Theory/Author Name and Background
This paper will focus on a Mid-Range Theory developed by Dorothea Orem known as Self-Care Deficit Theory. Dorothea Orem is one of the best known theorists in the field of nursing. She was born in 1914 in Baltimore, Maryland. During her entire life, Orem was greatly involved in service, practice, and nursing education (El-Kader, 2002). She received several professional awards and honorary awards as a result of her service and education in nursing. Orem served in several positions during her nursing career including administrator, staff, director, consultant, professor, and private duty. She also worked in operating rooms, pediatrics, surgical, emergency rooms and medical units (Tomey and Alligood, 2002).
Self-Care Deficit Theory was developed by Orem early in her career life and it was refined it before and after retirement. Development of the Self-Care Deficit Theory was mainly influenced by her life experiences. The three main factors that are believed to have caused much influence in the development of the theory include; nursing theory conferences, development of nursing curriculum, and experiences with women’s movement (Meleis, 1997). Between 1949 and 1957, Orem served at the Indiana State Board of Health, Division of Hospital and Institutional Services. As she continued to explore the field of nursing, Orem felt that is was necessary to upgrade the state of nursing in all hospitals in the state. This encouraged her to formulate her definition of nursing practice (El-Kader, 2002).
Orem moved to CUA School of Nursing in 1959 where she served as an assistant professor of nursing education and as an acting dean. It is from this institution where Orem began to develop her first concept of self-care (El-Kader, 2002). When working as a curriculum consultant in the Health Education and Welfare Department, Orem strived to upgrade the nursing training through curriculum development (Orem, 1959). In the same year, she published a book that addressed the concept of self-care. Ideas and opinions that Orem used to develop here Self-Care Deficit Theory were obtained from her intensive exposure to nurses and their efforts especially when she attended women’s movements and nursing theory conferences between 1949 and 1957 (Meleis, 1997).
Since Orem developed the Self-Care Deficit Theory, nurses, medical doctor and authors have increasingly borrowed ideas of the theory and health care workers have even tried to apply her ideas at their places of work. To date, there are several researches that have been carried out on Self-Care Deficit Theory. According to Bekel, Panfil, and Scupin (2005), Self-Care Deficit Theory is highly relevant for the future development of German Health Care System as far as care provision and management are concerned. These authors emphasize that proper understanding and application of the concepts of Self-Care Deficit Theory helps to increase autonomy of suffering patients as well as those of their families.
In 2006, Lima, Pereira, and Chianca conducted a study to investigate the importance of Self-Care Deficit Theory in the North America Nursing Diagnoses Association, (NANDA), classification. The authors concluded that Self-Care Deficit Theory allows all nursing diagnoses to be classified according to the NANDA. As Laferriere (1995), states, Orem’s Self-Care Deficit Theory is highly applicable in hospice nursing care. The author analyzes the relationship between the six concepts of Orem’s theory and hospice care and concludes that Self-Care theory is valuable to nurses as far as offering palliative care is concerned.
Orem’s initial phenomenon of concern centered on man’s need for self-care and continued self management in order to recover from disease, sustain health, and cope with the effects of a health problem (Orem, 1959). The main idea behind the development of Self-Care Deficit Theory was the great need to help human beings overcome limitations. Orem’s theory therefore designs a structure where the nurse is required to offer assistance to a client in order to help him or her maintain sufficient level of self-care. According to Orem, the extent of nursing care and intervention depends on the client’s ability to meet the needs of self-care (Orem, 1959).
Nursing theories are normally classified according to the anthropology or discipline from which they were generated. According to Meleis (1997), Orem’s Self-Care Deficit Theory is interactive in nature. Orem developed the theory following numerous interactions with successful nurses when she attended women’s movements and nursing theory conferences (Meleis, 1997). El-Kader (2002) points out that Orem’s Self-Care Deficit Theory uses inductive reasoning. Inductive reasoning is evident on the way Orem developed the various concepts of the theory. As Orem (1959), states, the concepts of Self-Care Deficit Theory were defined based on Orem’s experience in concrete nursing practice situations as well, as analysis of nursing care materials such as the nursing curriculum.
Apart from inductive reasoning, El-Kader (2002) explains that Orem’s Self-Care Deficit Theory was developed as a result of deductive reasoning. Orem read widely and utilized personal thoughts, ideas, and opinions to formulate her theory, indicating that there is an element of deduction in her work (Orem, 1959). Over the years, the concepts and components have been changed as a result of varying interpretations.
There are seven major concepts of Orem’s Self-Care Deficit Theory namely; self-care, self-care agency, basic conditioning factors, therapeutic self-care demand, self-care deficit, nursing agency, and nursing system. Self-care refers to activities that individuals perform on their own in order to improve health and maintain life (Meleis, 1997). Self-care agency entails the power of human beings to engage in activities that promote well-being. Self-care agency is normally influenced by basic conditioning factors. Basic conditioning factors include health state, age, family system factors, health care system factors, socio-cultural orientation, environmental factors, patterns of living, resource availability, and resource adequacy (Meleis, 1997).
The other concept of Orem’s Self-Care Deficit Theory, therapeutic self-care demand, refers to the a collection of actions that must be performed for a certain period of time using relevant methods to meet the self-care needs of patients. Self-care deficit describes when self-care is really needed. Self-care is always necessary when a patient is incapable of performing actions that lead to sufficient self-care (Masters, 2011). Nursing agency as another concept of Orem’s Self-Care Deficit Theory refers to the attributes of trained nurses that enable them to know, act, and assist others to meet self-care demands by helping them to develop individual self-care agency. Lastly, nursing system refers to the result of relationship between the nurse and his or her client. A nursing system is created when the therapeutic self-care demands of the client exceed the self-care agency available, resulting into the need for a nursing intervention (Meleis, 1997).
Orem has defined the seven concepts of Self-Care Deficit theory both theoretically and operationally. This is evident in the manner in which she theoretically displays the meaning of self-care and operationally describes the relationship between the client and a trained nurse to enhance understanding (Meleis, 1997). Orem has demonstrated consistency in the definition of concepts and usage of other terms in the theory. For instance, the meanings of nursing, nurse, patient, and self-care do not change in the entire description of Self-Care Deficit Theory (Masters, 2011). Additionally, Orem has defined the terms and concepts explicitly, that helps to promote understanding of the seven concepts and the entire theory.
According to Meleis (1997), propositions refer to statements that define relationships among actions, situations, or events. The seven concepts of Self-Care Deficit Theory have got some relationships. For instance, basic conditioning factors such as developmental state, experiences, age, and socio-cultural backgrounds influence self-care agency and self-care (El-Kader, 2002). Again, skills required to promote self-care agency and self-care for patients are learned and recalled. This means that nurses require some form of training in order to effectively assist clients to perform activities that promote health and well-being (Masters, 2011).
Additionally, self-care agency and therapeutic self-care demand need to be balanced by self-care deficits. In other words, ability of a patient to perform self-care activities and the general therapeutic demands of that client will determine the degree of nursing that the client needs (Masters, 2011). Moreover, both nurses and patients work together to ensure that self-care needs are effectively met. Nurses are charged with the responsibility of assessing their clients’ abilities to perform activities that promote self-care. The nurses use the results of their assessments to select reliable and valid actions and processes that will help them in meeting self-care needs (Orem, 1959).
When developing the Self-Care Deficit Theory, Orem made a number of assumptions. She believed that nurses purposefully and intentionally offer nursing services as a way of helping those who are in need. Another assumption underlying Orem’s theory is that, individuals are always willing and capable of performing activities that promote self-care as well as those of dependent family members (El-Kader, 2002). Again, ability of a person to engage in activities that promote self-care depends on his or her development, well-being, and health.
Orem also assumed that education and culture highly influence individuals, and that through human interaction and communication, a person can learn to perform self-care activities (Meleis, 1997). Another assumption of Self-Care Deficit Theory is that systematic and deliberate actions are performed in order to help promote self-care. Again, each and every person possesses powers, capabilities, interests, personal dispositions, and talents. Consequently, Orem presumed that people are separate for others and from their environment (El-Kader, 2002).
A metaparadigm is defined as a broad perspective of disciplines that form a framework for development of an entire structure or concept. The four metaparadigm concepts of nursing are nursing, health, environment, and person (Masters, 2011). Self-Care Deficit Theory has a description of the four metaparadigm concepts of nursing. As far are nursing is concerned, Orem’s theory views nursing as a community as a technology, community health service, and an art. Self-Care Deficit Theory is viewed as health service in the community because it requires social interaction between a nurse and a patient based on community values (El-Kader, 2002). The theory sees nursing as an art because it requires nurses to design actions that will improve self-care among patients. Orem’s theory sees nursing as technology because it entails application of various techniques of practice such as effective communication, promotion of human growth and development, maintenance of interpersonal relationships, and many other techniques (Meleis, 1997). Nursing involves the ability to help clients in planning, provision, and management of self-care to promote good health and well-being. Techniques employed in nursing include teaching the client, acting for the benefit of the client, guiding the client, and providing physical and psychological support (Masters, 2011).
Health generally refers to a state of being and good health requires soundness of the whole body. Soundness means strength, vigor, and absence of disease. According to Orem’s Self- Care Deficit Theory, health refers to the state of the body and how it functions (El-Kader, 2002). Nurses therefore strive to promote progressive development that helps the body to achieve higher level of functioning. As far as Orem’s Self-Care theory is concerned, a person and his or her environment are a functional unit with a mutual influence. Individuals are believed to be part of their environments and therefore their well-being and those of their families are affected by the four features of the environment: social, chemical, physical and biological (El-Kader, 2002).
In Self-Care Deficit Theory, a person is seen as the recipient of nursing care. A person is a living being who functions socially, symbolically and biologically. Additionally, a person has the capacity to learn techniques of meeting self-care needs are assumed by the Self-Care Deficit Theory. He or she can perform deliberate activities as well as beneficial actions. A person also has the potential to learn and develop (El-Kader, 2002). Self-Care Deficit theory addresses the four metaparadigm concepts of nursing with maximum lucidness and consistency.
Orem’s Self-Care Deficit Theory can be used to make appropriate decisions when carrying out nursing process (Orem, 1959). Nursing process entails assessment, nursing diagnosis, planning, implementation, and evaluation. Assessment involves determination of a person’s health status as well as his or her immediate health needs. This is followed by diagnosis where the nurse determines the person’s requirements for self-care. The capacity level of the client to perform self-care will be used as the basis of devising a plan for assistance with a scientific rationale (Tomey and Alligood, 2002).
The nurse therefore designs a plan by incorporating all the components of the client’s therapeutic self-care demands. This should be followed by selection of the best plans that will help the patient to efficiently overcome self-care deficits (Meleis, 1997). After planning session, the nurse will again employ the Self-Care Deficit Theory in implementation and evaluation of the best alternative. The nurse will help his or her client to achieved defined health benefits by putting the identified plan into action. Evaluation will involve analysis of whether the implemented plan is resulting into the expected health outcomes (Masters, 2011).
To date, many nursing institutions have used Orem’s theory as a conceptual framework in achieving primary, secondary, and tertiary levels of prevention (Bekel, Panfil and Scupin, 2005). Specifically, Self-Care Deficit Theory can be used in nursing education to teach patients about personal health issues. For instance, suppose a room contains contaminated air, the therapeutic self-care demand is that, a person will be required to maintain effective respiration in order to stay safe and alive. Considering the situation in the room, it is clear that self-care agency is inadequate. If a nursing diagnosis is conducted, and the nurse discovers that that there is a potential for impaired respiratory status, the nurse will have to teach the client about the importance of staying away from the room in order to prevent further respiratory problems (Tomey and Alligood, 2002)..
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