Introduction
According to Marriner-Tomey (1994), theory is defined as the purpose of providing knowledge to improve practice by describing, explaining, predicting and controlling phenomena. As cited by Perry (2001), a nursing theory is a conceptualization of some aspect of nursing communicated for the purpose of describing, explaining, predicting nursing care. All nursing practice is based on nursing theories as theory provides nurses with a perspective to view client situations, a way to organize data and a method to analyze and interpret information (Perry, 2001). Hence, the study of theory helps develop analytical skills, challenge thinking, clarify values and assumptions and determine purposes for nursing practice, education and research.
With the emphasis that nursing professions are evidence based, nursing theories provide a distinctive nursing focus on practice, facilitate communication among nurses, and foster the development of common goals for patient care (Keen et al., 1998). A careful selection of theory that will help nurses to be critical and innovation in practice is important. For such theory to be specifically related to a clinical environment, a rigorous, and systematic analysis of it is essential (Wotton, 2000).
There are many nursing theories which all the nurses are quite familiar with, such as Orem’s self-care deficit theory, Roy’s adaptation theory and Watson’s caring theory. Orem’s self-care deficit theory viewed self-care is a development and the use of personal health practices and coping skills. These two individual factors are important determinants of health (Federal, Provincial and Territorial Advisory Committee on Population Health, 1994).
The notion of self care is central to Orem’s model and is appealed to me as it fits my belief that the nurses help patient to meet their self-care needs. According to Gantz (1990), nursing work in self-care focuses on identifying and assessing self-care needs and abilities, intervening in ways that meet these needs and evaluating the effectiveness of the interventions with clients. Hence, this model was chosen for this paper to enable me to relate closely to a number of areas within my hospital settings where patients are encouraged and educated to care for themselves.
Orem’s emphasis on self-care is similar to Henderson’s (1996). From a nursing perspective, the object of self-care is through the collaboration of clients, their families and support networks to assist the individual, sick or well, in the performance of activities contributing to health or its recovery (or to peaceful death) that he would perform unaided them gain independence as rapidly as possible (Henderson,1966). The objective of nursing, therefore, is to help that person live despite the illness (Blanchet 1996).
According to Fawcett (1995) and McKenna (1997), each nursing model is built around defining the four principal theoretical elements of nursing theory: person, environment, health and nursing. This paper will discuss concepts of Orem’s self-care deficit theory and its relationships between concepts of metaparadigm.
Person
Patients are individuals that constantly act to maintain a balance between their abilities to achieve self-care and the various therapeutic self-care demands (Orem, 1991) that are needed for their self-care abilities. Orem (1991) believes that an individual or client is a biological, psychosocial being with the potential for self-care, meaning a capacity or willingness to provide care for themselves towards the maintenance of life, health and well-being. They may or may not be dependent on others. An imbalance between therapeutic self-care demands and self-care agency, by self or meaningful other leads to a self-care deficit. When this occurs nursing intervention is required. However, Orem does not appear to extend her model to address the nurse-society relationship and lacking in the area of public education (Goodwin, 1990).
Majority of our patients in my ward belong two the following groups. Those who do not experience any changes in their physical structure, for example, admitted for hypertension, hyperglycemia, etc. This group of clients is usually middle age group and most independent. The area of my working is to meet the needs of nursing care by them. The clients’ anxiety level are assessed, adequate education of disease process are rendered, treatment plan, outcomes and discharge plan are all performed during their admissions.
On the extreme, we also have clients who are experiencing changes in their physical structure, for instance, those who have undergone surgeries, like total hip replacement, below knee amputation, etc. Nursing interventions are only required when the patients or their significant others are not able to take charge of their well-beings. Any self-care deficit will be identified preoperatively and postoperatively. Clients will also be continuously assessed and areas that needed to be advocated are identified. Nursing care will be applied in respect of ethical consideration to promote the concepts of cliet autonomy, nursing autonomy, advocacy and paternalism (Yeo, 1989 as cited in Wotton, 2000).
Environment
According to Fawcett, (2005, p.5), “environment refers to the person’s significant others and physical surroundings, as well as to the setting in which nursing occurs, which ranges from the person’s home to clinical agencies to society as a whole. It also refers to all the local, regional, national, and worldwide cultural, social, political, and economic conditions that are associated with the person’s health”.
Any individuals became ill and admitted to a hospital can no longer control their surroundings and it added stresses and demands on their self-care capabilities. In our ward, efforts were being made to ensure that patients were not deprived of a safe and comfortable environment. Nurses are also part of this environment and their role is to help the clients when appropriate. Nurses work closely with the housekeeping, maintenance and support services to provide environment that is conducive and to provide protection for the clients from hazards and hostile surroundings, like poor lighting, slippery floor, etc. Hence, it will bring out positive experiences and makes the clients feel comfortable and respected in the abilities to care for themselves.
There is a lost of control whenever the clients left the ward. A nurse from our hospital will work closely with them and their caregivers to ensure that their home environment is conducive for the development and encouragement of self-care. For example, home visits were made to ensure that modifications to be made in the homes so that the clients’ daily activities were not compromised.
Health
Health is often viewed as “dynamic and ever changing” (George, 1990, p.109), and Orem (1980) sees health as perfect when living things are structurally and functionally in whole. The description of health incorporates physical, psychological, interpersonal and social elements towards a state of wholeness and human integrity (Orem, 1991).
Health is achieved through a process of self-care which is one’s actions directed “to regulate one’s functioning in the interests of one’s life, integrated functioning and well-being” (Orem, 1985, p.31). However, when a person experienced injuries, disease or illness, he or she will likely to have additional demands for self-care.
The idea of collective responsibility towards health is sympathetic to the ideal of collaborative action within primary health care. As such, our nursing practice in the ward involves (1) Health maintenance, which involves nursing activities, such as, smoking cessation programme that will help patients to remain healthy. (2) Health promotion which aims to encourage patient to take charge of their own health and well being. It involves activities such as talks on various exercise programmes, healthy lifestyle programme, etc. (3) Health restoration which involves nursing activities to help to improve health. For instance, teaching on the effects of medications, teaching on the exercises to get patients to higher level of fitness, etc.
Nursing
The metaparadigm concept nursing in Orem Self Care model refers to “the actions taken by nurses on behalf of or in conjunction with the person, and the goals or outcomes of nursing actions. Nursing actions typically are viewed as a systematic process of assessment, labeling, planning, intervention, and evaluation” (Fawcett, 2005, p.5). The role of the nurse in the ward is a complementary one and it is closely related to the individual client’s need and his ability to undertake self-care. Effective and efficient nursing actions can contribute to the accomplishment of a person’s usual and therapeutic self-care by compensating for or aiding in overcoming the physical or psychic conditions or disabilities that hinder one from rendering self-care effectively (Orem, 2001).
According to Meleis’s (1997) views of Orem’s theory of nursing system which include wholly compensatory nursing, partly compensatory nursing and supportive-educative or development nursing. In wholly compensatory nursing, client will be provided with total nursing care, such as elimination, hydration , nutrition, pain management, wound management, etc., to prevent any complications. The partly compensatory nursing will involves both the nurse and the client in meeting self-care needs. This is will be delivered in conjunction with supportive-educative or development nursing, which involves a system to assist the client in decision making, behaviour control, and acquire knowledge and skills.
In the ward, nursing actions evolves around assisting in decision making; checking, adjusting and meeting self-care needs. This is only made possible when nurses are made to go through various training in both basic and advanced nursing skills. It is necessary to equip the nurses with the relevant skills to help their clients. On many occasions, nurses will also need to work hand in hand with clients’ families’ members in conjunction with supportive-educative or developmental nursing. It will ensure that the client is coping well and complying with safety measure education after discharge.
Conclusion
Orem’s theory encourages a more responsible and independent wellness of an individual as a whole. The model may result in shorter lengths of stay for the clients and a reduction in unnecessary expensive hospital care. The theory has also emphasised on home care with support systems and specifications as to when nursing is needed. By working on this assignment, it has allowed me to appreciate the holistic nursing care provided by my hospital in relation with the four aspects of metaparadigm for my client who has self-care deficit. The application of Orem’s theory in my clinical setting has also included clients’ significant others while focusing on enhancing and restoring individual optimum health.
In times of growing budget restraints and the hospital funding based on case mix, Orem’s model may provide attractive factors for the nursing administrators to consider the model serious. It is undisputable that it has the potential to be cost effective and at the same time encourages a more responsible and independent client population.
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