Background of Nursing as a profession

Discuss about the Application of the Orems Self-Care Theory for Clinical Practice.

Nursing is a field that has undergone changes in history of the profession. The field can be traced back to the earlier times when nuns were charged with the responsivity of caring for the sick. The need to have professionals trained as nurses led to the evolution of the field to what is called nursing whose role is central to survival of any healthcare system. Nursing in the modern world appear in every department within a nursing facility since they carry out the role of care giving. They are changed with the responsibility of administering care to patients and ensuring that they achieve the best of care to pull through life situations (Martinsen, 2011). Nurses like any other professional are guided by a code of practice that is theoretically defined on how they approach patient related issues. Scholars like Dorothy Orem developed theories to guide these practitioners on the approaches that they can use to handle patient situations while administering care. The theories propose purposeful, systematic and rigorous ways through application of scientific inquiry to arrive at solutions that meet the needs of the patient. Colley (2003) suggests that the theories guide nurses on how to approach incidences in their practice by using a standard practice for handling patient problems. This essay analyses the work of Dorothea Orem in presenting the self-care deficit nursing theory.

The reason why I chose the theory is because of the works of Dorothy Orem in the field of nursing. The theory developed through nursing research in nursing and the need to develop answers to why people needed the field of nursing. The field of nursing in 1930s was an ill-defined profession that lacked value within the healthcare sector. The need to improve nursing and make people understand that it plays a role in the field of health and caring of people (McEwen & Wills, 2014). Her works in the field of nursing led to several honors that she received from the American Society of nursing.  Further, she went ahead to form the International Orem Society for Nursing Science and Scholarship as a way of preserving and facilitating the understanding and use of Orem’s Self-care deficit nursing theory.

Alligood & Tomey (2011) argue that the role that Dorothy played in the field of nursing was not merely developing a theory but rather a process of reviving the practice and making the field to be recognized as playing a role in the healthcare sector. She was dedicated to her work and continued working even after retiring. She was devoted and had a passion in the field of nursing where she wanted everybody to view nursing as a profession with values and ways of doing work that are similar to the way other professions work. Nurses were seen as low profile people whose role in the hospital was doing the other work.

Importance of Dorothea Orem’s work in nursing

According to Green (2013) the theory proposed by Dorothy is one of the grand theories of nursing that has helped build the field. The theory is complex in scope since it focusses on addressing the broad areas within the discipline. It was developed thoughtfully through appraisal of existing ideas and incorporation of some other theories to form solid explanations of the field healthcare. The theory was formed from complex concepts that are abstract and global thus allowing its application in a nursing environment (Fawcett & DeSanto-Madeya, 2013). Dorothy’s theory is a grand approach to nursing through appraisal of existing ideas to develop diverse ways of viewing the nursing phenomena and proposing strategies that can be applied to make the field better.

In nursing, a theory has to incorporate the four concepts of the environment, the individual, the practitioner and the health system to be accepted as a nursing theory. The four concepts give the relevance of the profession in the four areas by proposing strategies that can be applied to make the profession better (Chinn & Kramer, 2010). The four major areas form the role that the nurse plays in addressing the issues that affect them. The patient has to be approached as a whole, thus seeking to address all areas of life that affect him/her. Then there is the patient’s’ health and wellbeing which determines the ability to heal. The environment describes other factors that influence the health of the individual while nursing responsibilities form the strategies that the nurse applies in addressing patient’s needs.

The self-care theory was conceived to teach nurses to assist patients by improving their ability to perform acts of self-care. From the theory, self-care entails activities that the practitioner performs to restore wellbeing and personal health changed by disease or infirmity (Arora, 2015). Such activities are part of the daily life of individuals and being sick renders them unable to perform such tasks since they are unable to work on their own. From Dorothy’s perspective, self-care is a human need that nurses should assist patient’s to achieve through providing health-related outcomes that allow them to recover and maintain heath.

Nursing- Dorothy argued that nursing is an art where the health practitioner offers specialized assistance to people with certain disabilities to enable them meet their needs and at the same time participating in medical care (George, 2011).

Humans- the theory views humans as men, women and children who form material objects of nursing and those who prove direct care.

Description of Self-Care Deficit Nursing Theory

Environment- these are biological, chemical or physical components in an individual’s life that affect the operation of the individual.

Health- it is viewed as a state encompassing both individuals and groups reflected on the patient’s self through to communicate with others through an available means.   

Self-care- this entails activities that the professional initiates towards the patient to restore wellbeing and health.  

Self-care agency- this is a set of systems that work together to influence self-care depending on the available conditions.    Basic condition factors- gender, age, health state, development state, family system factors, environmental factor and resource adequacy.

Therapeutic self-care demand- these are a range of actions and procedures that need to be taken by the professional to restore well-being or the ability of the patient to enjoy normalcy.

Self-care deficit- the nurse is supposed to help the individual meet the basic conditions of life if they are lack someone to assist them or they are incapable of assisting themselves.

Nursing agency- this is a complex property with health professionals trained as nurses with knowledge that can enable them meet the therapeutic demands of self-care.

Nursing system- these are varied relationships between the patients, the practitioner and the nursing system to form the sum total of all actions that the patient receives.

