Orem’s Self Care Deficit
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Orem’s Self-Care Deficit Theory
Introduction
The nursing theory is meant to stimulate and support knowledge development related to description and definition controlling the nursing phenomena. Self-care theory, as well as other nursing theories, are based on human needs and the purpose of practice. Dorothea Orem, a nurse, came up with this theory. In her approach, she nested the other three sub-theories. These are the theories of care, the self-care deficit theory, and the nursing systems. In her metaparadigm, she describes nursing to be more than ordinary assistance necessary to meet the need for self-care. This theory also suggests that the nursing profession can be adept under three main realms. These are self –care, self- care deficit, and the nursing systems. These parameters can be used to asses if in wholesome person- care deficit provides a prudent and efficient framework for learning, practicing, and implement nursing care in a nursing environment, which has led to criticism of health.
Self-care Theory
Orem’s interest in nursing is a pillar in which nursing theory is made. McEwen & Wills, 2017) argues that each of the parameters in Orem’s theory can stand on their own or influence the factors affecting people. Nursing is viewed as an art in which the nursing officer gives persons with an inability to meet self-needs specialized assistance with intelligence and evidence basis. Direct care is provided to groups requiring to meet the self- care. The environment also determines an intervention to be made due to the existence of different social and cultural affiliations that may push for the change. Orem sees health as being structurally and functionally whole. It is also a state that encompasses both health of an individual and a group as a mirror to reflect self- agency.
The self- care is seen as a human regulatory function that initiates action geared towards supplying necessary materials required to ensure a continued life growth and maintenance of integrity. The absolute ability to get involved in activities that promote one’s well-being and Orem refers to health as self- agency. However, individuals may lack the power to meet their self-agency, thus calling for specialized assistance. When this specialized care is unavailable, the resultant state is always undesirable health outcomes. Orem’s theory also acknowledges the efforts or continuous actions undertaken by an individual over time to meet self-care needs. The factors that influence self-care agency encompass the person’s ability to interact with social systems oneself and maintain functionality in health and social actions. They include, age of an individual, the sex, social, cultural factors family systems, and environmental issues (McEwen & Wills, 2017). These determine the ease at which an individual can get access to health resources and services.
Self-care Deficit Theory
The self- care deficit exists where the needs outdo personal willingness and ability to meet the self-care agency. Taylor & Orem (2006) the deficit is controlled by both human and environmental factors. The self –care requisites are actions performed by an individual or from an individual with a motive of controlling social and environmental factors that influences social functioning and development. They are developmental, universal, and self-care requisites associated with health care discrepancies. When a self-care deficit outdoes the self- care agency, there is a need for intervention. This, in Orem’s theory, is referred to as therapeutic self-care demands. Here the nurses’ assistance in meeting the self-care needs of a patient is needed to ensure the client at hand lives a comfortable life as the self -care needs are met.
The environmental contribution is evident in Orem’s theory. She suggests that human being is in continuous communications and exchanges with one another as well as their environment to remain alive and functional. Mature human nature endures deprivations in accepting others make up for their self- care deficits. Groups of human beings allocate their responsibilities to provide care to group members who experience hardships in making necessary and deliberate actions about their self-care (Taylor & Orem, 2006). Therapeutic intervention from a nurse is provided when the self- care deficit is evident, especially when age or disease factor is the root cause of the need.
The Nursing Systems
Orem’s theory would not be complete without a fundamental concept of the nursing systems. Bastable, (2017), this system develops mechanisms and roles role relationships through which nurses address their patient’s health and self –care needs. Here the legitimate nurse uses evidence-based criteria to conclude that the client’s therapeutic self –care demands exceeds available self -care agency, thus leading to the need for nursing. The nursing agency is a component of the nursing system; it compensates and caters to people with evident self-care deficit. The people equipped with the right attributes and skills like nurses are employed to provide for those in need of care.
During a plan for intervention, Orem’s self- care deficit theory tables the three levels of nursing systems in responses as follows. The first is a wholly compensatory system where the client is incapable of attaining any level of self- care on their own and ultimately depends on the policy for nursing care. The second case represents a partial compensatory system. The nurse involves the client in conducting their healthcare-related procedures. The patient, however, cannot manage on their own. Finally, there is a support educative system. Here the patient is capable of providing their own self -care (Davidson, 2012). The nurse provides support and education on how the patient should conduct the procedures.
Implementation of Orem’s Self Care Deficit Theory
Orem’s self- care deficit theory is effective when offering palliative care primarily to the patient with chronic conditions (Afrasiabifar et al. 2016) notes that several research studies have been conducted to validate the importance of Orem’s nursing theory in daily nursing procedures. Among many ones that have proven Orem’s theory as a fundamental tool in nursing intervention is the model created aiming at reducing fatigue and symptoms associated with nervous system defects in demyelination disorder known as multiple sclerosis.
