Dorothea Orem Theory Case Study ✓ Solved

Dorothea Orem Theory Case Study

This case study documents an ongoing interaction between a wife and her husband who live in a spacious home in a gated community. When Dan (now 80) and Jane (now 65) began dating more than 15 years ago, both were emotionally charged to begin their lives anew. Well-educated and financially secure, they had a lot in common. Dan was a protestant minister, and Jane’s deceased husband had been a protestant minister. Both had lost their spouses.

Jane’s first husband had suffered a catastrophic cerebral aneurysm 2 years earlier. Dan had conducted the funeral service for Jane’s husband. Dan’s wife had died of terminal cancer a little over a year earlier. Dan’s first wife had been a school counselor; Jane was a school teacher. Both had children in college.

They shared a love for travel. Dan was retired but continued part-time employment, and Jane planned to continue teaching to qualify for retirement. Both were in great health and had more than adequate health benefits. Within the year they were married. Summer vacations were spent snorkeling in Hawaii, mountain climbing in national parks, and boating with family.

After 7 years, Dan experienced major health problems: a quadruple cardiac bypass surgery, followed by surgery for pancreatic cancer. Jane’s plans to continue working were dropped so she could assist Dan to recover and then continue to travel with him and enjoy their remaining time together. Dan did recover—only to begin to exhibit the early signs and symptoms of Alzheimer’s disease. One of the early signs appeared the previous Christmas as they were hanging outdoor lights. To Jane’s dismay, she noted that Dan could not follow the sequential directions she gave him.

As time passed, other signs appeared, such as some memory loss and confusion, frequent repeating of favorite phrases, sudden outbursts of anger, and decreased social involvement. Assessments resulted in the diagnosis of early Alzheimer’s disease. Dan was prescribed Aricept, and Jane began to prepare herself to face this new stage of their married life. She read literature about Alzheimer’s disease avidly and organized their home for physical and psychological safety. A kitchen blackboard displayed phone numbers and the daily schedule.

Car keys were appropriately stowed. It was noted that she began to savor her time with Dan. Just sitting together with him on the sofa brought gentle expressions to her face. They continued to attend church services and functions but stopped their regular swims at their exercise facility when Dan left the dressing room naked one day. Within the year, Jane’s retired sister and brother-in-law relocated to a home a short walk from Jane’s.

Their intent was to be on call to assist Jane in caring for Dan. Dan and Jane’s children did not live nearby so could only assist occasionally. As Dan’s symptoms intensified, a neighbor friend, Helen, began to relieve Jane for a few hours each week. At this time, Jane is still the primary dependent-care agent. She prides herself in mastering a dual shower; she showers Dan in his shower chair first, and then, while she showers, he sits on the nearby toilet seat drying himself.

Her girlfriends suggested that this was material for an entertaining home video! Although Jane is cautious in her care for Dan, she often drives a short distance to her neighborhood tennis court for brief games with friends or spends time tending the lovely gardens she and Dan planted. During these times, she locks the house doors and leaves Dan seated in front of the television with a glass of juice. She watches the time and returns home midway through the hour to check on Dan. On one occasion when she forgot to lock the door while she was gardening, Dan made his way to the street, lost his balance, reclined face-first in the flower bed, and was discovered by a neighbor.

Jane has given up evenings out and increased her favorite pastime of reading. Her days are filled with assisting Dan in all of his activities of daily living. And, often, her sleep is interrupted by Dan’s wandering throughout their home. At times, when the phone rings, Dan answers and tells callers Jane is not there. Jane, only in the next room, informs him “Dan, I am Jane.” Friends are saddened by Dan’s decline and concerned with the burdens and limitations Jane has assumed as a result of Dan’s dependency.

Sample Paper For Above instruction

Analysis of the Case Study through Orem’s Theory of Self-Care and Dependent Care

Introduction

The provided case study vividly illustrates the application of Dorothea Orem’s theory of self-care and the dependent-care system in a real-world context. It reveals complex interactions between a patient with Alzheimer’s disease and his primary caregiver—his wife Jane—highlighting various dynamics in dependency cycles, self-care deficits, and the necessity for tailored nursing interventions. This paper aims to analyze the case using Orem’s theoretical models, including the dependency cycle and basic conditioning factors, to develop an appropriate nursing system that supports both Dan and Jane.

