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NURSING CARE PLAN ACCORDING TO OREM

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APPLICATION OF OREMS SELF CARE DEFICIT NURSING THEORY IN THE CARE OF AN

ASTHMATIC PATIENT AND A CRITIQUE OF THE THEORY. R1606049

PATIENT PROFILE

Master X came to the hospital in the company of this parents with complaints of difficulty in breathing, wheezing, tightness of the chest, cough and vomiting exacerbated by the cough.

He states he is not been sleeping well for the past two days because of the above symptoms. This will be his sixth visit with similar complaints. In the past he was admitted, treated and discharged home. Master X is 16years old. He lives with both parents and a sibling in a compound house rented by his parents. The house has an untarred road running right in front of it. He is an adolescent in third year in junior high school. He is Christian and worships every Sunday with the Catholic Church. He likes to pay football, has a pet dog and his favourite meal is fufu with light soup. His father is very worried and states that he sleeps bare chested at night despite this being warned not to do so all the time. He and parents cannot tell if there are situations or incidents that aggravate attacks. He states that he is aware of his condition but does not carry his medication with him because he doesn’t want his friends to see him as weak and always sick. Both he and parents express concerns that condition seems to be recurring. On assessment client is agitated and irritable, cyanotic with vital signs reading; respiration-40cpm, heart rate 130bpm, oxygen saturation 85%, temperature 37.7, blood pressure 130/90mmhg, use of accessory muscles in breathing with wheezing breath sounds.

DATA COLLECTION ACCORDING TO OREM’S THEORY OF SELF CARE DEFICIT

1.

BASIC CONDITIONING FACTORS

Age

Gender

Developmental state

Health state

Sociocultural orientation

16years

Male

Identity versus confusion

Acute onset of chronic illness

Formal education, Christian, Ghanaian

Health care treatment/ system

Family system

Patterns of living

Environment

Resources

2.

UNIVERSAL SELF CARE REQUISATES

Institutional care, diagnosis, treatment plan, self-care transitioning.

Lives with both parents and a sibling

Spends 8 hours of the day in school on weekdays. Likes to play football daily and sleeps mostly bare chested at night

Urban, clean, dusty road, has a pet dog

Parents

Air

Water

Food

Elimination

Activity and rest

Solitude/ social interaction

Prevention of hazards

Promotion of normalcy

Difficulty in breathing

No restrictions, fluid intake insufficient due to vomiting

No restrictions, adequate intake.

Weight 57kg, height 170cm

Normal pattern

Interrupted sleep patterns due to persistent cough

Interacts with peers, likes to play football.

Needs instructions on avoiding triggers.

He sleeps bare chested most nights

Has a healthy relationship with both parents

3.

DEVELOPMENTAL SELF CARE REQUISATES

Maintenance of developmental environment

Carries out activities of daily living by himself, holds views of peers high

Prevention/ management of conditions threatening normal development

Not complaint with treatment regimen for chronic condition, not avoiding triggers

4.

HEALTH DEVIATION SELF CARE REQUISATES

Seeking medical assistance when health status altered

Seeks health care frequently when health state is altered

Awareness/ management of disease process

Aware of condition. No evidence however of knowledge on how to avoid having attacks or manage them.

Adherence to medical regimen

Awareness/ potential problems associated with regimen

Modification of self-image to incorporate changes to health status

Cooperates with treatment. Not aware of how to use metred dose inhaler(spacer) and nebulizer

Not aware of side effects of medication and the need to always have sprays or inhaled bronchodilators around him.

Portrays same self-image. Concerned that his peers might consider him a weak person if they know

Adjustment of lifestyle to accommodate No changes made. Passionate about changes in health status and medical regimen playing football and concerned about always carry medication on him.