Multiple sclerosis is an autoimmune disorder in which there is an impairment of transmission of nervous impulses due to progressive demyelination and accumulation of plaques cerebral and spinal cord axons. It occurs in various types, which are as follows; the first is relapsing-remitting, progressive- relapsing, primary progressive, and secondary progressive. The condition has a wide range of symptoms such as fatigue, motionlessness numbness, pains, and tremors, visual and sexual disorders. Fatigue has been identified as the primary symptom reported by the majority of the patients. So far, no method has proved to be decisive in treating multiple sclerosis (Afrasiabifar et al. 2016). The use of immunosuppressive pharmacotherapy in palliative care modality is not effective in mitigating fatigue and other psychosomatic complications in patients.
Orem’s self -care model has been of help in the application of total care. With improvements, the model has been used to upgrade the patient’s self- care skills. Since multiple sclerosis treatment modalities require long term modalities of treatment, therefore, initiation and maintenance of self-care skills by nurses have played a significant role in the management of multiple sclerosis patients. Research studies have been conducted to examine the effect of Orem’s self- care model in the management of fatigue in a patient with multiple sclerosis. The researchers conducted a study using a single-blind randomized study. (Afrasiabifar et al. 2016) explains that the participants’ inclusion criteria were a confirmed diagnosis of multiple sclerosis. Upon the results, interventions were planned to base on Orem’s self-care model. A comprehensive assessment of self -care needs, which are developmental, universal, and health deviation needs, was done. A nursing diagnosis of a person followed the assessment- care deficit then goal-setting following nursing system design. The goal system model incorporates wholly, compensatory, and supportive- educative nursing systems. Finally, the method of helping, for example, teaching, supporting, and providing for the environment is done. Another routine nursing procedure in the nursing process follows up, for example, implementation and evaluation.
The researchers identified self -care deficit issues as follows; fatigue related to hyperthermia, disease process, disease complication, and adverse drug effects. The intervention method for this nursing diagnosis would be providing for the patient’s environment and guiding the patient. Hazard prevention related to visual disorder, which is intervened by supporting and guiding the patient to enhance safety. Comprehensive Orem’s theory has been covered as the researcher first identified what self -care needs they require, for example, activity or rest, prevention of hazard, and maintenance are of normalcy. Implementation modalities depending on nursing include massages, relief of pain, warm water shower, and rest are appropriate for pain management. To cater to visual disorders, one uses a shield for one eye, books with larger fonts, and designing the house environment would be appropriate. The results of the study indicated that Orem’s self –care model was all-inclusive; thus, the reduction of fatigue and improvement of daily activities was evident (Afrasiabifar et al. 2016). This shows efficiency in the nursing process when one applies Orem’s self-care deficit modalities
Women suffering from chronic leg ulcers and sickle cell disease experiences a lot self- care deficits issues related to the disease process and resultant signs and symptoms of these conditions. According to (Lacerda et al., 2019), Sickle cell disease is a hereditary genetic condition that impairs the morphology of erythrocytes, thus impairment of oxygen transportation to various tissues. Leg ulcers, on the other hand, is a severe dermatological condition with significant morbidity burden in communities. Both have a prevalence rate of 22%. Similar to the research done on multiple sclerosis patients, the study was meant to identify self- care deficits in women with the sickle disease and leg ulcers.
The findings of the researchers classified the deficits according to universal self –care, developmental, and health care deficits. Most of the women who presented with the condition had a self-care deficit related to sociability. They reported embarrassing situations experienced due to odor from the ulcers. They also experienced nutritional imbalances as a result of low intake following the myth and misconceptions surrounding certain types of food like fish and certain vegetables. Developmental self –care deficits are caused by frequent hospitalization, causing a break from regular activities (Lacerda et al., 2019). Universal self- care deficits are associated with impairment of sociability deficits brought about by the presence of ulcers, thus causing isolation and suffering.
Conclusion
Other studies have been done to support the relevance on self – care deficit theory, for example, nutrition, status, and fatigue in patients with colorectal cancers, among others. Therefore Orem’s Self-Care Deficit theory concepts view people as capable of taking necessary actions to promote their health. The nursing system mitigates the effects caused by self -care deficits on the patient.
References
Afrasiabifar, A., Mehri, Z., Sadat, S. J., & Shirazi, H. R. G. (2016). The effect of Orem’s self-care model on fatigue in patients with multiple sclerosis: A single-blind randomized clinical trial study. Iranian Red Crescent Medical Journal, 18(8).
Bastable, S. B. (2017). Nurse as educator: Principles of teaching and learning for nursing practice. Jones & Bartlett Learning.
Davidson, S. (2012). Challenging RN-BSN students to apply Orem’s theory to practice. Bulletin luxembourgeois des questions Sociales 2012 Volume 29, 29, 131.
Lacerda, F. K. L., Ferreira, S. L., Nascimento, E. R. D., Costa, D. O., & Cordeiro, R. C. (2019). Self-care deficits in women with leg ulcers and sickle cell disease. Revista Brasileira de Enfermagem, 72, 72-78.
McEwen, M., & Wills, E. M. (2017). The theoretical basis for nursing. Lippincott Williams & Wilkins.
Taylor, S. G., & Orem, D. E. (2006). Self-care deficit theory of nursing. Nursing Theorists and Their Work. Missouri: Mosby Elsevier.