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Application of Orem’s self-care deficit theory in nursing practice

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Introduction

Concepts are fundamental building blocks of theoretical frameworks or scientific knowledge for various academic disciplines. The concepts represent the knowledge, ideas, meaning, and experiences of human beings. Concepts serve different purposes as far the field of nursing is concerned. One of the primary roles of concepts is to provide clarity on specific ideas on their relationship to their theoretical and practical application to the nursing as a profession.

The idea of concept analysis is instrumental in the nursing literature especially when it comes to the development of new concepts and refining of the already existing ideas for the purpose of formulating new nursing concepts in the nursing profession. This paper is going to address the idea of self-care. The idea of self-care has improved over a number of years ago.

The various variations in the definition of self-care have made it hard for individuals especially within the nursing profession to understand the meaning of self-care. The concept of self-care was obtained from Orem theory which was developed by Dorothea Orem between 1959 and 2001. The theory is usually applied to the primary care and insists on promoting independence by encouraging individuals to perform activities on their own. (Younas, 2017).

The paper will define and explain the idea of self-care, have the literature review, describe the attributes, account for the antecedent and consequences, provide empirical referents, provide a model case, and two alternative cases.

Definition /Explanation of Self-care

Orem defined the idea of self-care as the practice of activities which individual’s initiate and carry out on their behalf in maintaining the quality of life, health, and well-being. Self-care is a purposeful action performed in sequence and with a pattern. (Smith & Parker, 2015).

Self-care refers to any activity done voluntarily to help individuals maintain their mental, emotional, or physical health. It enables people to feel relaxed, healthy, and ready to take on their work and responsibilities. Self-care can also be defined as measures which people take for themselves, with and on behalf of others to protect, develop, improve, and keep track on their health, wellness, or wellbeing. Self-care is among the major concepts frequently referred to in both practical and theoretical nursing.

Self-care presents many benefits to an individual. One of the advantages is that it reduces the chances of overload burnout. There comes at a moment where people cannot take any more of something. Self-care enables people not reach this point. (Button, Roos, Spasić, Adamson, & van Deursen, 2015). Self-care helps to minimize the adverse effects of stress. At times too much stress can be harmful to our health, and this result to the breakdown of body and mind. With self-care, we can be able to control the pressure. Additionally, it helps us to refocus. In nursing, the idea of self-care has widely been used in conjunction with other concepts such as exercises.

The combination of the two nursing ideas has aided in the treatment of various conditions such knee injury. Around the world, the expanding predominance of chronic infection inspires worry on different levels, including health care costs, quality of life, and labor force issues to meet expanding demand for services. One reaction has been a move in legislative health program to empower more contribution of the chronically sick people in their health care through involvement in self-management plans. Included in self-management projects is simply the fundamental idea of self-care, an intricate and multidimensional concept. (Grady, & Gough, 2014).

Literature Review

In the first literature review, 110 patients were studied. The objective of the survey was to find out the effects the Orem self-care plan on the quality of life of burn patients. (Hashemi et al., 2014). The sample population was selected randomly and placed into two groups for experiment and control. Data was collected using questionnaires. It was revealed that the quality of life of patients in the experimental group improved while those in the control group didn’t develop. It was concluded that the use of Orem self-care plan helped to improve the quality of life of patients, and therefore it should be embedded into the treatment program.

The second literature review focused on the effects of the Orem’s self-care model on fatigue on several sclerosis patients. In this research, 63 patients were randomly selected for sampling. The sample was then divided into two groups, the intervention group, and non-intervention group. The model was applied to the intervention group. The skills and willingness were observed at 76.19% and 4.76% in intervention and non-intervention group respectively. Fatigue in the intervention group reduced significantly. The study found out that Orem’s self-care model was suitable for reducing fatigue of multiple sclerosis patients. (Afrasiabifar, Mehri, Javad Sadat, & Ghaffarian Shirazi, 2016).

The third literature studied the impact of Orem’s self-care theory on the self-care of adolescents who have asthma. (Altay, & Çavuşoğlu, 2013). Under this study, 80 adolescents suffering from asthma received home visits and personalized treatment based on the concepts of the model. The experiment categorized the selected sample into two parts. The first group belonged to the intervention group while the second belonged to the control group. The control group was visited two times while the response category was visited eight times. It was revealed that the five self-management skills medicine usage, applying an asthma action plan, peak expiratory flow meter usage, maintaining daily track schedule, and preventing against causative agents varied significantly between the first and last visit among the experimental group. To the control group, the self-management skills didn’t change. The study concluded that the model improved self-care skills among the adolescents suffering from asthma.

