Orems Self-Care Deficit Theory: Case Study

Mr. Shoaib is a 62 year old male patient admitted to your ward. He has right ischemic CVA and resultant left site body paralysis. He has no sensation or movement in the left side of body. He has lost his gag reflux and is unable to swallow food. An N/G tube is placed for providing him nutrition. Mr. Shoaib is not able to change his position and is dependent on care givers for changing his position. He is also not able to carry out his routine daily life activities. His family is worried about whether he would be able to regain control of his life or not. They are also worried whether they would be able to provide him the care he needs when he is discharged from the hospital.

As a nurse I am well equipped to meet the various needs of patients demonstrating self-care deficits. According to scenario the methods nurses can follow to address certain issues. As nurses I can help patients maintain their own personal hygiene by providing reminders and motivation for self-care. This could include daily prompting for activities like bathing and washing up. For dressing/grooming I can help their patients by recommending clothing that is easy to put on and remove, giving them privacy, and providing frequent motivation. For feeding I can help enable patients to feed themselves as soon as possible. By creating a conducive environment to eating (positioning the patient, etc.), patients can stay independent throughout their meals. Toileting a nurse should work to simplify toileting for patients. This can include using bedpans, suppositories, stool softeners, or commodes. Nurses should also be nearby in case of any accidents or falls. In swallow assessment and speech deficit nurses should work closely with speech pathologists to ensure that any type of speech deficit will not interfere with communication about care.

Introduction

Self-care is defined as the activities initiated and performed by individuals to maintain a high quality of life, health, and wellbeing, and it is considered as a learned attitude acquired through personal interest, education and medical experiences (Orem 2001; Avdal Unsal and Kizilci 2010; Hartweg and Pickens 2016). The theory explains what self-care is and why it is necessary to sustain life (Ozturk and Karatas 2008; Pektekin 2013). According to self-care theory, human beings are capable of defining and covering their own needs (Avdal Unsal and Kizilci 2010). Nurses, then, are expected to develop skills to identify self-care skills of care receivers and to strive to understand those skills. When self-care power is not properly identified, nurses are unable to do the following:

Make decisions about already present or potential self-care deficits and their causes.
Produce a sound method to deliver valid and reliable assistance as well as pick up and practice useful nursing systems (Yesilbalkan Usta et al. 2005).

Self-care was introduced by Orem as one of the components of self-care nursing theory. Orem recognizes human and environment as a single unit and believes that human and environment, and also humans themselves, influence each other reciprocally in this unit. Beliefs, social and cultural background, personal characteristics, and relationship between health care providers and clients are some of the factors which influence self-care behaviors. In addition, ethnicity, socioeconomic background, educational level, employment status, environmental factors such as pollution, sociopolitical variables, and lack of knowledge are other factors affecting self-care behaviors.

Importance

The importance of self-care concept is related to human’s need for maintaining and promoting health and recovery. Lack of healthcare services and inadequate access to health services for the whole community can increase expenditure of healthcare services. Self-care activities relieves symptoms and complications of diseases, shorten recovery, and reduce hospital stay and re hospitalization rate. It has been reported that lack of self-care knowledge in patients with chronic disease, such as CVA, is the main reason for frequent referring to healthcare centers and re hospitalization.[2,7]

Self-care model: principles

The deliberate action of self-care is essential for health and well-being and when, due to health-related self-care limitations, individuals are unable to meet therapeutic self-care demands and experience self-care deficits, nurses are needed to assist persons to accomplish self-care. The nurse and patient meet in the helping situation where nurses design, manage, and maintain systems of care. These nursing systems include the social, interpersonal, and technological sub-systems and are designed to assist persons to meet self-care demands and thus to meet self-care requisites in living day-to-day. The self-care model guides the nurse to focus on the individual and his self-care behavior in living day-to-day rather than on any specific problem, symptom, or condition.

Analysis

The purpose of the nursing theories is to provide an interrelating framework focusing on the nursing practice. The defined nursing theories promote better patient care, improve the status of nursing profession, and improve the communication between the nurses, and provide guidance to the researches and education (Keefe, 2011). Orems Self-Care Deficit Theory is more recommended for the acute-care setting, where a patient receives active but short-term treatment for a severe injury or episode of illness. Orem focuses on finding the self-care deficit of the patient and providing the necessary care to promote his or her well-being.