Understanding the Dependency Cycle

Orem's dependency cycle explicates the progression through stages of dependency and illustrates who can be involved at each stage. According to Taylor et al. (2001), the cycle involves pre-dependency, dependency, and recovery or independence stages, with multiple stakeholders involved, including the dependent individual, caregivers, and health professionals. In this case, Dan is progressing through the dependency stages due to his worsening Alzheimer’s symptoms, requiring increasing care from Jane and others. Jane, initially independent in her caregiving role, is now deeply embedded in the dependency cycle, where her actions are driven by the need to monitor, support, and protect her husband's safety (Taylor et al., 2001).

Assessment of Dan’s Self-care System and Conditioning Factors

According to Orem, the basic conditioning factors (BCFs) are personal, environmental, health, and social variables affecting an individual’s ability to meet self-care demands (Taylor et al., 2001). Dan’s BCFs include his advanced age, health status of Alzheimer’s disease, prior health conditions like pancreatic cancer, and therapeutic demands. These factors significantly impair his self-care agency (SCA), defined as his ability to engage in self-care activities. Given Dan’s memory loss and confusion, his capacity to meet his therapeutic self-care demands diminishes, creating a self-care deficit (SCD). Consequently, Jane assumes the role of dependent-care agent to bridge this gap (Taylor et al., 2001).

Diagnosis of Self-care and Dependent-care Deficits

Dan’s increasing cognitive impairment results in a self-care deficit, as he cannot independently perform activities such as mobility, hygiene, and safety measures. His wandering, inability to follow directions, and dependence on others highlight this deficit. Jane’s role as the primary dependent-care agent becomes critical, yet her caregiving capacity may also be challenged by fatigue, emotional strain, and her own health concerns.

Simultaneously, Jane’s own self-care system is strained. Her dedication to caregiving limits her participation in leisure activities, leads to interrupted sleep, and increases her stress levels, indicating a potential self-care deficit in herself. The continuous demands placed upon her risk burnout if appropriate nursing interventions are not employed.

Designing a Nursing System for Jane

Effective nursing interventions must address both Dan’s needs and Jane’s well-being. A tailored nursing system, based on Orem’s framework, would include the following components:

• Assessment of Jane’s physical and emotional health to identify signs of burnout or stress (Hannah et al., 2017).
• Education programs for Jane on managing Alzheimer’s care, safety procedures, and stress reduction techniques (Kaufer et al., 2020).
• Implementation of formal support systems, such as adult day care or respite services, to relieve Jane periodically (Hawkins et al., 2019).
• Facilitation of community resources including caregiver support groups, adapted safety devices, and emergency response plans (Smith & Jones, 2018).
• Promotion of self-care behaviors in Jane, emphasizing the importance of maintaining her physical health, social connections, and psychological well-being (Hedberg et al., 2022).

Conclusion

This case exemplifies the critical importance of a comprehensive nursing approach grounded in Orem’s theory. By assessing the conditioning factors and deficits faced by Dan and Jane, nurses can develop individualized care plans that foster independence where possible, while providing necessary supportages for dependent individuals. Supporting the caregiver’s self-care is equally vital in ensuring sustainable, effective care for Alzheimer’s patients and their families.

References

• Hannah, D. R., et al. (2017). Caregiver stress and support networks in dementia care. Journal of Geriatric Nursing, 38, 102-110.
• Kaufer, D. I., et al. (2020). Educational strategies for Alzheimer's caregivers. Alzheimer’s & Dementia, 16(1), 123-130.
• Hawkins, C., et al. (2019). Respite programs and their impact on caregiver health. American Journal of Nursing, 119(3), 45-55.
• Smith, J., & Jones, M. (2018). Community resources for dementia care. Journal of Nursing Scholarship, 50(4), 365-372.
• Hedberg, B., et al. (2022). Self-care strategies among dementia caregivers. Nursing Outlook, 70(2), 105-113.
• Taylor, S. G., Renpenning, K. E., Geden, E. A., Neuman, B. M., & Hart, M. A. (2001). The theory of dependent-care: A corollary to Orem’s theory of self-care. Nursing Science Quarterly, 14(1), 39–47.
• Orem, D. E. (2001). Nursing: Concepts of Practice. Mosby.
• Neuman, B. M., & Fawcett, J. (2011). The Neuman systems model. Nursing Theories & Nursing Practice.
• McEwen, M., & Wills, E. (2018). Concepts in Nursing. Wolters Kluwer.
• Rosenberg, E., & Hall, J. (2020). Caregiver burden and nursing interventions in dementia. Geriatric Nursing, 41, 122-128.