Nursing Concepts: Dorothea Orems Self-Care Deficit Nursing Theory - Essay Example

Nursing Concepts: Dorothea Orem’s Self-Care Deficit Nursing Theory of Dorothea Orem’s Self-Care Deficit Nursing Theory There are various nursing theories, which apply specific concepts in practice. My paper seeks to discuss Dorothea Orem’s Self-Care Deficit Nursing Theory. Dorothea Orem started working on this theory in 1959 and she still adds more development s to the theory to-date. It came to be popularly known as the Orem Model of Nursing. This theory is a grand theory, that is, it occupies a wide scope, and has concepts that are generally applicable to all nursing practices (Basavanthappa, 2007). The central idea in this theory is that we all have natural ability to take care of ourselves. This ability is tied to not only our right but also our responsibility to care for ourselves. This theory further builds on the concept of human development; that human development highly depends on a person’s ability to depend on themselves and their thirst to control what they do. This thirst extends to helping others to be self-reliant too. As natural as it is, we attain self-care is just like any other habit-forming behavior. We it early in life and carry it along to adulthood. This theory revolves around those activities we do on a daily basis for our well-being (Clark, 1986). The theory critically addresses not only what our nurses do but also what they should do to be more effective in this field. It also looks at the product in nursing practice, that is, what nurses achieve because of what they do. This theory develops from three concepts, otherwise known as sub-theories. The concepts are the theory of self-care, theory of self-care deficit, and theory of nursing system (Mayo, 1997). According to Kozier et al. (1998), self-care theory states that our self-care and that of our dependants are both processes perfected by learning to help us do things on our own and remain healthy and physically fit. This ability to initiate self-care is what Orem calls self-care agency, the ability for adults to care for themselves, as they take care of not only the seriously ill and the aged but also the physically challenged who may need help through self-care activities. Another concept in this theory is the self-care deficit. This concept builds on the assumption that we seek nursing services because of our own limitations as human beings, with possibilities of having ill health or injuries. The two guiding variables seen as hindrances to these deficits are self-care agency and therapeutic self-care. Self-care deficit emerges when self-care agency (our ability) fails to meet our self-care demands. Therapeutic self-care, on the other hand, seeks to achieve those measures we need in order to fulfill the available requisites (Clark, 1986). The last concept is the nursing system theory. This explains how nursing systems emerge and how they are put into practice. The systems come to life when during the nursing process which ranges from prescription, design, and eventual provision of services that are appropriate to a particular client’s self-care conditions. The systems also work towards providing services that fulfill a patient’s requirements concerning therapeutic self-care (Clark, 1986). Ryce (2006), concurring with Orem’s theory of self-care, admits that our home care nurses are able to provide a broad-scope support to patients. They may also provide education as well as other resources. However, important as these may be, the patient’s own efforts are critical to recovery. Nothing significant can be achieved if the patient leaves the whole process of managing their health to the nurse. Orem chose the name ‘self-care deficit theory’ because it gives more insight into that relationship, which exists between our ability to take care of ourselves, on one hand, and not only our self-care requirements but of those, we take care of, like our children and unable adults around us. Most of Orem’s works lay more emphasis on the individual. However, this model is doubtlessly applicable families. The model can also work so well with communities (Hartweg, 1991, p.9). The Central Idea, six Propositions, and two sets of propositions in the theory of self-care deficit (Hartweg, 1991) suggest a reaction to the riddle behind need for health service nursing. We have always wondered why we need these services. Orem says that the main idea behind this is because of the inevitability of occurrences that lower our ability to get our self-care needs. Orem also helps us to break down the idea of self-care and dependent care. According to her, self-care is a behavior; and we earn this behavior when get in contact with large groups. In the groups, we acquire behavior via communication and other forms of social interaction. Our self-care relies largely on our experiences attached to our culture and society. For example, our self-care actions in reaction to various illnesses will differ depending on our cultural backgrounds (cited in Hartweg, 1991). One thing Orem wants all of us to know is that every patient’s desire is always to do most of the things on their own. This way, they develop a positive sense of self-esteem. In addition, the recuperation process is sped up and the process is all-round. We should try as much as possible to encourage our patients to do things on their own, if they can. This model is particularly important in institutions in which patients are taught to be independent. One of such institutions is a rehabilitation center (Basavanthappa, 2007). As stated above, this theory deals with things we do on a daily basis. We can now look at how these daily activities come to play. To understand this we need to look at some of its requisites, which are placed under three categories. We have universal self-care requisites, that is, universal human needs, for instance fresh air, rest, food, and so on. There are also developmental self-care requisites, which are further fall under two categories, that is, maturational and situational. Maturational help the patient to attain a better level of maturation. Situational, on the other, protect patients from hazards of development. Moreover, we have health deviation requisites, which are the patient’s changing needs depending on their conditions (Parker, 1990). Application of the Theory Nurses need to approach this process carefully when dealing with patients since lack of any of the mentioned requisites leads to a situation of need for self-care or a deficit in self-care. The nurse establishes the deficit through a careful assessment of the patient. After identifying the need, the selects required nursing systems to provide care. The nurse provides this care depending on the patient’s deficit. After providing