Dorothea Orems Self-Care Deficit Theory - Essay Example

?Running Head: Dorothea Orem’s Self-Care Deficit Theory. Dorothea Orem’s Self-Care Deficit Theory                Name:           Institution:            Date: Abstract Orem’s self care deficit theory of nursing is one among three theories that make up her grand nursing theory. The self-care deficit theory is based on the philosophy that individuals and groups are able, responsible and willing to take care of their health. In relation to this, the theory recognizes that health challenges result from the fact that individuals fail to exercise self care, and this deficit leads to health challenges. As such, the nursing profession is meant to intervene by simply facilitating self care where necessary through education or supportive means to help subjects learn about self care. The theory emphasizes the essence of the patients’ or groups’ participation in facilitating their care. It facilitates healthcare provision through education, direct action, guidance, support and provision of the appropriate environment for engaging in self care. In spite of the proven efficiency of the theory in aspects such as addressing the root cause of health problems, the theory faces challenges that arise from non-compliance to educational values delivered due to complacency and negligence. This review of the theory not only reviews the overall aspects of the theory, but also the probable application, efficiency, challenges and improvements necessary. Introduction Nursing theories are derivatives of conceptual frameworks with principles and doctrines that define the underlying basis of nursing practice. Unlike the name suggests, they are not purely opinionated and theoretical, but rather supported by actual knowledge that has proven their applicability through time. The theoretical aspect originates from the fact that they were theoretically formulated, but in actual sense they have been proven as being effective through their application as functional elements of nursing practice. The concepts of nursing theories define and characterize the nursing practice. In a nutshell, nursing denotes a human interaction developed to foster health by working within the boundaries of the patient and his environment (Dennis, 2008). According to Orem, the practice is both therapeutic and supportive. The supportive aspect is meant to enhance wholeness in the event of a patient’s experience of failing health by facilitating care that the patient cannot achieve through personal efforts. There are numerous theories that support and define the practice of nursing, but this paper particularly highlights Dorothea Orem’s “Self-Care Deficit Nursing Theory,” which is a middle range theory that makes up the three theories under her grand theory. Dorothea Orem’s grand theory was developed during her working experience which included serving as a nurse practitioner, educator, administrator and consultant. It is during her engagement with the development of the education field of nursing that she formulated the theory as part of her dissertation works at the masters’ level (Currentnursing.com, 2012). Orem’s Self-Care Deficit Nursing Theory The self-care deficit theory is mainly based on the principle of encouraging patients to be independent in the facilitation of their own care. It is the central focal point in Orem’s grand theory. The theory defines when nursing intervention is deemed necessary (Dennis, 2008). It also describes how patients and groups of people in need of healthcare can get helped by nursing interventions. The application of the theory often comes to play when the involved subject/s are unable to facilitate self-care. The inability to administer personal care when in need of healthcare is what gives the theory the deficit denotation. As such, the theory is used in identifying cases with deficit of care, where the subjects in question are unable to sufficiently undertake steps that guarantee them good health. According to the theory, nursing serves the purpose of fulfilling sufficiency of care by meeting the self care needs of the patients or rather facilitating self provision. The theory identifies five methods through which the self care deficit theoretical approach can facilitate nursing intervention in the medical field (George, 2011). The five methods of intervention under the theory: According to this theoretical framework the need for nursing intervention is first identified and thereafter the following methods are chosen to facilitate the nursing interventions: (1) engagement in direct intervention steps of care (this occurs without the patients’ involvement); (2) guiding the patient towards achieving self care; (3) teaching the patient or group on how to carry out self care; (4) supporting the individual or group in carrying out self care or (5) providing an enabling environment through which the patient can exercise self care that is sufficient to meet the present or future personal requirements of care or requisites (Currentnursing.com, 2012). The requisites denote the various categories of actions directed towards self care either as a result of meeting general and developmental requirements of health or ill health. The universal requisites include the day-to-day self care activities that we commonly undertake even without conscious concern about using them as a means to take care of our health. These may for example include eating a balanced diet, preventing exhaustion by balancing work and rest, maintaining sufficient water intake and air, preventing hazards and accidents and enhancing human functional ability. These are activities often associated with the maintenance of our normal human integrity, and may not be consciously thought of as health care measures (Currentnursing.com, 2012). But they do contribute to health and well-being. The developmental based requisites include health related adjustments done in life for situational cases and they are done in response to