Orem-Nursing Grand Theory - Assignment Example

Orem-Nursing Grand Theory Introduction The practice of nursing is often argued to be quite complex, which requires utmost attention. Over the previous few decades, several nursing models as well as theories have been developed with the intention of guiding the nursing practices. These nursing models are recognized to possess numerous advantages that assist in promoting sound nursing practices, but at the same time, certain limitations are also identified to accompany with these nursing models. Correspondingly, choosing right model for guiding nursing practice has become quite difficult in the contemporary era (Comley, 1994; Hanucharumkul, 1989). With this concern, the assignment intends to describe, evaluate and discuss the application of Orem-Nursing Grand Theory. The assignment also provides a detailed analysis and evaluation of the theory along with its application in diverse fields. Theory/Author Name and Background The Theorist's Background and the Impact of Her Experiences on the Theory Development Orem’s General or Grand Theory of Nursing comprises three condensed theories, namely “self-care theories”, “self-deficit theory” and “nursing theory”. The theory was developed by Dorothea Orem. The theorist Orem was born in Baltimore in the year 1914. In 1934, she obtained her diploma in nursing from Washington D.C.’s Providence Hospital School of Nursing. In 1939, she received her bachelor of science in nursing education and in 1945 she obtained her master of science in nursing education from Catholic University of America. It is worth mentioning that she had a wide-ranging background in terms of clinical practice which included adult med-surg, private duty, paediatrics and ER supervisor. She also served as an administrator of nursing service as well as supervisor of the school of nursing at Providence Hospital in Detroit. In the year 1949, Orem joined Indiana State Board of Health, Hospital Division where she functioned as a support agent for upgrading and improving the nursing services in several hospitals in Indiana. During 1958-59, Orem rendered her service as an advisor to “the Office of Education”, “Department of Health”, “Education and Welfare” in Washington and was involved in enhancing practical nurse training. This work inspired her to strive for identifying the conditions influencing the decision about the need for nursing care. As an answer to her quest resulted in generation of idea in which she expressed that a nurse is “another self”. This idea turns out in the form of nursing concept which she recognized as “Self-care”, “Self Care Deficit” and “Nursing Theory” (The University of Tennessee, 2014). The Crucial References for the Original and/or Current Work Of the Theorist and Other Authors Writing About the Selected Theory The grand theory of nursing was formulated by Dorothea Orem in the 1950s. Dorothea Orem developed this theory after functioning in various clinical settings and completing her Diploma, Bachelor’s and Master’s degree in Nursing Education. The book published by Orem, “Guidelines for Developing Curricula for the Education of Practical Nursing” was the basis of her work. In the year 1971, the book “Nursing: Concepts of Practice” was published by Orem, which eventually forms the basis for other authors to write about the selected theory (EI-Kader, n.d.). The Phenomenon of Concern or Problems Addressed By the Theory Initially, the definition of nursing propounded by Orem included "man's need for self-care action and the provision and management of it on a continuous basis in order to sustain life and health, recover from disease or injury, and cope with their effects" (EI-Kader, n.d.). In this regard, the concept of self care explains about taking own care and dependents in terms of learned behaviors that tend to standardize ‘human structural integrity, functioning and advancement’. The self-care deficit theory articulates that individuals experiences self-care restrictions pertaining to their health state and may take advantage from nursing provision relevant to the care efforts. The nursing system theory is developed when a nurse mediates with a client to recommend design or deliver care to cater a self care deficit or standardize the own self-care capabilities of the client (Comley, 1994; Hanucharumkul, 1989). Theory Description Explanation about Whether the Theory Uses Deductive, Inductive or Retroductive Reasoning with Evidences Orem began to formulate conceptual models mainly to enhance nursing curriculum. Notably, Orem’s conceptual model of self care can be inferred to derive from her inductive thoughts. The model stemmed from in-depth experiences in nursing practice, “of when and why people can be helped through nursing as distinguished from