NURSING CARE PLAN ACCORDING TO OREM’S THEORY OF SELF CARE DEFICIT

Diagnostic operations

Therapeutic self-care demand

Air

Maintain effective respiration

Adequacy of self-care agency

Inadequate

Nursing diagnosis

Desired outcomes

Ineffective breathing pattern related to swelling and spasm of the bronchial tubes as evidenced by dyspnoea

Client will maintain optimal breathing pattern as evidenced by normal respiratory rate and absence of dyspnoea

Nursing

Prescriptive operations Regulatory operations system design

Methods of helping

Nursing orders Rational

Partly compensatory

Support

Guidance

Teaching

Positioning- elevate head end of bed, assess breath and adventitious sounds such as wheezes and stridor,

Administer intra nasal oxygen,

Monitor vital signs, oxygen saturation and arterial blood gases every 15 minutes,

Encourage pursed lip breathing for exhalation, administer prescribed medication, assess response to medication

To promote maximum lung expansion, boast oxygen supply, diminishing wheezing and indistinct breath sounds may indicate early respiratory failure, oxygen saturation determines amount of oxygen in the blood and arterial blood gases for respiratory acidosis, pursed lip breathing improves breathing pattern, medications to relax the lung muscles and reduce inflammation and mucus secretion.

Control

Implementation Evaluation

Head end of bed elevated, breath and adventitious sounds assessed, intra nasal oxygen administered at

5L, vital signs, oxygen saturation and arterial blood gases monitored every 15 minutes, pursed lip breathing for exhalation encouraged, prescribed medication administered, medication response assessed

Goal fully met as normal breathing pattern was restored.

Water

Maintain electrolyte balance

Food

Inadequate Potential for fluid volume deficit related to vomiting

Inadequate Potential for imbalanced normal heart rate

(60-100 beats per minute), urine output greater than 30 ml/hour and normal skin turgor

Patient will maintain

Patient will maintain normal fluid volume as evidenced by normal systolic blood pressure

(systolic blood pressure greater than or equal to 90 mm HG),

Supportive educative

Supportive educative

Teaching

Support

Guiding

Monitor and document vital signs especially blood pressure and heart rate as necessary, assess skin turgor and mucous membranes for signs of dehydration, encourage intake of oral rehydration salts, administer intravenous fluids, monitor input and output chart, administer prescribed medication

Changes in vital signs may indicate hypotension, skin elasticity and dry mucous membrane can be used to determine dehydration, intake of oral rehydration salts and intravenous fluids for fluid replacement, input and output monitoring determines quantity of fluid retained

Vital signs especially blood pressure and heart rate monitored as necessary and documented, skin turgor and mucous membranes assessed for signs of dehydration,

50mls of oral rehydration salts served after each vomit and client encouraged to drink,

Intravenous fluids administered, input and output chart monitored, prescribed medication served.

Goal fully met as patient maintained normal fluid volume during hospitalisati on

Teaching support

Observe oral hygiene, feed in

Oral hygiene has a

Positive effect on

Oral hygiene observed, food

Goal fully met as

Maintain sufficient food intake nutrition less than body requirements related to vomiting optimal levels of nutritional status

Elimination

At present no problem

Adequate Potential for inadequate urine production related to fluid loss through vomiting

Patient maintains balanced input and output with clear odour free urine

Supportive educative guiding

Guiding

Teaching

Support bits frequently, monitor input and output chart, maintain pleasant environment, serve varied non spicy foods.

Monitor vital signs, assess severity of vomiting, encourage adequate fluid intake, monitor input and output chart especially fluid intake and urine output, observe urine for concentration and consistency, serve prescribed medication appetite, feeding in bits lessens feeling of fullness and urge to vomit, input and output chart measures quantity of food and water retained, pleasant environment and non-spicy foods reduces stimulus to vomit

Change in vital signs may suggest decreased fluid volume, assessing severity of vomit determines quantity of fluid loss, encouraging fluid intake replaces lost fluid, input and output chart determines amount of fluid retained, observe urine concentration for low production of urine by the kidneys served attractively in bits frequently, input and output monitored, pleasant environment maintained, varied non spicy foods served

Vital signs monitored and documented, severity of vomiting assessed, adequate fluid intake encouraged, input and output chart monitored especially fluid intake and urine output, concentration of urine observed and documented, prescribed client maintained optimal levels of nutrition throughout hospitalisati on

Goal fully met as patient did not develop urine elimination problems during hospitalisati on

Activity and rest

Maintain balance

Inadequate Disturbed sleep pattern related to excessive cough and anxiety

Client will attain optimal amounts of sleep as evidenced by statements of feeling well rested.