Creating an increased awareness of the need for a nursing theory in the field of nursing is an initial step in enhancing the level of professionalism among nurses. Orems theory, being appropriate to clinicians at all levels, should be considered as a frame work for the delivery of nursing care to patients .Future training and orientation programs for nurses could specify this model as the basis for care, identifying and correlating its various components to the various levels of care implemented by the nurse. To demonstrate the application of theory to practice more specifically, one can correlate the level of care and type of injury to the systems identified by Orem. Nursing care for patients with CVA and resulting sequel requires total care and relies on input from other disciplines as well. The patient is unable to perform any aspects of self-care. This level of care correlates with the compensatory system. While this type of care is delivered each day in the environment, bed side nurses can be aware that they are functioning from within Orems framework. The patient is encouraged to take part in his or her own dressing changes, and even family members are encourage to take part, in some cases. This level of care correlates with the partially compensatory system, where the patient is encouraged to take part in self-care and the nurse facilitates. This application of theory to practice is easily seen in the CVA patient. The are totally dependent on other for daily activity. Those patients who are preparing for discharge, either to home or to a rehabilitation unit. Again, the activities that nurses perform that assist the patient in reaching that goal are performed within Orems framework. Once these patients have been discharged, nurses may follow their care and progress through rehabilitation centers and/or support groups, or maybe even survivor functions. As the nurse seeks appropriate resources such as case management, psychological consulting, or physical therapy consulting for the patient, the goal is to assist the survivor to integrate not only back into society, but into the work force, school, and home. Some nurses also provide education to community and industry as these patients return to their previous activities. This level of care directly correlates to the educative-development system and demonstrates a systematic and thorough approach to care from within Orems framework. Orems view of nursing as helping systems in which the helping is determined by the degree to which the patient is able to accomplish his or her self-care requirements further supports these correlations.26 As with nursing systems, methods of helping can also be classified in terms of extensiveness of help provided: A) doing for another; B) guiding and directing another; C) providing physical support; D) providing psychological support; E) providing a supportive environment; and F) teaching.26

These definitions and concepts can be directly correlated to goals in caring for CVA patients. Recent debate exists that the inclusion of courses teaching the theories of nursing may not be necessary. This debate is in opposition to the basic tenets of this discussion which is that theory serves as a guide to all disciplinary practice, research, and education. Most of what a nurse does to perform the tasks of caring for a patient is guided by a mental construct. Nursing conceptual models serve as guides for and sources of both middle-range theory and practice theory.(1)

Nursing theory, as defined by Melees, 9 is an articulated and communicated conceptualization of invented or discovered reality (central phenomena and relationships) in or pertaining to nursing for the purpose of describing, explaining, predicting, or prescribing nursing care. This definition illustrates the importance of communicating nursing theory and the purpose of prescription of nursing care.9 Another valid point, as stated by George,9 is the importance of understanding the cyclical impact that theory, research, and practice have on one another. For instance, middle-range theory can be tested in clinical practice. Clinical research is the testing process for theory. The research process may alter theory or even invalidate it. The more research that is conducted about a specific theory, the more useful the theory is to practice.9 Practice should be based on the theories of the discipline that are validated through research; research findings are published in the periodical literature as well as in books.9 All of these inputs to nursing practice are hallmarks of a profession. As a profession, burn nursing has a need to expand, develop, and grow professionally. The first step in reaching this goal and ensuring the delivery of theory based care lies in the process of assuring that nurses will develop a better overall view of the why they deliver specific tasks for specific patient needs. This can be accomplished by teaching and relating nursing theory during nurse training. As stated previously, this approach would illustrate the importance of communicating nursing theory and the purpose of prescription of nursing care.9

Orem asserted that nursing care and self-care procedures include both intellectual and practical dimensions. Self-care theory demonstrates that nursing care is meant to determine why the care receiver needs nursing, to organize and plan a nursing care, and to maintain the sustainability of nursing care (Ozturk and Karatas 2008; Velioglu 2012; Pektekin 2013).

Orem defined self-care as the practice of everyday life activities that individuals efficiently and intentionally perform on their own on a continuous basis. Self-care refers to a learned attitude developed with personal interest, education and medical experiences (Tomey and Alligood 1998; Ozturk and Karatas 2008; Velioglu 2012). Orems theory is an umbrella theory that is comprised of three nursing theories, which are subsequently discussed (Orem 1990; Baker and Denyes 2008; Altay and Cavusoglu 2008; Pektekin 2013

Conclusion

Nursing theories are instrumental in explaining the professional phenomena and their relations with each other to conceptualize nursing practices and to identify nursing care. Self-care is defined as daily life activities initiated and performed by individuals to sustain life, health, and wellbeing, and it is considered as ones constant participation in their own health promotion. Self-care theory legitimizes the urgent need for self-care to maintain daily life activities, which requires the patient to participate in their own care. However, nurses can evaluate and compensate for the deficiencies of those unable to perceive and perform due to impairments in psychomotor functions.

Orems contribution to the field of nursing is substantial. Every day, nurses diagnose self-care deficits, and this allows them to craft solutions for their patients while staying mindful of their need to be independent and feel like they have control over their rehabilitation and treatment.

Department of Critical Care Nursing, Center for Nursing Care Research and Faculty of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
Department of Nursing, School of Nursing and Midwifery, Flinders University, Adelaide, Australia
Department of Medical surgical Nursing, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran