Importance of Theory
The nursing profession has become an integral component in the delivery of quality health care services. In order to enhance the quality of nursing practices, nursing theories are utilized as standards of practice that use scientific disciplines to guide research that enhances nursing knowledge, explain, predict and control the desired outcomes of nursing care practices. Generally, nursing theories help build a framework that will help nurses examine situations, establish a structure for the organization, analysis and assist in the decision making process in the delivery of health care services. Nursing theories are necessary in order to further enhance, develop knowledge and improve the best nursing practices, education and research. The purpose of nursing theories is to guide the assessment, intervention, and evaluation of the nursing care and to define the best measures for the delivery of quality nursing care services. The main concept of nursing theory is to explain, describe, predict and prescribe nursing care to produce the best outcomes.
The theoretical discipline of knowledge in the nursing practice is essential in addressing issues and questions in a particular practice setting where the nurse provides care for a specific population (Parker, 2015). One of the commonly used nursing theories in practice that is widely used in the nursing profession is Dorothea Orem’s Self Care Theory. Orem's self care model of nursing is conceptualized based on the wholeness of the individual. The holistic model guides the nursing practitioner in considering the physical, psychological, social and spiritual aspects of the individual patient (Wilson, Woollands and Barrett, 2014). This model of nursing theory is widely used in the primary care settings and encourages patients to become as independent as possible. This paper aims to describe the importance of nursing theories to the nursing profession, with emphasis on explaining the foundation and theoretical concepts of Orem's Self Care Theory and its application of the professional nursing field of practices.
Importance of Nursing Theory
Nursing is a discipline that requires advancement and continuous research to build the theoretical knowledge base that will enhance the profession. The improvement of patient safety and quality of outcomes are among the frameworks of the nursing profession. Nursing theories aim to conceptualize the ideal assessment, intervention and evaluation of the nursing care and practices that will produce the best outcomes in the delivery of patient care. The different theoretical models in nursing are being used in developing the frameworks in nursing education, research and practices. It provides a landscape for the foundation of nursing practice, improve the development of nursing knowledge and indicate which direction nursing curriculum should be developed in the future. When nursing became a profession, there was a recognition of the need for specialized knowledge that will guide the practice and teaching of nursing. Nursing theory is very useful in the nursing profession as it provides the concepts, methodology and principles that guide nurses in the decision making process in a given situation or patient condition (Roussel, 2014).
Nursing theories are generally incorporated in the nursing master's program because it is an essential element in the nursing practice and profession that helps in developing a comprehensive and holistic approach to care. Alligood (2014) also emphasize the emergence of nursing degree programs that seek to address the need for specialized clinical nursing practice and nursing theories become an essential foundation in the research programs that aim to enhance knowledge based practices in the field of nursing clinical practice. The practice of the nursing profession demands the application of a nursing process consisting of well established problem solving approach and the systematic application of assessment, diagnosis, plan and evaluation of individual patient care (Standing, 2010). The nurses' role demand the application of problem solving, critical thinking, clinical judgment and decision making. It also involves the application of personal values and experience which are made more meaningful by the nursing theories as bodies of knowledge that aid in enhancing the nursing profession with a better understanding on the science of care, thereby making the nursing profession distinct from the other healthcare professions. The theoretical development in the concepts of nursing care and practices will aid the nursing practitioners to articulate their purpose within a complex healthcare environment with more defined roles and responsibilities (McCrae, 2011). One area of concern regarding the use of nursing theories within the profession underpins the philosophical beliefs and values of the author and is critically considered to be within a narrow perspective. Some critics would point out that the use of nursing theory does not underpin the relationship between the concepts and the outcome on patient care for being descriptive and fails to present a practice based discipline.
The self care theory was conceptualized by Dorothea Orem, an American theorist who initially developed the theory for academic use. The theory was first published in the Nursing: Concepts of Practice in 1971 which was subsequently published in 1980, 1995 and 2001. The key concepts of the theory is directed towards the capability of a person to regulate their own functioning and development. Orem hypothesizes that individuals possess the skills, knowledge, motivation and behaviors that allow them to carry out the essential activities for a healthy life. Nurses are regarded as a nursing agency that helps the individual address his deficits to meet the demands for living healthy or reducing the demands of an illness from the patient by teaching them new skills and knowledge. The theory focuses on the deliberate practice actions of nurses that are carried out in order to meet the therapeutic self care demands from the individual with the help of nursing interventions (Fitzpatrick and Kazer, 2012).