Supportive educative

Support guidance

Determine the clients usual sleep habits, elevate head end of bed, maintain quiet environment, use minimal lightening, address restrictive clothing, address anxiety, serve prescribed medication

Determine usual sleep pattern to make baseline comparisons, elevate head end of bed to promote breathing, maintain quiet environment to minimise distractions, minimal lightening to promote sleep, address restrictive clothing to increase comfort, address anxiety to reduce fear and prescribed medication to reduce cough and other symptoms medication served.

Clients usual sleep pattern determined,

Head end of bed elevated, quiet environment maintained, minimal lightening used, restrictive clothing removed, anxiety addressed and prescribed medication served

Goal fully met as client maintained normal sleep patterns during hospitalisati on

Solitude/ social interaction

At present no problem adequate

Prevention of hazards

Keep patient safe

Inadequate

Potential for impaired social interaction related to chronic illness and over protection from parents

Potential for personal injury related to irritability client and family will understand need for adequate socialization by time of discharge as evidenced by verbalisatio n of strategies( adherence to treatment and support group attendance) to adopt to maintain socialization client will remain free of injuries during hospitalizati on as evidenced

Supportive educative

Supportive educative

Guidance teaching support

Assess client and family’s feelings relative to social isolation, discuss condition with client and family and encourage questions, clarify misconceptions, provide support group therapy, give education on medical regimen and need to comply

To obtain data to work with, discuss condition to impact knowledge, encourage questions to clarify misconception, support group to identify new ways to promote socialisation educate on adherence to medical regimen to promote health

Family engaged in discussion on condition and encouraged to ask questions.

Teaching with aids done and all misconceptions clarified, support group therapy provided, education given on medical regimen and need to comply

Goal fully met as client and family demonstrat ed an understandi ng for the need for socialisation and verbalised strategies to adopt to maintain socialisation

Support

Teaching guidance

Assess general status of client,

Increase observation, keep bed side rails in place, eliminate all hazards, attend to

Assess to determine extent of irritability, increase observation and attending to calls to intervene promptly if need be, keep bed side rails up to prevent patient

Assessment of general status done, client closely observed at all times, bed side rails put in place, hazards eliminated,

Goal fully met as client remained free of injuries on discharge

Promotion of normalcy

Improve health status through life style changes that avoid triggers

Inadequate Deficient knowledge related to long term medical management and triggering factors for asthma.

Patient and family will verbalise knowledge of chronicity of condition, triggering factors, manageme nt and community resource available to help client cope.

Supportive educative

Maintain developme ntal environme nt

Support increased

Adequate Potential for delay in normal development related to isolation by absence of injuries

Client will verbalise the need to avoid isolation by adhering to treatment

Supportive

Educative

Teaching

Support guidance

Teaching guidance client’s calls promptly

Assess knowledge on triggers, and management during attacks, educate on warning signs and importance of early treatment, identify precipitating factors for attacks, and provide support group therapy.

Counsel on condition and clarify misconceptions, provide support group therapy from falling, eliminate hazards to protect patient from harm

Knowledge will make client know how to control them and how to correctly use metred dose inhalers, early warning signs and early treatment prevents exacerbation of symptoms, support groups offers opportunities to learn new ways of adapting to the condition client’s calls attended to promptly.

Counsel to equip them with knowledge on the condition and clarify misconception for better cooperation, support group

Patient knowledge on triggers and care during attacks assessed, education on early warning signs and early treatment done, precipitating factors for attacks identified and support group therapy provided.

Counselling on condition done and misconceptions clarified, support group therapy provided

Goal fully met as patient and family demonstrat ed an understandi ng of chronicity of the condition, triggers and its manageme nt and resources available to help in coping

Goal fully met as client and family verbalised need to promote

normalcy in environmen t

Prevent/ manage developme ntal threats

Manage threats to developme nt by receiving appropriate therapy.