other forms of human services” (EI-Kader, n.d.). Orem’s knowledge and insights pertaining human condition along with the need for nursing were developed as a concept of “self-care deficit”. For instance, induction from practice is clearly apparent in Orem’s detailed explanations of how concepts in the theory were ascertained and delineated grounded on “experience in concrete nursing practice situations or results of analysis of nursing care materials” (EI-Kader, n.d.). Orem's theory recognizes the concepts that can be operationally delineated. The theories of Orem specifically deals with the needs of a person, which is termed as “you and me”, and the “we” of the commune (Masters, 2014). According to varied concepts of the theory, environment tends to influence the health needs of a person that can be modified and used by nurses to meet the person’s requirements. In addition, health is recognized by Orem as the state of well-being, which is realized by a person “with or without the intervention of nurses” (Comley, 1994; Hanucharumkul, 1989). Interpretation of How the Concepts Are Defined Orem’s theory depicts the relationships amid varied concepts based on which hypotheses have been generated and assumptions are stated clearly. Orem's concept of health is holistic in nature, as she viewed health as “progressive integrated development of a human being as an individual unity moving toward higher and higher levels of integration” (Hanucharumkul, 1989). In this regard, the theorist explains the attention of nursing as the advancement of self-care of a person and as only complementing care provided by clients either for themselves or their dependents. Nevertheless, Orem’s definition of the concept of environment is ascertained to be vague. Accordingly, Orem defines environment predominately in the developmental context in terms of psychosocial and/or physical settings that stimulate goal-directed behaviors. Orem remained much careful in defining the aspects of human care that are exceptional to the nurses as different to other healthcare experts (Comley, 1994; Hanucharumkul, 1989). The Relationships (Propositions) Among the Major Concepts The major concepts identified by Orem in her theory are interrelated to one another. In precise, it can be affirmed that the three condensed theories of Orem’s Grand theory including “self-care theories”, “self-deficit theory” and “nursing theory” are interrelated in nature. Focal point of all the sub theories is that human beings work and maintain health as well as well-being by ensuring care for own as well as dependents. Her theory of nursing system articulates the theories of self-care deficit and self-care as a complete theory of nursing (Comley, 1994; Hanucharumkul, 1989). Evaluation Identification of Explicit and Implicit Assumptions (Values/Beliefs) Underlying the Theory Five explicit assumptions are determined to underlie the Orem’s grand theory of nursing that have been discussed hereunder. Incessant deliberate efforts are required by human beings for themselves as well as their dependents in order to survive and function according to natural human capabilities The power of acting intentionally is exercised by human beings in the form of care for self and other Older human beings have greater requirements for self care as well as care for others Human agency is performed in exploring and transmitting means to determine the care requirements for self and others Groups of human beings valuing structured relationships combine tasks and distribute responsibilities for delivering care to group members Source: (Comley, 1994; Hanucharumkul, 1989). The Grand Theory and Four Metaparadigm Concepts of Nursing The concepts identified by Orem in relation to her theory can be related to four nursing metaparadigms that entail ‘environment’, ‘nursing’, ‘health’ and ‘person.’ According to the theory, the metaparadigm of person is defined as ‘integrated whole or unity functioning biologically’. The metaparadigm of health is defined as an instance of personal integrity. In this regard, varied health aspects such as physical, interpersonal, psychological and social are recognized to be inseparable. Environment is defined as a set of psychosocial and/or physical conditions that lead towards generating ideal goal settings, promoting creativity and transforming attitudes along with values while contributing towards improved physical growth. Nursing is defined as a supportive service, an art or a technology, which identifies individual needs and capacity for self-care as well as helping people to survive and sustain (Comley, 1994). Discussion about the Clarity, Lucidness and Consistency of the Theory The nursing theorist Orem has incorporated various concepts in her nursing model. The definitions of the concepts