The Concept Analysis
The Concept Analysis
In our daily lives, it is expected for us to look over and take care of ourselves. However, there are limitations, which hinder us from doing and performing such activities. That is why; we need other people to continue activities we cannot do. For instance, when we are experiencing pain or any disease, we go to healthcare institutions so that healthcare professionals can attend to our needs. These individuals, especially nurses, are required to provide healthcare needs to patients. Thus, nursing models and theories are established for the purpose of advancing the discipline and addressing issues and concerns regarding the professional practice of nursing (Parker, 2001). One of the most common nursing theory used in the practice of nursing is Dorothea Orem’s Self-care Deficit Theory, which discusses the goal of nursing in the patient’s life. It gives people the different perspectives regarding patients, nurses, and the interactions between them (University of Tennessee, 2014). It comprises of three sub-theories namely, Self-care, Self-care Deficit, and Nursing System. The focus of this paper is the concept of nursing and how it provides care to individuals. This can overcome certain diseases and sustain health and life. The Theory of Self-care deficit by Dorothea Orem and the concept of nursing system is further analyzed in this paper. In addition, defining attributes, antecedents and consequences, empirical referents, model cases and alternatives are provided.
The Concept of Nursing System Defined
The primary purpose of the General Theory of Self-care deficit developed by Dorothea Orem is the identification of possible deficits in an individual’s self-care and eliminate or alleviate them. Orem illustrates that the process of the nursing discipline is a kind of system, which permits diagnosis of the need for care, planning of the exact procedure, and intervention. In order to conduct this process, the following criteria must be observed: self-care requisites must be identified; needed self-care skills must be identified; therapeutic demands must be identified; and assistance in nursing systems must be thoroughly planned (Tomey & Alligood, 2002). The Theory of Nursing System is one of the sub theories of the Self-care Deficit Theory. According to Taylor (2006), this theory explains and describes how the self-care needs of the patient will be met by the patient himself, the nurse, or of both of them.
Literature Review
In Orem’s Self-care Deficit Nursing Theory, the term self-care is the primary concept that is being explained. This term refers to the practice of activities that are being performed and developed by individuals in different periods, which aim to maintain and preserve personal well-being and life (Orem, 2001). It is also defined as a universal concept which covers all aspects of experience including daily activities which are both basic and instrumental (Queirós, Vidinha, & Filho, 2014). Her aim was to define the concern and goal of the nursing practice. She then discussed that nursing’s concern is that nurses should provide care to individuals and that the nursing’s goal is to overcome the limitations of humans (Berbiglia, 2010). In addition, nursing is a kind of discipline which makes use of clinical judgment in the provision of care to enable people to maintain, advance or restore health, to cope and alleviate suffering and other health problems, and to promote the best possible quality of life, even until death (Royal College of Nursing, 2003). That is why nurses are required to follow certain theories to their practice in order to attend to the needs of patients (Davidson, 2012). With this, Orem’s theory focuses on the demands of individuals to self-care, which nurses can provide through certain actions to promote well-being and life (Shah, Abdullah & Khan, 2015).
The Self-care Deficit Theory involves three interrelated sub theories which are the Self-care theory, Self-care deficit theory, and the Nursing systems theory, though the focus of the paper will be the third theory. Nursing systems, as defined by Barroso and her colleagues (2010), targets interventions which are based on the self-care needs of patients to perform daily activities developed by nurses. Three types of practice of the nursing discipline in nursing systems have been identified by Orem. These are the fully compensatory system, partly compensatory system, and supportive-educative system. In the fully compensatory system, individuals cannot perform tasks needed for self-care that is why nursing replaces them. For the partly compensatory system, individuals need nursing only to carry out activities they cannot perform on their own making them work together to achieve the desired self-care goals. Lastly, the supportive-educative system requires educational tools and resources and is applied when individuals can perform activities of self-care although they still need nurses to supervise and teach them to carry out these activities. This system can also be relevant to caregivers, which are informal duly trained to provide nursing care (Marriner Tomey & Alligood, 2002).
Defining Attributes
In Orem’s theory of nursing systems, three attributes are identified. These are the interpersonal relationship between the patient and the nurse; nursing agency, and therapeutic self-care demand.
Relationship between patient and nurse
Nursing systems involve a deeper interaction between the patient and the nurse, as they are the key players in order to address healthcare concerns. Patients are primarily required to know their self-care demands so that it would be easier for healthcare professionals to know what areas of self-care they need to address. On the other hand, nurses should have the desire to help other people who are in need so that they can reach the patient’s self-care goal. They should communicate with one another because new knowledge, skills, and proper attitude can emerge from this relationship. In addition, mutual trust will be established which contributes in reducing the anxiety of patients resulting to better patient experience (Rortveit, et. al, 2015).
