How do you define self-care

Dorothea E. Orem: The model of self-care

In the next few months we will publish the e-book “Self-Management in Nursing”. As a foretaste, we are publishing some updated articles in advance from the series of the same name. Today we dedicate ourselves to the model of self-care according to Dorothea E. Orem: a modern classic from the care theory. What is this model currently telling us? Why is self care so important?

Prevention, i.e. prevention in the health sector, is currently on everyone's lips. Hardly a day goes by without reading things like “Eat a healthy diet and get enough exercise” or “Exercise your gray cells” in the media. Behind this is a larger social program: As our society is getting older and older, personal responsibility for a healthy and balanced lifestyle is more important than ever. Dorothea E. Orem's model of self-care provides some very remarkable clues and insights that are still of lasting importance today. Orem's model first became better known to the public with the publication of the book “nursing concepts of practice” in 1971.

The social value of prevention

Think of our society as a larger system made up of smaller systems. The smaller systems include the economy, politics, but also health care, nursing and medicine. And all of these systems mutually influence each other. Now imagine the whole thing as a city, let's say in the year 2030. Only elderly people live in this city. There are virtually no younger family members or professional caregivers left to support these elderly people with care. In addition, most of the households of these very old city dwellers are single households. Because the relationship between the generations had fundamentally changed up to this point.

The majority of households are single-person households, while three-generation households or similar constellations are increasingly becoming the exception. Already today 23 million people in Germany live with us alone. And every third person over 65 already lives in a one-person household. The future scenario outlined here is therefore not that far-fetched.

What do you think the costs will be incurred if we do not gradually start to attach more importance to prevention? I am not only talking about costs from a financial point of view, but also about costs that we have to bear in the social sense if we do not give sufficient thought to the supply structure of the future at an early stage - especially against the background of demographic change.

We know from the professional care sector, for example, that the number of mental illnesses in Germany has currently risen disproportionately. For example, in a large-scale empirical study from 2011 in which researchers evaluated over 1,500 questionnaires, the reasons for being “burned out” in the care industry in Germany among professional care workers were examined in more detail. In addition to a poor working atmosphere between doctors and nurses and a lack of recognition, 93 percent of the nursing staff at high risk of burnout perceive the staffing level as too thin in this study. The same study also mentions the average absenteeism of carers at work, with comparatively very high absenteeism: Professional caregivers have 24.9 days per year - alongside street cleaners (28.8 days per year) and forest workers (25.1 days per year) Year) - the highest absenteeism in work. Here is a link to the results of the study: Pflegezeitschrift_Burnout.pdf.

These developments appear to include from a social point of view to be an indicator that the great importance of prevention and the need for self-care have not really been properly internalized in practice. In this context, self-care does not only mean taking the responsibility for caring for elderly people in need seriously and encouraging their own self-care, but also providing adequate care for one's own care: for example, sufficient mental and physical balance. Because we are currently living in a century in which chronic diseases such as Alzheimer's and mental illnesses such as depression are on the rise.

The French sociologist Alain Ehrenberg traced this development extremely precisely and illuminatingly in his seminal book “The Exhausted Self: Depression and Society in the Present”. It is, inter alia, It is remarkable that mental illnesses such as depression can be found mainly in western cultures or in cultures that adapt our performance scheme with its sometimes fatal consequences for people and the environment.

The model of self-care according to Dorothea E. Orem

What does self care mean? What does Dorothea E. Orem understand by the model of self-care? The term self-care is understood to mean actions that are directed towards the self or the environment - with the aim of maintaining the state of health for as long as possible. Strictly speaking, our organism is anything but healthy, because our nature is not programmed for eternal life, but it cannot be denied that the quality of life can be increased through self-care.

The Orem care model is a model in which the independence of care is encouraged. The central idea of ​​Orem is that people can improve their health and well-being by taking care of themselves, namely “taking care of themselves”. But how does it work? And what happens when this is only possible to a very limited extent - for example in the case of dementia?

Orem has gained a lot of experience in practical questions of care and supply. This is mainly due to the fact that she initially worked in this field for many years after completing her training as a nurse at a nursing school in Washington, D. C., in the early 1930s. But not only that: In 1939 and 1945 she also acquired the first and second academic degrees in nursing education, eventually held several influential offices and positions, wrote various writings and books on nursing-related issues, received several honorary doctorates and founded her own in 1980 Nursing and Nursing Education Consultancy - "Orem & Shields, Inc." in Maryland in the USA.