The fourth literature review focused on developing and validating the Self-care Requisite Scales (SCRS). (Roldán-Merino, Lluch-Canut, Menarguez-Alcaina, Foix-Sanjuan, & Haro Abad, 2013). The instrument was meant to assess self-care requisites in patients who have schizophrenia treated in the area. The initial phase was carried out to come up with a questionnaire through experts and the validity of the content. The psychometric assessment was then conducted with a consistent sample of 341 patients. The scale showed adequate internal stability and consistency over a period. The confirmatory analysis revealed that the theoretical model fitted self-care requisites recommended by Orem’s theory. The researchers concluded that the instruments were valid and suitable for use in the clinical practice especially in the development of effective care plan for every patient.

The next literature review was based on the research carried out to evaluate the impact of Orem’s self-care theory on the self-esteem of adolescents suffering from asthma. (Hemati, Mosaviasl, Abasi, Ghazavi, & Kiani, 2015).The semi-experimental research assessed 64 asthmatic adolescents admitted to Shariati Hospital, Isfahan. The subjects were divided into two groups i.e. control and intervention groups. Then, self-management training program was carried out in accordance with Orem’s self-care theory in 82-hour sessions. Self-esteem was evaluated among the subjects before the experiment. Data was gathered using the questionnaire of demographic features. The results demonstrated a significant difference in self-esteem among the two groups. This difference was insignificant before the study. The variation was high in the intervention group and statistically insignificant in the control group. The researchers concluded by recommending the model in hospitals to promote the health of adolescents.


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The sixth review was conducted to explore the concept of self-care in patients suffering from chronic hepatitis. This qualitative study recruited the subjects from the metropolitan area.
Data was gathered using semi-structured interviews. The research found that use of Orem theory could not meet the requirements for self-care in patients with hepatitis since the patients had important sexual, belonging, respect, economical, physical, and psychological-behavioral needs, did not have adequate knowledge concerning self-care. (Mohammadi, Hasanpour-Dehkordi, & Nikbakht-Nasrabadi, 2016).

Defining Attributes

Attributes refer to identifying features. One of the defining characteristics of self-care is that it boosts control. The second attribute is that it is an enabling process, and third is that it leads to the improvement of the quality of life. Being an enabling process means that the concept promotes independence in that it enables patients to carry out more on their own. Boosting control implies that patients will establish more goals and strive to achieve them. (Emily Roberts MA, 2015). Being an improvement means that patients can achieve everything they need. In addition to improvement of the quality of life, individuals who practice self-care possess various features such as cognitive ability to assess, judge, and come up with decisions about personal environmental situations and factors relevant to self-care actions. Individuals who exercise self-care also possess the personal interest in conducting self-care actions to attain the desired result. They also have psychological and physical abilities to participate in self-care actions and power to carry out self-care actions effectively.

Antecedent and Consequence

Antecedent refers to what occurs before a particular concept to make it necessary. The idea of self-care requires a desire or need to conduct self-care practices to get goal-oriented results. The idea of self-care agency encompasses the person’s ability to identify individual needs, to self-assess (environmental and personal resources), and to conduct effective self-care actions. This, therefore, means that the antecedents of self-care emanate from the person’s cognitive developmental level, physical, psychosocial developmental level, desire and need to carry out self-care actions, and goal-oriented results. The consequences of self-care concept are efficient performance of self-care practices and attainment of goal-oriented results. (Alspach,2011). Therefore, the effects or consequences of self-care concept include effective performance of self-care actions and achievement of desired results.

Empirical Referents

Techniques which are used to evaluate self-care actions are based on the memory of the patient, surveys, or time-intensive interviews on the capability to recall. Other methods make use of patients’ report regarding their frequency of particular self-care behaviors. The patient’s perception on self-care can be evaluated using the self-report questionnaire called Self-Care Inventory (SCI). The technique bases its assumption on the idea that not all the people have similar treatment prescription. The method allows different treatment regimens across individuals while assessing their knowledge of how well they are committed to their respective treatment regimens. (Khagram, Martin, Davies, & Speight, 2013). Several attempts have been made to find out the connection between self-care concept and conditioning factor, self-care concept, and self-care actions, and self-care concept and goal-oriented results.

