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CHAPTER 14 Dorothea E. Orem 253

frequent repeating of favorite phrases, sudden out- chair first, and then, while she showers, he sits
bursts of anger, and decreased social involvement. on the nearby toilet seat drying himself. Her girl
Assessments resulted in the diagnosis of early friends suggested that this was material for an
Alzheimer’s disease. Aricept was begun, and Jane entertaining home video! While Jane is cautious in
began to prepare herself to face this new stage of her care for Dan, she often drives a short distance
their married life. She read Alzheimer’s literature to her neighborhood tennis court for brief games
avidly and organized their home for physical with friends or spends time tending the lovely
and psychological safety. A kitchen blackboard gardens she and Dan planted. During these times,
displayed phone numbers and the daily schedule. she locks the house doors and leaves Dan seated
Car keys were appropriately stowed. It was noted in front of the television with a glass of juice.
that she began to savor her time with Dan. Just She watches the time and returns home midway
sitting together with him on the sofa brought through the hour to check on Dan. On one occa-
gentle expressions to her face. It was apparent that sion when she forgot to lock the door while she
she was building a store of memories. They contin- was gardening, Dan made his way to the street,
ued to attend church services and functions but lost his balance, reclined face-first in the flower
stopped their regular swims at their exercise facil- bed, and was discovered by a neighbor. Jane has
ity when Dan left the dressing room naked one given up evenings out and increased her favorite
day. Within the year, Jane’s retired sister and pastime of reading. Her days are filled with assist-
brother-in-law relocated to a home a short walk ing Dan in all of his activities of daily living. And,
from Jane’s. Their intent was to be on call to assist often, her nights’ sleep is interrupted by Dan’s
Jane in caring for Dan. Dan and Jane’s children wandering throughout their home. At times,
did not live nearby so could only assist occasion- when the phone rings, Dan answers and tells
ally. As Dan’s symptoms intensified, a neighbor callers Jane is not there. Jane, only in the next
friend, Helen, began to relieve Jane for a few hours room, informs him “Dan, I am Jane.” Friends are
each week. At this time, Jane is still the primary saddened by Dan’s decline and concerned with
dependent-care agent. She prides herself in mas- the burdens and limitations Jane has assumed due
tering a dual shower; she showers Dan in his shower to Dan’s dependency.

CRITICAL THINKING ACTIVITIES
Case Study Analysis 2. Now, using the Basic Dependent-Care System
We will use two conceptual models to analyze this case. model (Figure 14–4), assess Dan and Jane.
The Dependency Cycle (see Figure 14–3) presents Identify the basic conditioning factors (BCFs)
the way dependency occurs. The outer arrows show for each. Ask “What is the effect of Dan’s BCFs
how an independent person can become dependent, on his self-care agency (SCA)?” Is he able
progress to interdependency, and even become inde- to meet his therapeutic self-care demands
pendent again. (TSCDs)? Continue on to diagnose Dan’s self-
Figure 14–4 displays the Basic Dependent-Care care deficit (SCD) and resulting dependent-
System in which Dan and Jane are interacting. care deficit (DCD). Next, assess Jane’s self-care
1. Let’s examine this case through the Dependency system (SCS).
Cycle model (see Figure 14–3). The outer arrows 3. Design a nursing system that addresses Jane’s
show a progression through varying stages of SCS while she increases her role as dependent-
dependency. The inner circle represents who can care agent (DCA).
be involved in the dependency cycle. Indicate
where Jane and Dan are in this cycle.