changes in life. Health adjustments done in old age so as to adapt to the effects of aging may be considered a form of developmental requisites. The health deviation requisites include interventions undertaken in order to counter negative health effects which result from medical conditions that threaten good health. These include seeking medical attention, taking prescriptions as well as being aware of one’s medical conditions and learning how to live with the associated challenges (Currentnursing.com, 2012). Central philosophy in the self care deficit theory: The self-care deficit theory finds basis in the philosophy and belief that “all patients wish to care for themselves.” The philosophical holding is that patients can recover holistically and quickly if they are permitted to conduct their personal care to the best possible levels (Dennis, 2008). Orem’s main idea with regard to this theory focuses on the approach that the nurse uses in helping individuals, groups, communities or families who have limitations in terms of their capability to take care of their own health. The theory also emphasizes the need to develop self care knowledge in communities and individuals. Major assumptions in the self care deficit theory: The theory identifies people as being distinct identities that are responsible and self reliant in terms of taking care of their health needs and those of their family members. According to the theory nursing constitutes actions that are interactive in nature, and which occur between two or more people. The meeting of self care needs is held as being important for both primary care and cases in which ill health interventions are required. The possession of knowledge is also deemed as being essential in the promotion of self care (the focal point in facilitating self care). Therefore, it is very important for people to have knowledge on how to care for their health. Finally, the theory holds that dependent care and self care are both learned behaviors that develop through socio-cultural formation (Dennis, 2008). This implies that teaching or educational procedures can shift this aspect due to the dynamic nature of the situations involved. Probable implementation of the theory The self care deficit theory is best suited in cases where the health conditions in question require constant monitoring, care and interventions that are so frequent and regular that it might not be possible for the caregiver to always be present. For example, morbid obesity requires more of self care to control, rather than direct interventions by a practitioner (George, 2011). Morbid obesity is not only a health problem, but also a potential cause of greater vulnerability to other health conditions such as type II diabetes and cardiovascular problems. Perhaps the most effective way to overcome the challenge is by observing a strict dietary program that is low on fat and calories so as to cut down weight. The use of a regular regime of physical exercises is also necessary in aiding the weight reduction process. Notably, all these most effective interventions do not require attendance from any health caregiver once the subject under morbid obesity has the relevant knowledge on how to tailor their exercise regime and an appropriate dietary program. These two approaches to self care aimed at combating morbid obesity and other related conditions are effective and only possible for implementation through the right facilitation of appropriate education and environment within which the obese individuals can exercise control. Morbid obesity is becoming a big challenge in the developed world and the education and facilitation of appropriate environments may enable people to not only avoid the condition, but also get out of the condition through the pursuit of the above-mentioned two ways of combating the problem of weight gain. The theory may be used to find out how effective health education delivery can be in terms of helping morbid obese subjects to overcome the condition. The process may make use of three methods out of the five identified within the theory. A combination of education, support and guidance can offer perfect methods towards self care. The process would perhaps start off by selecting a sample population consisting of subjects with morbid obesity. These would then be assigned temporary membership in two groups. One group would act as control group, living their lives as usual and the other as the treatment group. The treatment group would then be offered educational programs on morbid obesity challenges and risk factors to health. Thereafter, they should be taken through an educational program that can help them identify potential causative agents of their conditions, which may include a poorly planned diet and/or an excessively sedentary life. In order to develop an intervention plan, they would also be taught about the basics of maintaining a proper dietary program and constant regime of physical exercises. After some observational period, the two groups would be assessed for morbid obesity indicators such as the Body Mass Index levels to determine if there are any improvements in terms of weight loss. The results obtained would most likely show that the treatment group that effectively undertook diet control and regular physical exercise has improved in terms of weight reduction. This would answer the question as to whether the adopted intervention plan based on the three methods drawn from the self care deficit theory would have brought about any positive changes to the group. The appropriateness of the application of this theory in the mentioned case is based on the fact that morbid obesity is mostly a lifestyle based condition. The condition results from factors such as taking diet that is high in fats and other high calorie foods. This is aggravated by other lifestyle factors such as the lack of regular exercise. A sedentary life that does not allow high caloric intake to burn results in accumulation which