The self care theory addresses the person both as a single or social entity and as the object to which the nursing care is directed. It also directs the concept towards health which is regarded as the ability of one to reflect on himself, to symbolize one's experience and his communication with others. The environment is regarded by the theory as consisting of the family, community and culture with biological, physical and chemical components. The theory conceptualizes the nursing profession as one that delivers a specialized assistance to individuals with disabilities that is more than an ordinary assistance to help them meet the need for self care. The self care theory has a potential use within a student's master track as a nurse practitioner because it introduces the concept and knowledge of self care that enhances the nurse's ability as a care provider in improving the ability of the patient towards addressing their self care deficit, especially when the patient or his family members have limited provision in providing effective care. Nursing agency as part of the concept of the theory can be a complex system of care that helps nurses to act, know and be able to meet the therapeutic needs of the patients by addressing their self care, thus integrating the theory to the nursing masters education will be highly beneficial.
Orem’s Self Care Theory and the Nurse Practitioner
The professional nurse practitioner is defined by the self care theory as a nursing agent that provides a primary care to patients who has a self care deficit to help them improve their ability to address their health care needs and optimize patient outcomes. The development of the theory demonstrated the understanding on what should be done and what needs to be done in the continuing development of practical science of nursing that use the conceptualizations and constructs of self care deficits (Renpenning and Taylor, 2013). The implication of the self care theory to the nurse practitioner is that it assists in the actions of nurses on the deliberate selection of care that will optimize an individual or group to maintain or improve their condition among themselves or within their environment. The goal in the primary nursing care is to render the patient and their family to become more capable in meeting the self care needs of the patient. The theory demonstrated the role of a nurse practitioner in holistically providing support to the needs of the patient to enhance his ability to care for himself through the use of technology, supportive system and educational approach.
Basavanthaappa (2011) indicate that Orem's theory on self care explains the role of a nurse practitioner as one that helps people meet their own therapeutic self care demands. This may be through the means of a wholly compensatory approach where the nurse practitioner helps to compensate for the total disability of the patient to perform self care ability. It can also be through partially compensatory nursing care that helps the patient's partial inability to carry out activities. The nurse's role may also be supporting-educative where the nurse assists the patient in the decision making process and helping them acquire skills and knowledge to help them in their condition.
An example on the application of the self care theory in the nursing practice has been demonstrated in a case study by Wagan (2013) on a 65 year old post amputee female patient. The patient was admitted for below the knee amputation to the medical surgical unit in a hospital. She suffered from diabetes and the poor healing of her wounds on her foot resulted in the amputation of her lower limb. She is now physically disabled and suffering from mental anguish because of an amputated limb. By applying the theory on self care, the goal of the nursing practice under this circumstance is to provide assistance to the patient in adequately preparing her to engage into self care to improve treatment outcomes and improve the quality of her standard of living. Under the patient condition as a post amputee, the wholly compensatory approach in nursing care was applied as well as the supporting educative approach. The patient was taught how to use the assistive device, learn the proper way of transfer, educated on stump care and diabetes care and the home environment was provided with proper assistive devices. Patient outcome demonstrated to be efficient.
The self care model of Orem was also applied in assessing the ability of a patient to meet self management requirements to improve her health condition. By using the concepts of the self care theory, nursing diagnosis necessitates the investigation of the patient's self care agency and the therapeutic demand for self care. The information was collaborated on the patient's response to the health problem and life processes. The patient realized that her weight loss problem was associated to her sedentary lifestyle that likewise contributed to her poor glycemic control problem resulting to obesity and fatigue. With proper nursing intervention, the patient was taught on the proper ways of weight management and glycemic control. This optimizes the self care agency of the patient in taking care of her health and to address her existing weight loss problem (Lunney, 2013).
Conclusion
Nursing theories provide for the theoretical foundation in improving the nursing profession as a discipline. It demonstrates to build concepts and principles that seek to enhance the nursing practice, education, and research to improve patient outcomes and to deliver quality nursing services. The self care theory of Dorothea Orem has gained a wide application in the clinical practice of nursing. Its theoretical framework is to view human beings as capable for providing care for themselves and provisions to manage their condition to sustain life and their health at optimal condition. It views nurse practitioners as agencies that can provide support, education and even the technology as means and measures that will enhance the patient’s ability to cope, manage and improve their health and illnesses. Nurses are therefore the stewards of delivering primary health care services that enhances an individual’s capability towards self care that demonstrated effectiveness in the patient outcomes and treatment. By writing this paper, this author fully appreciates the significance of applying nursing theories both in the academic and clinical practice fields. The self care theory of Orem in particular has the practical application in strengthening the patient’s ability to learn new skills in self care and to help educate them about their health condition that builds their self confidence and ability to manage their condition.
References:
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