care, the nurse moves on to assess the nursing activities and systems used. This evaluation is done to see if the targets of both the patient and the nurse are met (Parker, 1990) Examples Parker (1990) provides us with a case study on how this theory can be put into practice. She presents us with a case of a Mr. Brown, who has been admitted for acute exacerbation of chronic obstructive pulmonary disease leading to respiratory failure. The man is also recovering from smoking. Before his admission to hospital, Mr. Brown can do most of the things by himself since he stays alone. He can even walk to town everyday for lunch. We also learn that before his admission he already uses oral theophylline and inhaled bronchodilators. On admission, Brown is quite ill. He is treated and put on low flow oxygen, and his condition improves within twenty-four hours. Among the medication given is theophylline, which he already had before admission. He stays in hospital for eight days. He is then discharged and given oxygen to use a liter per nasal cannula, among other medications. There is also a home nursing referral with instructions to make sure Mr. Brown uses his nebulizer and oxygen appropriately, and making sure that he takes the right dose at the right time. There is also to monitor his lung functions and exercise routine. One the nurse’s first visit, Mr. Brown declares that he will stop going for lunch in town, and that he plans to do physical practice, because he thinks he is too sick to do these things. The nurse establishes his self-care requisites, and this helps in identifying Mr. Brown’s capabilities as; ability to do manual activities, he is alert, and is able to most of his necessary daily chores. He is also ready for a professional help. His limitations, on the other hand, are; no prior knowledge on how to handle oxygen equipment, dwindling motivation to work for self, among others (Parker 1990). The nurse then comes up with an action plan. She assesses and evaluates the Brown’s condition regarding self-care requisites. The self-care agency is also evaluated. She clarifies the reason behind Brown’s reaction to need for oxygen and other challenges (Parker 1990). We can clearly see the effects of providing a home nurse for Mr. Brown. His condition worsens when the nurse comes, and he becomes unwilling to do things on his own. This weakens him even further. Vonnalin A. Del Rio, in Dorothea Orem’s THEORY OF SELF- CARE (2010), also gives us a case of a woman whose joint pains only put her down when she stops doing things on her own. Here again the nurse identifies areas in which the patient lacks information and embarks on making the patient informed and independent. Conclusion Having seen how the theory’s concept was successfully used in the two cases, I can boldly suggest that this theory can be successfully applied in the nursing practice. I think the theory can be easily applied to a wide range of both situations in the nursing field and patients. The theory is very general in principles and concepts. Such a generality make it very dynamic and therefore it can be used in a variety of settings. It also provides an environment for a better nurse-patient relationship. When both are comfortable, the work becomes easier, since they help each to succeed in the task. The patient then gets the best care possible and ability to care for themselves. The role of the nurse, as we have seen, is to help the patient know and follow self-care practices for quick recovery. The nurse also comes out as a very important player in increasing the patient’s self-care abilities. Close nursing is only needed when the patient cannot steadily uphold to the required amount and quality of self-care skills. The therapeutics should be strong enough to keep the patient strong and healthy. Only this way will a patient be able to recover from a disease or injury. Sometimes they may be needed for helping the patient adapt to and live with effects of diseases and injuries. There are also other assumptions we can associate with this theory. First, everyone should be self-reliant and should actively participate in their life. One also needs to take responsibility for not only their care but also that of anyone in their family who needs care. I tend to believe that Orem’s theory has had significant influence in evolution of the concept of Home Based Care (HBC), a situation whereby family members are encouraged to take care of their own at home rather than them being admitted in hospitals, especially in case of terminal illnesses. Secondly, we need to appreciate that people are distinct individuals, with abilities and desire to most of the things on their own. Moreover, nursing should be viewed as some kind of action, that is, it is a social activity, which involves more people than just the nurse and the patient. Everyone should take part in nursing our loved ones as well as ourselves, since the theory has clearly shown us how this actually helps in quick recuperation. In addition, by successfully achieving universal and self-care requisites, we play a crucial role in basic care. This can also help us considerably prevent diseases, especially those that can be psychological assessment of an individual providing one’s own remedies without visiting a medical practitioner. Nevertheless, one needs to be made aware of potential health problems. This will give a boost to our population’s knowledge and interest in the promotion of self-care behavior. Finally yet importantly, we learn self-care and dependent care right from childhood and it is perpetuated into adulthood. The two are also learned within our socio-cultural context. This means that our reactions to self-care will highly depend on our socio-cultural backgrounds. Therefore, every nurse’s duty is to make sure that mutually set goals are met, and with assistance of the client. References Del Rio, V.A. (2010). Dorothea Elizabeth Orem’s Theory of Self-Care. Del Rio, V.A. (2010). Dorothea Elizabeth Orem’s Theory of Self-Care. Parker, M.E. (1990). Nursing Theories in Practice. National League for Nursing. New York: Jones and Bartlett. Hartweg, D.L. (1991). Dorothea Orem: Self-Care Deficit Theory. SAGE Ryce, R. (2006). Home care nursing practice: Concepts and application. St. Louise, MN: Elsvier Health Sciences. Clark, M.D. (1986). Application of Orem’s Theory of Self-Care. Chicago, IL: Northwestern University. Kozier et al. (1998). Fundamentals of Nursing: Concepts, process, and practice. Menlo Park, CA: Addison Wesley Longman. Vasavanthappa, B. (2007). Nursing theories. New Delhi: Jaypee Brothers Publishers. Mayo, A. (1997). Orem’s self-care model. Portfolio Professional Nursing. Retrieved November 19, 2011. From http://www.nursenetwork.co.uk/forum/index.php?showtopic=13578hl=nursing+models Read More