causes massive body weight gain of fat. Interventions for the problem are mainly on the two mentioned fronts-diet and exercise. Apparently, these are not the kind of interventions that require direct nursing attention, such as would be the case in a regular peritoneal dialysis case. The subjects can be empowered to effectively manage their diet and exercise regime so as to overcome the problem and its associated challenges. This makes the use of self care deficit theory appropriate because the theory is more concerned with empowering patients to take care and control elements and processes that determine the outcome of their conditions. In essence, taking charge is what the self care deficit theory terms as interventions to eliminate the deficit or shortcoming of self care. In the case of morbid obesity, subjects fail to take care of their lives appropriately through observing proper dietary intake and regular exercise. The interventions to be provided through the three highlighted methods would thus enable them to overcome their condition through carrying out the necessary self care steps. The implementation of the theory in this case requires the educative or supportive modality and approach because such patients are able to take control of their situation once educated properly about what they should do. However, it should be noted that full compliance to teachings is not guaranteed in this case because adherence to the health recommendations is a personal observance and this depends on individual motivation (Carol & Carol, 2001). This fact raises one great challenge in the application of the theory because a lot of control in terms of interventions is left in the hands of the subjects requiring help or nursing interventions. Inference from the theory’s basis indicates that the subjects requiring nursing interventions have already displayed some form of self care deficit, which is often a result of lacking technical capacity and knowledge or simply a matter of negligence. For example, a diabetic may require intervention after a deficit in self care is identified as in cases where wound healing becomes a challenge. In this case, the patient is technically unable to care for themselves. As such, they may require partial compensation in care. But the morbid obesity case may be as a result of the patient lacking knowledge on how to care for his/her health through the observance of a healthy diet and regular exercise regime (Dennis, 2008). This may be due to the fact that the patient does not know the effect of the two factors on his/her health. Alternatively, the patient may be fully aware of the effects of binge eating and a sedentary life, but the patient simply takes no action due to complacency or sheer negligence. In this case, the implementation of interventions based on the self care deficit theory may not be effective because in spite of the education delivered, the subjects may simply fail to take note of the issues taught and recommendations made. Complacency and negligence are likely to have a great influence on the outcomes of educational programs which are highly emphasized in this theory (Carol & Carol, 2001). These present a big challenge to the implementation of most interventions based on the self care deficit theory, especially those tailored from the educational method of approach. This is because the use of knowledge delivered solely depends on the ability of the subjects to implement it. Evaluation of the theory and conclusion The self-care deficit theory has great effectiveness because it finds basis in the initial identification of the source of most health challenges. Health challenges result from the fact that individuals are unable to take care of their health, and these deficits in self care either cause aggravation of already existent conditions or lead to new health challenges. This method tailors an approach that seeks to present ideas and knowledge that help the patients in facilitating their own care program. Tackling of problems is most efficient when the problem’s root causes are addressed, and this perhaps explains why this theoretical approach may be most effective in this regard. Primary health care relies on educational programs and this theoretical approach finds the best application in primary healthcare. However, the fact that the intervention approaches presented heavily rely on the individual or group, makes it challenging because the subject/s may simply fail to implement the knowledge delivered due to complacency or negligence (Taylor & Renpenning, 2011). Therefore, as a practitioner, failure due to such reasons should be anticipated. However, the user friendliness of the theory may be actually high because it has little associated risks and requirements of technical capabilities to implement. For example, the delivery of education on self care and directions is simple compared to the actual technical medical intervention that may be necessary when situations get complicated. The effectiveness of the theory may be enhanced by closer follow up to the educational programs. In an overall review, the self care deficit theory may be wanting, but when viewed from the overall perspective of the general Orem’s grand theory, it could be lauded as one of the most effective theories in nursing practice. References Carol, T. & Carol, L. (2001). The Art and Science of Nursing Care, 4th edition, Philadelphia, Lippincott publishers Currentnursing.com (2012). Dorothea Orem's Self-Care Theory, retrieved on April 6th 2012 from http://currentnursing.com/nursing_theory/self_care_deficit_theory.html Dennis, C. M. (2008). Self-care deficit theory of nursing: concepts and applications. Michigan: The University of Michigan George, B. J. (2011). Nursing Theories: The base for professional practice, 6th edition, New York, NY: Pearson Publishers Taylor, S. G., & Renpenning, K. (2011). Self-Care Science, Nursing Theory and Evidence- Based Practice. New York: Springer Publishing Company Read More