Inadequate secondary to chronic illness

Potential for developmental deficit related to frequent attacks and hospitalisation to maintain a normal developme ntal environmen t

Client and family will verbalise an understandi ng of the impact of frequent attacks and hospitalisati on on developme nt and state strategies to avoid it.

Supportive

Educative

Maintenanc e of health status

Inadequate Potential for continued alterations in health status

Client and family will express increased

Supportive educative

Teaching guidance

Teaching guiding

Assess for indications that client may be unable to adhere to therapeutic regimen, Provide support group therapy, educate on condition in terms he and family can understand and stress need to adhere to treatment, clarify all misconceptions, reinforce behaviours that ensure future compliance

Assess patient and family knowledge on condition, educate on health therapy to identify new ways to cope

Assess to identify gaps to fill, support group to identify new ways to cope, educate to foster understanding of the condition, stress adherence to treatment promote health and normal development, reinforce positive behaviour to reduce risk taking behaviour

Assess to know how much information to give, educate to equip them with

Client assessed for indications of non-compliance to therapeutic regimen, support group therapy provided, education on condition done using terms they understand and adherence to treatment stressed, misconceptions clarified, behaviour that ensure future compliance reinforced.

Patient and family knowledge on condition assessed, developme nt and identified resources to achieve this

Goal fully met as client and family

Promote health related to inadequate health seeking behaviours. interest in adhering to medical recommend ations to promote health

Awareness and manageme nt of disease process

Gain understandi ng of chronicity and complicatio ns of condition and its manageme nt

Inadequate Potential for developing complications

(status asthmaticus

)related to poor management of condition

Client and family will demonstrat e an increased willingness to avoid complicatio ns as evidenced by stating signs and symptoms, complicatio ns and manageme nt of condition

Supportive educative teaching seeking behaviours, educate on, management and preventing attacks

Provide conducive environment for teaching and learning, use teaching aids to give education on condition, educate on what to do during attacks, educate when to report to the hospital, allow questions and answer appropriately, clarify all misconceptions knowledge on health seeking behaviours, educate on management and prevention of attacks to minimise the severity and frequency of attacks and hospital visits education on health seeking behaviour, management and prevention of attacks done

Conducive environment to facilitate learning, teaching aids to boost understanding, educate on what to do during attacks and to report to the hospital immediately to prevent complications, allow questions and answers to address concerns, clarify misconception to reduce misinformation

Conducive environment for teaching and learning provided, teaching aids used to promote effective learning, education on what to do during attacks and when to report to the hospital done, client and family allowed to ask questions and answers provided appropriately, all misconceptions clarified expressed increased interest in adopting health seeking behaviours that promote health

Goal fully met as client and family demonstrat ed understandi ng and an increased willingness to avoid complicatio ns.

Adherence to medical regimen

Ensure adherence

Inadequate Risk for nonadherence to medical regimen related to knowledge deficit on complications of condition

Client and family will demonstrat e an increased willingness to adhere to medical treatment as evidence by stating risk associated with defaulting

Supportive educative

Awareness of potential problems

Understand chronicity of condition inadequate Knowledge deficit related to side effects of medical regimen

Client and family will gain an understandi ng of side effects

Supportive educative

Teaching guidance teaching

Provide conducive environment for teaching and learning, assess clients knowledge on asthma, assess past and current treatment and response to them, teach how to correctly use metered dose inhaler(spacer) and the use of peak flow meters, teach how to administer nebulizer treatments, reinforce what to do in an attack

(action plan), allow questions and give appropriate answers

Assess knowledge on side effects of medication, educate dosage and timing of medication,

Conducive environment to facilitate learning,

Assess to know how much information to give, assess past and present mediation to determine efficacy of the medication, teach how to use the spacer , peak flow meter and nebulizer to ensure effective use, reinforce action plan in attack to reduce symptoms and prevent complications, allow questions to address concerns

To know how much information is required, educate on dosage and timing to avoid overdose, educate on side

Conducive environment provided for teaching and learning, clients knowledge on asthma assessed, response to past and current treatment assessed, teaching on correct use of the metred dose inhaler and peak flow metre done, teaching on nebulizer treatment done and emphasis placed on what to do in an attack.