Nursing agency
Orem’s theory relies on the notion that nurses should assist in helping and providing service to patients. Nursing systems are usually done through the concept of nursing agency, which is defined as the skills, and personal experiences of nurses through their education and practice of the discipline that can help assist patients (Orem, 2001).
Therapeutic self-care demand
The patient’s therapeutic self-care demand, according to Banfield (2011), is a representation of all the self-care requisites of a certain patient in a given time and the mechanism through which the self-care requisites can be established.
Antecedent and Consequence
Antecedent
Before applying the right type of nursing system in a certain case, nursing assessment is important as this will identify the potential problems, which may have contributed to the self-care deficit of an individual and other factors that may occur during nursing care. Self-care requisites of the patients are collected as a source of data in order to determine why nursing is needed and establish and implement a plan of self-care and develop possible interventions and nursing system.
Consequence
After a nursing system is applied to a certain case, implementation and evaluation are two critical stages to achieve the desired health result. Nurses assist patients and their family in terms of self-care concerns, collect evidences, and evaluate whether the results achieved are the same with the results specified in the design of the nursing system applied. It is definitely important that patients must go back to their fully functional self or normal baseline, at least.
Empirical Referents
The empirical referents of nursing systems used to measure patient satisfaction include the level of satisfaction towards the nursing care service obtained, functional status which can address whether the patient can already perform activities toward self-care and if deficits are already reduced or gone.
The empirical referents of nursing professional experience include the years of nursing education, the degree acquired such as bachelor’s or master’s, and the years of nursing experience in different settings such as public hospitals or private institutions.
Model Case
One model case is a patient suffering from mild osteoarthritis. He is residing at the rural area but needs to be transferred to an urban hospital as this provides the newest medical equipment and drugs that are beneficial for the patient. With Orem’s theory, this case can be justified as this illness affects body functioning. The institution and healthcare professionals can assess why the patient is deficient. His self-care requisites and therapeutic demands are identified so that a certain nursing system plan can be established. Since he can still do self-care activities, he only needs supportive-educative system and the nurses can instruct the proper exercises he should do. In addition, nurses trained in physical therapy are the ones that should provide care for the patient. Lastly, after treatment, the nurses are required to evaluate whether the illness is reduced and the patient can already feel that he can perform all daily activities without limitations.
Alternative Cases
Borderline case
One borderline case is a patient suffering from dementia. Orem’s theory is applied as the patient receives the nursing care he needs, specifically partly compensatory system, because he cannot perform other activities of daily living. Also, deficits in brain functioning can be observed. Because the illness is a type of gradual deterioration of memory, this kind of deficit is difficult to handle because the patient cannot go back to his fully functional self and cannot perform the tasks that are required to take care for himself. That is why Orem’s theory cannot fully address this case.
Contrary case
One contrary case is a patient suffering from schizophrenia. An intern who is new in the nursing practice is assigned to provide care to this patient. Because of the lack of experience, he does not know what type of nursing system that can be applied to the patient. This patient also displays bizarre movements indicating that he cannot perform self-care activities which makes him difficult to handle. As a result, the theory is not applied to this case as the nurse cannot provide the patient his needed care and the patient did not receive any benefits that could alleviate his illness.
Conclusion
Every human life is important that is why many ways are being developed in order to lengthen and promote personal well-being, health, and life, and at the same time, reduce and alleviate pain and illness. Dorothea Orem’s Self-care deficit nursing theory is very beneficial to healthcare professionals especially in the practice of nursing as this tackles the factors that contribute to self-care. Its primary aim is to benefit the patient while advancing the discipline of nursing. This emphasizes the role of nurses in the patient’s lives, to attend to their needs and help them go back to their fully functional self.
Reference
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Barroso, L. M. M., et. al. (2010). Utility of self-care theory to assist the bearer of Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome. Acta Paul Enferm, 23(4), 562-567.
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Queirós, P. J., Vidinha, T. S., & Filho, A. J. (2014). Self-care: Orem’s theoretical contribution to the nursing discipline and profession, Revista de Enfermagem Referencia 4(3) 157-163.
Rortveit, K., et. al. (2015). Patient’s experiences of trust in the patient-nurse relationship: A systematic review of qualitative studies. Open Journal of Nursing, 5, 195-209.
Royal College of Nursing (2003). Defining nursing. London: Cavendish Square.
Shah, M., Abdullah, A., & Khan, H. (2015). Compare and contrast of grand theories: Orem’s self-care deficit theory and Roy’s adaptation model. International Journal of Science and Research, 4(1), 1834-1837.
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