relatioship ;

< = deficit relationship,

CHAPTER current
III or projectted

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 CHAPTER III
STUDY CASE

A. CASE

Ny. X Age 32 years, widow status, ethnic Javanese, Muslim, housewives, high
school education history, the husband had five years ago died, Ny. X lived
with his brother who works as a civil servant. Patients already have a son - 7-
year-old boy. Currently Ny. A space X treated at Hospital X, already 1 day
post op ec tubal ligation of the left ovarian cyst. Current conditions studied
compos mentis awareness, blood pressure 130/90 mm Hg, pulse 88 beats /
min, 20 breaths / min, at 370 C, TB: BB 156 cm and 45 kg, the client
complains of pain in the surgical wound, the pain feels hot such as a knife
slashed exhausted, the client looks grimacing, sweating, pain scale client 8.
catheterized urine, oral medication njeksi cepotaxim 1 g / 8 hours, injection
ulkumet 1 amp / 8 hours, injection catarolak 1 amp / 8 hours, gentamicin
injection of 1 amp / 12 hours, injection transamin 1 amp / 8 hours, tramadol
injection of 1 amp / 8 hours, inserted infusion RL 20 drops / minute, clients
are encouraged mobilization in bed, at that time there was one patient in room
A. The conditions at the time the client has shown a lot changes such as
reduced pain, at this time Ny. X is recommended for a mild activity slant right
weight right or tilted left, to meet the daily needs such as bathing, defecating
be assisted by a nurse while eating or drinking clients assisted families.

B. Application concept in the case of Mrs. X

If the implementing care nursing theory of self care Orem on Mrs. X using the
nursing process approach that includes assessment, nursing diagnosis,
planning, implementation and evaluation.

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1. assessment
When referring to the theory of self-care, then the things that need to be
examined are personal factors, universal self care, development self care,
health deviation, medical problems and plan and self-care deficit, and data
can be collected from the cases of Mrs. X, are as follows:

personal factors: age 32 years, parts of Java, an Indonesian citizen, Islam,

widows, work-home mom ladder, height 156 cm and weight 45 kg.

Universal self care: the client complains of pain in the surgical wound,
the pain felt hot as if it had slashed knife, the client looks grimacing,
sweating, pain scale 8, bathe and defecate in aid by nurses and family.

Development of self care: Ny. X lived with his brother who works as a
civil servant, limitation of activity due to pain in the surgical wound, the
pain felt hot like it had slashed the knife, need help fully / total, it takes
practice doing light activity.

Health Deviation: Actual disruptions comfortable feeling of pain and can

not perform the activity.

Medical problems and plan: medical diagnosis is Post Op ec Tubektomi

the left ovarian cyst.

Planning: break, monitor vital signs (blood pressure, pulse, respiration

and temperature), teach the client in relaxation techniques (deep
breathing), assist the patient in meeting the needs of ADL (activities tilt
left / right-tilted, assist clients in meeting the needs of personal hygiene),
teach patients and families gradual about Mrs. X treatments, relaxation to
take a deep breath when the pain appears.

Self Care Deficit: the dependence of patients with families and carers for
the disease condition that the patient is able to meet self-care and other
activities especially strenuous activity.

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 2. Nursing Diagnosis
Based on the results of the assessment and analysis of data some nursing
diagnoses that can be enforced in Ny. X is:

1. Pain
2. activity intolerance
3. Self care deficit
3. Planning
Develop goals, interventions and rationalization in accordance with the
nursing diagnoses that appeared

diagnostics Nursing: Pain

Objective: Having done nursing action for 3 x 24 hours, the client can
adapt to pain, with criteria:

a. pain scale mild (1-3)

b. face relaxed clients
c. clients do not moan / cry
INTERVENTION

a. approach to clients and families

b. Assess the level of pain intensity and frequency of

c. observation of vital signs

d. Doing collaboration with the medical team in analgesic

RATIONAL

Administration a good relationship makes the client and family cooperative

b. the level of pain intensity and frequency indicate pain scale
c. provide an explanation will increase the client's knowledge about pain.
d. to know the development of clients.
e. a nurse dependent action, which serves to block stimulation analgesic pain.