Model Case

Mrs. Anderson is a 48-year old black American woman was diagnosed with type I diabetes mellitus 18 years ago. The moment she became aware of her condition, she made a strong commitment to self-care his diabetes management. Mrs. Anderson participated in the diabetes educational training program offered in the community hospital. She learned about the condition and its complications, and the mechanisms which can be used to check her care to maintain adequate diabetes control. Since then, Mrs. Anderson has been maintaining her blood glucose levels to change her insulin intake, and when she perceives physical symptoms which she judges as being hyperglycemic or hypoglycemic body reactions. She follows a diabetic regimen such as diet management, insulin administration, exercises, regular eye checkup, and foot care. Mrs. Anderson also has consistent appointments with her health care provider to evaluate her diabetes management. Up to now, Mrs. Anderson has maintained effective diabetes control, as evidenced by her glycosylated hemoglobin content level of less than 8%, and no disease-connected complications.
Mrs. Anderson shows all the defining attributes of self-care. She acquired the skills and knowledge vital to manager her self-care. Mrs. Anderson is capable of identifying her needs and assessing her personal, physical, environmental resources to take part in self-care actions. She has also shown an interest in attaining and maintaining effective diabetes control to prevent the complications relating to the disease.

Borderline Case

Mr. Jones is a 24-year old white male who was diagnosed with the type I diabetes 5 years ago. Mr. Jones took part in a diabetes training program in which he learned about the condition and how to control self-care actions to attain good diabetes control. Although Mr. Jones has diabetes information and self-care skills, he doesn’t adhere to his diet, blood glucose monitoring, and exercise regimes. He gives himself insulin, but he doesn’t regulate its dosage in relation to his blood glucose monitoring since he doesn’t monitor his blood glucose routinely. Since his diagnosis, Mr. Jones has been admitted several times because of hyperglycemia. Additionally, his glycosylated hemoglobin level has always been more than 10%.

Mr. Jones partially shows the characteristics of self-care concept. He can carry out self-care actions, but he chooses to conduct only some of them. He lacks interest in carrying out self-care actions to attain diabetes control as shown by his glycosylated hemoglobin level. Mr.
Jones appears to have cognitive, physical, psychological, decision-making, and judgment capabilities. He chooses to carry out some of the self-care actions.

Contrary Case

Mrs. Greg is a 70-year-old white female who was diagnosed with coronary artery condition. During catheterization, the narrowing of her left main coronary artery was bigger than 70%, which determined the coronary artery bypass graft surgery. After surgical operation, Mrs.Greg had the chance to get nutritional training and discharge classes to learn on how to carry out administer medication, dressing changes, and check for symptoms and signs of complications.

However, Mrs. Greg didn’t take part in those classes; when approached by her nutritionist, she didn’t want to learn about her diet, and she told her nutritionist to talk with her husband. She also sent her husband to attend the classes instead of going herself. During hospitalization, Mrs. Greg didn’t possess the initiative for ambulating, performing various respiratory exercises, sitting up in bedside chair, or even going to the washroom for voiding. Most of her time was spent in bed watching television or sleeping. Nurses and her family members had to tell her what to do and encourage her as well as help her when she was doing anything. Because of her character, Mrs.Greg had to stay in the healthcare for seven days instead of five days, which is the mean hospital stay for patients with the same situation.

Mrs. Greg didn’t show the cognitive, physical, and psychosocial abilities for judgment, behavior performance, and decision-making. Mrs. Greg didn’t show interest in carrying out self-care actions to gain the desired outcome. Additionally, Mrs. Greg didn’t have abilities to carry out self-care actions effectively as evidenced by her lack of skills and knowledge which were taught in training classes and her nutritionist’s instructions.

Conclusion

The analysis of the idea of self-care in relation to its defining attributes or features, antecedents, consequences, and empirical referents gives information relating to nursing research and practice. Developing appropriate nursing strategies is key to help one’s maintenance and development of self-care. Moreover, assessing one’s level of self-management and to what degree it connects to environmental and personal elements, goal-oriented outcomes, and self-care actions are crucial for selecting those particular strategies.


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