Concerns clarified

Education on condition, what to do in attacks and long term management of

Goal fully met as client and family demonstrat ed an increased willingness to adhere to medical regimen

Goal fully met as client and family expressed understandi

associated with treatment regimen

Modify selfimage to incorporate changed health status

inadequate Actual threats to self-image related to disease and long term treatment

Adjust lifestyle to accommod ate health status changes and

inadequate Impaired adjustment related to health status requiring change in lifestyle.

Client and family will express increased interest in self-image modificatio n that integrates a treatment plan for health promotion

Client and family will express an increased interest in lifestyle changes that avoid

Supportive educative

Supportive educative

Teaching guidance educate on side effects of medication and when to report to the hospital, educate on need to adhere to treatment.

Provide support group therapy, allow expression of concerns, offer suggestions on effective ways on interacting with peers, encourage discussion of condition with peers and other family members effects to equip client and family with what to expect, educate on when to report to avoid complications, educate on adherence to improve health

Group therapy to learn new ways to cope with condition, allow expression of fears to address them, offer suggestions to aid coping, encourage discussion to facilitate acceptance, the condition done ng of the side effects associated with the treatment regimen

Support group therapy provided, client allowed to express concerns, suggestions offered on effective ways of interacting with peers, discussion of condition with peers encouraged

Goal fully met as client and family expressed increased interest in self-image medication for health promotion

Teaching guidance

Assess obstacles to life style changes,

Involve client and family in discussions on condition (asthma) placing emphasis on need to

Promote trust, cooperation and encourage adherence, avoid triggers especially those mentioned because they have been associated with

Discussions involving client and family on need for lifestyle changes carried out, emphasis placed on avoiding triggers.

Goal fully met as client and family expressed increased interest in lifestyle

medical regimen

+ triggers and promote health minimise attack by avoiding triggers especially physical exertion, cold weather, pets and dust, emphasise medication adherence and need to always carry them along, assist client to identify ways treatments can be incorporated in to lifestyle, reinforce need to always have emergency numbers and an identification tag, allow questions. client, medications to reduce incidence, to avoid complications, for easy identification and to clarify misconception

Medication adherence and need to carry them on him emphasised, emphasis placed on need to always carry emergency phone numbers and an identification tag, questions allowed and misconceptions clarified. changes that avoid triggers

A CRITIQUE OF OREM’S SELF CARE DEFICIT NURSING THEORY

INTRODUCTION

The knowledge base of a profession is normally expressed in the form of concepts, propositions and theories. Nursing has currently reached this level of theoretical evolution.

(Hugh Mckenna). Nursing theories and models, integrated with evidence based practice aims to improve on care rendered to the patient. One of the modern day theorist, Dorothea Orem’s self-care deficit nursing theory is one theory that has widely been used in practice with positive results. It is in view of this that the self care deficit theory was employed in the care of a sixteen year old that presented with an asthmatic attack to the emergency ward.

OVERVIEW OF THE SELF CARE DEFICIT THEORY

Nursing practice oriented by the self care deficit nursing theory represents a caring approach that uses experiential and specialized knowledge (science) to design and produce nursing care

(art). The body of knowledge that guides the art and science incorporates empirical and antecedent knowledge (Orem, 1995). The theory is based on three central theories of self care deficit, theory of self-care and theory of nursing systems. Its central philosophy is that individuals wish to care for themselves and should be aided to care for themselves if they cannot do so on their own. It also encourages that they be allowed to perform their self care to the best of their abilities as they recover more quickly and holistically.

COMPONENTS AND DEFINITIONS OF MAJOR CONCEPTS

Self care

This is said to be the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health and well-being. (GCNM lecture notes 2016)

Self care agency

This is the human’s ability or power to engage in self-care and is affected by basic conditioning factors. (GCNM lecture notes 2016)

Self care deficit

This is when an adult (or in the case of a dependent, the parent or guardian) is incapable of or limited in the provision of continuous effective self-care.

Basic conditioning factors

These are stated as the age, gender, developmental state, health state, sociocultural orientation, patterns of living, health care system, family system factors, environmental factors and resource adequacy and availability.