It is thanks to Orem that issues of health responsibility and prevention under the heading of “self-care” - applied from medicine to care and made accessible to a wider public. The question of how you can take care of yourself - in a health sense - is first and foremost a medical issue. If, for example, you go to an appointment with your family doctor again, the question is mostly about the state of your health or what measures should be taken and what medication should be prescribed to improve your condition.

The doctor's view of the state of your health can partly also be related to self-care: How do you personally ensure the balance between body and mind? What strategies do you use in everyday life when you get into a major stressful situation again? Such questions are geared towards medical issues. Accordingly, the key terms that Orem uses have strong medical references, such as terms like “diagnosis”. The Orem model is based on a total of three theoretical parts.

This includes the following theoretical sub-elements:

  • the theory about self-care
  • the self-care deficit theory
  • the theory about the care system

Self-care theory is purposeful and deals with issues related to human development and health. At Orem, the focus is on one's own ability to act: Is a person capable of providing for their own care or not? A person who has dementia, for example, is only able to do this to a very limited extent. However, in this case, too, it is not a question of increasing the dependency between the carer and the person in need - on the contrary, the person in need of help, even with dementia, is at least to a certain extent to be seen as an active person.

A good example of this is a caregiver who does not give too much thought to the forgetfulness of a person with dementia, but asks in which areas this person is still able to act and to what extent this ability to act can be maintained. Let us further assume that this person can still make tea, make beds and water flowers on their own. So we strengthen these skills by promoting them in a supportive way. And this is precisely why self-care is improved: Because the person with dementia will certainly have a much better feeling - especially if independence has always played a major role in their life up to now - if they can at least perceive themselves as an independently acting person.

The self-care deficit theory states that we are dealing with people who are no longer able to care for themselves due to health restrictions. This is clearly the case with people with dementia. If it is no longer guaranteed to maintain self-care, at least in some areas, on the other hand the relationship of dependency between the person caring for and the person being cared for also increases.

With this in mind, Orem uses the term “dependency care deficit”. This means that the need for caring attention is much greater than the current level of self-care skills. It should also be emphasized that Orem's focus in this dependency relationship during her lifetime (she lived until 2007) only focused very little on chronic illnesses - let alone dementia separately. The aim here is to expand their self-care concept to include chronic cases and therefore also to include dementia.

Conclusion: what does the self-care model tell us today?

The theory of the nursing system is that nursing without interaction, without human relationships and things like that is unthinkable. This objection is particularly evident in the relationship between caregivers and elderly people in need of help, but also in connection with social responsibility when it comes to questions of future care. At this interface, too, it makes sense to think further about the Orem model, to question it and to update it in some areas, because during Orem's lifetime Orem addressed the question of the environment, but never really explored it satisfactorily.

By “environment” I mean the environment in which we move on a daily basis - be it the organizational environment, for example people who work together with certain people in a certain department of an organization (nurses, doctors, etc.) and the relationships with one another the care of the patient is impaired, or the family environment. You may recall that the focus of this series on “Self-Management in Nursing” is primarily on the relationship aspect. Those who have a good relationship with themselves also have a better relationship with other people whom they cultivate.

This brings us to the end of this article: The question of self-care does not only refer to those people for whom we as professional caregivers care, but also to your own personal self-care. And self-care or self-care is not related to purely physical aspects such as sufficient exercise or the supply of certain medication. We must also not ignore how important mental balance is at the same time. So the question of the extent to which chronic stress is also a headache and how this type of stress can be avoided as early as possible. On the other hand, all of these factors are directly related to the way in which we usually shape our relationships: A good degree of self-care accordingly also contributes to more relaxed and sustainable relationships.

Source of the photos:

Photo: /

Photo: Pauline S. /

Sister KA / PflegeWiki

Marcus Klug currently works as a communication scientist and social media manager at the DZD Dialog and Transfer Center, where he oversees the Knowledge Transfer 2.0 project. The project has already been awarded the 2013 Agnes Karll Care Prize. His focus is on knowledge communication in the social web. In addition, since May 2012 he has been the chief editor in charge of, together with Michael Lindner: Platform for change and lifelong learning. Contact: [email protected]


Further reading:

  • Ehrenberg, A. (2004): The Exhausted Self. Depression and Society in the Present. Frankfurt: Campus Verlag.
  • Orem, D. E .; Hartweg, D. L. (1991): Self-Care Deficit Theory. London: Sage Publications.
  • Orem, D. E. (1985): Nursing: Concepts of Practice. New York: McGraw-Hill.