included in the model can be advocated to be clear and transparent. Besides, the theory is consistent in the way they connect with such concepts. As stated earlier, Orem’s theory is based on five key explicit assumptions along with supplementary presuppositions for sub theories. Correspondingly, the assumptions of Orem are also clear and normally acknowledged by the nursing community (Comley, 1994; Hanucharumkul, 1989). Application Examining How the Theory Would Guide Nursing Actions Orem's theory represents different images of nursing practice. The theory has contributed towards gaining substantial knowledge, insights and values in terms of nursing discipline particularly in the domain of self-care and nursing system. The theory is also ascertained to be potentially useful in regulating nursing practice. The Orem’s theory has been used more regularly in myriad nursing applications. Accordingly, nurses using Orem's theory is anticipated to work diligently in determining self-care requirements and capabilities of the patients (Hanucharumkul, 1989). Use of This Theory in the Area of Nursing Over the years, Orem’s grand theory is applied in varied situations. The application of the theory is identified to be ranging from the areas like practice, education and informatics to administration level. In the context of nursing practice, Orem’s theory can be applied in formulating disease management intervention. The theory can also be applied to resolve the problems faced by the patients. The theory is advocated to be applied in the nurse-patient environment for providing better and effective care to the patients. In addition, the theory is also ascertained to be useful in changing the behaviors of the patients by motivating them to recognize and share their feelings along with thoughts (Comley, 1994; Parker, 1993). In the context of education, Orem’s theory can be applied in teaching the patients about how to conduct self care activities, which would aid them to get emotionally stable. The theory can also be utilized in the context of assessing patients' self care needs based on which appropriate care plan can be devised, implemented and re-evaluated. The theory can also be used to organize as well as structure nursing knowledge and practice. In the context of informatics, the theory is determined to be effective in promoting the ethical use of healthcare informatics. Besides, the theory can also be used in conducting research and designing effective nursing staff education program. In addition, relating to area of administration, the model can find its applicability in appraising the performance of the nursing staff (Comley, 1994; Parker, 1993). Conclusion From the above analysis and discussion, it can be ascertained that several models of nursing practice have been evolved over the previous few years. In this regard, Orem’s general or grand nursing theory is ascertained to be one of the significant achievements in the field of nursing. The theory is ascertained to be the collection of three sub theories that embrace self-care theory, self-deficit theory and nursing theory. Specially mentioning, the notion of inductive thought can be related with the development of Orem’s conceptual model. The concepts articulated in Orem’s theory are observed to be interrelated. It can be apparently observed that the above discussed theory of Orem is principally based on five explicit assumptions. To conclude the development of Orem’s theory, it is duly considered to provide immense support in the field of nursing practice. The theory is ascertained to be useful in varied domains including nursing practice, education, informatics and administration. The increased level of applicability of this theory is determined to contribute towards its frequent and widespread use in nursing practice. Nevertheless, it can be argued that more clarity is needed in order to ensure that the theory is applied in any particular situation in an effective manner with the deliverance of varied positive outcomes. References Comley, A. L. (1994). A comparative analysis of Orem's self-care model and Peplau's interpersonal theory. Journal of Advanced Nursing, 20, 755-760. EI-Kader, N. A. (n.d.). Self-care deficit theory. Retrieved from http://up.edu.ps/ocw/repositories/pdf-archive/New%20orem%20theory.pdf Hanucharumkul, S. (1989). Comparative analysis of Orem's and King's Theories. Journal of Advanced Nursing, 14, 365-372. Masters, K. (2014). Nursing Theories: a framework for professional practice. USA: Jones & Bartlett Publishers. Parker, M. E. (1993). Patterns of nursing theories in practice. USA: Jones & Bartlett Learning. The University of Tennessee. (2014). Theory based nursing practice (TBNP). Retrieved from http://www.utc.edu/nursing/pdfs/classes/orem-handbook.pdf Read More