Therapeutic self care demand

Defined as the summation of activities or self care actions needed to be performed to alleviate an existing disease or correct an existing health deviation.

Self care requisates

These are requirements a person must meet and perform in order to achieve wellbeing.

According to Orem these are three as listed;

Universal self care requisates which include all physiological needs such as water, air etc.

Developmental self care requisates which include actions that are undertaken to provide for the developmental growth of the patient

Health deviation self care requisates which are required in conditions of illness, injury, or disease or may result from medical measures required to diagnose and correct the condition.

Nursing system

These include functions that the nurse must perform in order to meet client’s needs. This system is activated when the client’s therapeutic self-care demand exceeds available self-care agency, leading to the need for nursing.

Nursing agency

For nursing design to be met the nurse must possess established capabilities known as the nursing agency. These capabilities include knowledge, attitude and skills to be effective

Theory of self care

Orem’s theory of self care is based on the following concepts: Self care, Self care agency,

Therapeutic self care demand and Self care requisites.

Theory of self care deficit

According to Orem, nursing is required when an adult is incapable or limited in the provision of continuous, effective self-care. In providing care the nurse employs methods of helping which include; Acting for and doing for others, guiding others, supporting another, teaching another and providing an environment promoting personal development.

Theory of nursing systems

This describes how the patient's self-care needs will be met by the nurse, the patient, or by both.

Orem identifies three classifications of nursing system to meet the self-care requisites of the patient: wholly compensatory system, partly compensatory system and supportive-educative system.

Assumptions of the theory

Orem makes the following assumptions in her theory;

People should be self-reliant, and responsible for their care, as well as others in their family who need care.

People are distinct individuals.

Nursing is an action or interaction between two or more people. Meeting universal and development self-care requisites is an important component of primary health care and illness prevention.

A person's knowledge of potential health problems is needed for promoting self-care behaviours.

Self-care and dependent care are behaviours learned within a socio-cultural context.

(GCNM, lecture notes 2016)

DEFINITION OF NURSING METAPARADIGMS IN THE SELF CARE DEFICIT THEORY

Environment

Made up of physical, chemical and biological features. It includes the family, culture and community.

Human

Comprise of men, women, and children. They are cared for either singly or as social units.

They are the focus of nursing care. (GCNM lecture notes 2016)

Nursing

The art through which the nurse gives specialized assistance to persons who are unable to meet their self care needs all by themselves. The nurse also intelligently participates in the medical care the individual receives from the physician. (GCNM lecture notes 2016)

Health

Being structurally and functionally whole or sound. It also encompasses both the health of individuals and of groups. It also includes the ability to reflect on one’s self, to symbolize experience and to communicate with others. (GCNM lecture notes 2016)

CRITIQUE

Orem’s self care deficit theory is comprehensive in nature and widely accepted. Its application in practical settings has received both positive and negative reviews. I hope to in this critique highlight both the strengths and weaknesses of the theory.

Clarity

In the theory definitions are clear, organised and well defined with no excessive narrative.

However there is repetition of words and terms that can be confusing. This observation is supported by Mendoza, et al (2004) who stated that students studying Orem’s theory are often perplexed on the different terminologies with similar meanings. Concepts are used consistently throughout and are not disjointed. However, they appear to be redundant as they become more detailed. Definitions given to some of them separately seems to be a deliberate attempt to make the theory broader. For example, Orem defines self care deficit

separately from the theory of self care deficit. The two could have been merged without necessarily distorting the idea behind the theory. A lot more of such examples can be highlighted if we implore further. This view is supported by Abdul (2002) that Orem’s theory is redundant in some way.

Simplicity

Orem’s theory is easy to understand in the sense that it explains what an individual must do to maintain health and also defines exactly when the nurse must step in the event that the individual is unable to do so on his own. The relationship between concepts are complex but applicable practically to achieve results. However, though terms used are easily understood, the theory is still complex in the sense that it is composed of three theories put together and broken down into even more layers. (Theory of self care, theory of self care deficit and theory of nursing systems). Abdul 2002 supports this view by stating that Orem’s theory is simple with limited number of concepts but complex in terms of number of theories put together.