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 4. implementation of
In accordance with the interventions that have been prepared on a plan based
on six areas proposed by Orem
5. Evaluation
1.Painlost / reduced
DEFICIENCY AND EXCESSOREM

EXCESSTHEORY:

1. Theory Orem already Operational and is used in research, practice and

administration.
2. Orem theory more widely used role in terms of overcoming the problem
acute and chronic pain patients
3. used as guidelines for the manufacture of the educational curriculum and
diploma nursing graduates
4. Although the environment is limited in research, education and
administration but have the fairly comprehensive coverage of all the theory
into practice.
FLAWS:

1. Theories and models of nursing more inclined to matters related dengan

kriteria treatment. Thus, more widely used as a guide to practice rather than
research. It's about practice and to practice.
2. Theories and models oriented pain conditions (illness-oriented as in acute
conditions and chronic, where there is no indication of the use of the theory
on the client dengan kondisi healthy. Coleman, 1980, stated that the theory
of Orem as a theoretical yang genkan for the activities of nursing in
providing services in the hospital.
3. Theory and models of Orem more inclined to care for adults than in the
other group.
4. theories and models of Orem only emphasizes the individual, but not to the
family, and the community.

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5. in theory and models of Orem, relations emphasis was on relations between
the nurse and the sick (patients ) rather than on the relationship between the
nurses, it can be seen from the statement Orem that nurse effect is restore /
help patients / individuals decreased independence to meet the care needs
him.
6. Use of theories and models of Orem in the administration did not provide
guidance much as proposed by Miller, 1980 that there are many theories can
use the administration but does not provide much guidance and examples
for implementation on a large scale in the field of
7. Less discuss how to foster self care self coaching patient through by nurses
and effective communication. In addition to cultural factors often hamper
the application of this theory of self care and less investigated the activity is
not give associated with its implementation such as procurement of
equipment in process implementation, making contracts with patients,
documentation, coordination whit group other things, the provision of
modules and order stock medical

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 CHAPTER IV
CONCLUSION

Of exposure in previous chapters, the authors conclude that:

1. Nursing concepts and models developed by Orem more emphasis on

ability of individuals to meet his care needs without any dependence with
others (independent)
2. Nursing concepts and models developed by Orem more emphasis on the
ability of individuals to meet his care needs without There is a dependency
with others (independent).

3. The conceptual model developed by Orem consists of three is theory

deficit self-care, self-care and nursing theory system.

4. There are three levels of an individual's ability to comply her self-care

needs are wholly compensatory nursing system, Partly comensatory
nursing system, Supportive educative nursing system.

5. The nursing process according to Orem namely through three (3) steps are
implementation of management cases through data analysis, system design
determine the level of nursing dependency and establish nursing
diagnoses; Planning for care provision and evaluation of treatment for
control.

6. Model theory and concepts put forward by and lack Orem has several
advantages that could be considered for the development of the theory for
the better and can be widely applied in various areas of nursing.

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Alligood-Tomey, A.(2006).Nursing theorists and their work. Sixth edition.

Toronto: Mosby

George, JB (1995). Nursing theories: The base for professional nursing practice.
Fourth edition. Connecticut: Appleton &Lange.

Marriner, A. (2004). Nursing Theorists and Their Work.(Ismail Ekawijaya,

translators). Toronto: The Cosmoby (First Book Published in 1986).

Paula j.christensen & Jeanet K.Weaney, Nursing Process: A Conceptual Model

Application, ed4 1195, by Mosby-year bookinc

rangkang "Sheikh (2008), the concept model of" self-care theory ", accessed on

30 March 2018 through http: / /syehaceh.wordpress.com/2011/11/04/konsep-

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