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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
16years
Gender
Male
Developmental state
Identity versus confusion
Health state
Acute onset of chronic illness
Sociocultural orientation
Formal education, Christian, Ghanaian
Health care treatment/ system
Institutional care, diagnosis, treatment
plan, self-care transitioning.
Family system
Lives with both parents and a sibling
Patterns of living
Spends 8 hours of the day in school on
weekdays. Likes to play football daily
and sleeps mostly bare chested at night
Environment
Urban, clean, dusty road, has a pet dog
Resources
Parents
2. UNIVERSAL SELF CARE REQUISATES
Air
Difficulty in breathing
Water
No restrictions, fluid intake insufficient
due to vomiting
Food
No restrictions, adequate intake.
Weight 57kg, height 170cm
Elimination
Normal pattern
Activity and rest
Interrupted sleep patterns due to
persistent cough
Solitude/ social interaction
Interacts with peers, likes to play
football.
Prevention of hazards
Needs instructions on avoiding triggers.
He sleeps bare chested most nights
Promotion of normalcy
Has a healthy relationship with both
parents
3. DEVELOPMENTAL SELF CARE REQUISATES
Maintenance of developmental
Carries out activities of daily living by
environment
himself, holds views of peers high
Prevention/ management of conditions
Not complaint with treatment regimen
threatening normal development
for chronic condition, not avoiding
triggers
4. HEALTH DEVIATION SELF CARE REQUISATES
Seeking medical assistance when health
Seeks health care frequently when
status altered
health state is altered
Awareness/ management of disease
Aware of condition. No evidence
process
however of knowledge on how to avoid
having attacks or manage them.
Adherence to medical regimen
Cooperates with treatment. Not aware
of how to use metred dose
inhaler(spacer) and nebulizer
Awareness/ potential problems
Not aware of side effects of medication
associated with regimen
and the need to always have sprays or
inhaled bronchodilators around him.
Modification of self-image to
Portrays same self-image. Concerned
incorporate changes to health status
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
playing football and concerned about
regimen
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
Prescriptive operations
Regulatory operations
Control
Nursing
diagnosis
Desired
outcomes
Nursing
system design
Methods
of helping
Nursing orders
Rational
Implementation
Evaluation
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
Partly
compensatory
Support
Guidance
Teaching
Positioningelevate 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.
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
Inadequate
Potential for
fluid volume
deficit related
to vomiting
Food
Inadequate
Potential for
imbalanced
Patient will
maintain
normal fluid
volume as
evidenced
by normal
systolic
blood
pressure
(systolic
blood
pressure
greater
than or
equal to 90
mm HG),
normal
heart rate
(60-100
beats per
minute),
urine
output
greater
than 30
ml/hour
and normal
skin turgor
Patient will
maintain
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
Supportive
educative
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
Elimination
At present
no problem
Adequate
nutrition less
than body
requirements
related to
vomiting
optimal
levels of
nutritional
status
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
bits frequently,
monitor input and
output chart,
maintain pleasant
environment, serve
varied non spicy
foods.
Guiding
Teaching
Support
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
client
maintained
optimal
levels of
nutrition
throughout
hospitalisati
on
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
Goal fully
met as
patient did
not develop
urine
elimination
problems
during
hospitalisati
on
Activity and Inadequate
rest
Maintain
balance
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
Potential for
impaired social
interaction
related to
chronic illness
and over
protection
from parents
Prevention
of hazards
Keep
patient safe
Inadequate
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
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
Supportive
educative
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
by absence
of injuries
client’s calls
promptly
Promotion Inadequate
of normalcy
Improve
health
status
through life
style
changes
that avoid
triggers
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
Teaching
Support
guidance
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.
Maintain
developme
ntal
environme
nt
Support
increased
Potential for
delay in
normal
development
related to
isolation
Client will
verbalise
the need to
avoid
isolation by
adhering to
treatment
Supportive
Educative
Teaching
guidance
Counsel on
condition and
clarify
misconceptions,
provide support
group therapy
Adequate
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
Counselling on
condition done
and
misconceptions
clarified, support
group therapy
provided
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.
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.
secondary to
chronic illness
Inadequate
Maintenanc Inadequate
e of health
status
to maintain
a normal
developme
ntal
environmen
t
Potential for
Client and
Supportive
developmental family will
Educative
deficit related verbalise an
to frequent
understandi
attacks and
ng of the
hospitalisation impact of
frequent
attacks and
hospitalisati
on on
developme
nt and state
strategies
to avoid it.
Potential for
continued
alterations in
health status
Client and
family will
express
increased
Supportive educative
therapy to identify
new ways to cope
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
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
developme
nt and
identified
resources
to achieve
this
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,
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 Inadequate
and
manageme
nt of
disease
process
Gain
understandi
ng of
chronicity
and
complicatio
ns of
condition
and its
manageme
nt
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
seeking
behaviours,
educate on,
management and
preventing attacks
Supportive
educative
teaching
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
expressed
increased
interest in
adopting
health
seeking
behaviours
that
promote
health
Conducive
Conducive
Goal fully
environment to
environment for
met as
facilitate learning,
teaching and
client and
teaching aids to
learning
family
boost understanding, provided,
demonstrat
educate on what to
teaching aids
ed
do during attacks
used to promote understandi
and to report to the
effective learning, ng and an
hospital immediately education on
increased
to prevent
what to do during willingness
complications, allow attacks and when to avoid
questions and
to report to the
complicatio
answers to address
hospital done,
ns.
concerns, clarify
client and family
misconception to
allowed to ask
reduce
questions and
misinformation
answers provided
appropriately, all
misconceptions
clarified
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
Teaching
guidance
Awareness
of potential
problems
Understand
chronicity
of condition
inadequate
Knowledge
deficit related
to side effects
of medical
regimen
Client and
Supportive
family will
educative
gain an
understandi
ng of side
effects
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
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
Goal fully
met as
client and
family
demonstrat
ed an
increased
willingness
to adhere
to medical
regimen
To know how much
information is
required, educate on
dosage and timing to
avoid overdose,
educate on side
Education on
condition, what
to do in attacks
and long term
management of
Goal fully
met as
client and
family
expressed
understandi
associated
with
treatment
regimen
Modify self- inadequate
image to
incorporate
changed
health
status
Actual threats
to self-image
related to
disease and
long term
treatment
Adjust
lifestyle to
accommod
ate health
status
changes
and
Impaired
adjustment
related to
health status
requiring
change in
lifestyle.
inadequate
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
educate on side
effects of
medication and
when to report to
the hospital,
educate on need to
adhere to
treatment.
Supportive
educative
Teaching
guidance
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
Supportive
educative
Teaching
guidance
Assess obstacles to
life style changes,
Involve client and
family in
discussions on
condition (asthma)
placing emphasis
on need to
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
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
changes
adherence and
that avoid
need to carry
triggers
them on him
emphasised,
emphasis placed
on need to
always carry
emergency phone
numbers and an
identification tag,
questions
allowed and
misconceptions
clarified.
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.
References
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