Generality

The theory is not only applicable in clinical practice, but also in nursing education, nursing administration and research. Also, both novice nurses and experts can apply Orem’s theory without difficulty. The theory however is more inclined to physiological and sociological wellbeing of the individual whilst neglecting the emotional and mental wellbeing of the individual. Orem suggest that an individual must willingly express a lack of the ability to maintain self care to receive same. This is however not the case in all instances. For example an individual with mental health issues might not willingly admit to needing help with self care and going by Orem’s concepts it will be difficult to nurse such a patient. This is supported by Moustafa (1999) who greatly stressed that the lack of mental health on this theory could possibly cause problems when applied in a health care setting. George 2010, however states that Orem in a later discussion emphasises the importance of a positive mental health.

Accessibility

It is a readily applicable theory with entities well defined and measureable. concepts can be operationalized and empirically tested in research studies. The theory has been used in several researches that has yielded significant result regarding scope, complexity and clinical usefulness. A number of theories were conducted which were derived from her theory and its implication served as a guide in the development of tools for patients self care assessment.

An example is the development of the community care deficit nursing models from Orem’s self care deficit nursing theory. (Serey, S et al, 2005)

Importance

The theories impact on the clinical setting is significant. It defines need for nursing care and when to act. It also delineates the various interactions between nurse and patient. It is tied to nursing goals, clinical practice and research. Nursing based on the theory is driven by the nurse’s relationship with patients self-care needs. Some research articles also use Orem’s theory as a theoretical frameworks and hypothesis derived from concepts. This is supported by George, 2006.

Strengths

Major strengths include the fact that it can be used by all categories of nurses, from the beginner to the expert. It also specifically defines when nursing is needed or when the nurse should step in to help maintain self care necessary to sustain life and health. Three identifiable nursing systems were clearly described and easily understood. The portrayal of nursing care as that which provides assistance to people was apparent in every concept and helps to keep the nurse focused on her role. Another major strength of Orem’s theory is the inclusion of the nursing process whilst also specifying and identifying the steps in the process. The use of the self care requisites of the person in data collection helps to individualise care as these are unique to each person. She also mentioned that the nursing process involves intellectual and practical phases. Orem’s theory also not only focuses on individual self care but also multi person units.

Limitations

A major limitation is it appears the theory is illness oriented. WHO defines health as a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. By this definition, everyone should be given health care services regardless of whether they are physically ill or not. Orem however implies in her theory that health care should only be rendered to those with health deviation self care requisates.

The theory also neglects the dynamic nature of health. Orem’s presentation of three fixed nursing systems to employ in restoring health connotes rigidity. Provision is not made for the dynamic state of health and the exploration of all possible avenues to maintain or restore health. The theory can be said to be simple yet complex because of the embedment of three sub theories (theory of self care, theory of self care deficit and theory of nursing systems).

The use of self-care in multitude of terms also makes it confusing. She also does not acknowledge the emotional needs of the individual throughout her work. The role of the environment to the nurse patient relationship and health though mentioned was not discussed. Also self care as defined by Orem in her theory cannot be applied to the aged and infants.

MY REFLECTION ON THE THEORY AS APPLIED TO CLIENT (SUMMARY)

Orem’s theory of self care deficit is not only practical but applicable as well. It is also not only concerned with nursing the client in the phase of active illness but can be used effectively in teaching for rehabilitative and self-care transition purposes. However, although the theory has been widely acclaimed and received positive reviews with its application in practical settings I found a number of flaws in relation to my client. It lacked in dealing with the emotional needs of my client which would have impacted positively with his anxiety. His spiritual needs were not also taken care of in the application of the theory. Orem sought to suggest that an individual’s self care needs depended on him and the use of nursing systems to assist if need be. However the role of his parents in the self care needs of this adolescent was just as important. Although the theory acknowledges the family, community and environment in self care action, its primary focus is on the individual. Nursing with specific

consideration to the background or cultural orientation of the client was also not aptly dealt with in the theory.

In conclusion, Orem’s theory continues to be useful in practice despite the flaws highlighted.

I would recommend its use in the future in nursing clients for its comprehensive nature.

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