When the nursing practitioner is handling patient related care, the nurse focusses on self-care prerequisites required by the patient through diagnosing and the correct condition of the patient and then seeking the appropriate medical assistance that fits the patient and modifying the self-care concept based on the individual (Masters, 2011). The theory has three basic nursing systems that the nursing practitioner needs to apply.

The first system is the wholly compensatory system defined by the condition the patient is facing that renders him/her unable to perform the basic requisites of self-care. Such inability renders the patient susceptible thus relying on the assistance of the family and practitioner to meet personal needs through self-directed and controlled ambulated care to refrain from such condition. Sitzman & Eichelberger (2011) suggests that the practitioner needs to understand the universal basic self-care processes that most humans can easily perform and have been rendered unable through illness, injury or disease. The inability of patient’s to meet these conditions forms the basic reason why they seek medical care. Wilson (2009) states that the nurse has to ensure that the patient can perform these conditions and assist them if they have been rendered unable to do so. Such activities are termed as universal self-care prerequisites which include eating, egestion process, and other activities that relate to promoting the functionality of the body. When people are sick or injured they may fail to meet one of the conditions since all the conditions require some level of physical effort. Therefore, the nursing practitioner needs to understand that self-care is about assisting patient’s meet these basic universal requisites.

Concepts of Self-Care Deficit Nursing Theory

The second is the developmental self-care requisites associated with clinical events where both the nurse and the patient participate in setting the conditions that suit the healthcare needs. Clark (2009) suggests that ways of assisting the patient to meet their needs include taking action for the sake of the patient, guiding them, supporting them, creating an environment that promotes personal development and teaching them how to cope with obstacles that they face in future based on their new condition. Such strategies including guiding the patient on how to adjust with the new conditions that the sickness exposes them to.

The last aspect of the theory is the supportive-development system where the patient learns to perform required measures through therapeutic self-care. Such measures include carrying out medical prescriptions as required, and adjusting lifestyle to the new state of sickness, and learning to live the effects of pathological conditions that the disease causes the patient (Afrasiabifar, Mehri, Sadat, & Shiraz, 2016). The theory uses three systems to identify personal needs that the patient faces; wholly compensatory systems, partial compensatory systems, and supportive-educative systems.

Self-care is based on the assumption that people can take care of their own health. Orem’s self-care theory is based on the assumption of assisting the patient to achieve the best condition of life through applying ay of the three processes that are required to assist the patient regain their normal life situation or cope with the situation (Alligood & Tomey, 2011). Patients are faced with disease or infirmity challenges that render them unable to lead their normal life. To Orem, the role of the nurse is to assist the individual cope with the situation or adapt mechanisms that are required to manage the existing situation. When the theory is applied in nursing, three stages of assessment, diagnosis/planning and implementation are used.

Assessment entails diagnosis and prescription of the condition that the patient is undergoing to make the right judgment regarding patient care. The professional has to collect data from the patient and determine the level of self-care and the capacity of the patient to perform the intended self-care (Bassak-Nejad, Rahimi, & Majdinasab, 2014). All healthcare professionals that relate to the patient’s situation like physicians give their perspective on what needs to be done to the patient. The professional will set healthcare goals with the patient under this stage within the context of lifestyle, health status and life history. When setting the goals it is worth noting that patient-centered care encompasses the environment, the health care requirements and the professional to meet the needs of the individual.

Role of Nursing Practitioner in Self-Care Deficit Nursing Theory

The professional will then design the nursing system and plan of delivery based on the assessment that has been made on the patient. The system has to be compensatory and supportive to the patient’s needs. Self-care recognizes the fact that the individual needs to take care of their own welfare and if they fail to do so then they need to be assisted (Kaur, Behera, Gupta, & Verma, 2009). During diagnosis and goals setting. Areas that the patient’s feels unable to meet the healthcare needs can be identified to ensure that the patient copes with the situation. Therapeutic needs of patient’s vary from patient to patient thus they need to be executed at an individual level rather than group level.

The last stage is implementation and evaluation of the set goals and agreed therapeutic processes that need to be administered to the patient. This process focusses on producing and managing the nursing system where the nurse assists the patient or their family to meet the self-care needs thus achieving a positive health towards the related outcomes (Arman & Hok, 2015). Actions takes under this stage focus on the rationale of the diagnosis based on the individual needs of the individual patient.  The results can be evaluated to determine if the planned outcomes have been achieved or not.

When applying self-care, the Orem’s model acknowledges three levels of; wholly compensatory system, partial compensatory system and the supportive educative system. The first system is applied to patient’s who require total nursing care to patients who are unable to perform any level of self-care. The process needs to be administered to patients until they reach a higher level of care that they can take care of by themselves. The partially compensatory system is a progress level that the patient gains when healing is taking place (Clark, 2009). In this relationship the nurse promotes the patient to an agent where the share responsibilities in restoring the condition through self-care. Psychological and social factors that influence healing like family support are used in every stage of therapeutic care to allow the patient manage the situation. Lastly, O’Shaughnessy (2014) states that the supportive-educative system entails the patient beginning to perform most levels most levels of self-care. The nurse patient relationship changes as the professional becomes a teacher who supports and teaches the patient how to integrate back into the society. This process goes on up to the point when the professional withdraw care from the patient.

Conclusion

The Orem’s theory of care offers an insight on the process that nurses can take patient’s through to enable them to achieve the desired self-care level. The theory recognizes that the role of the nurse varies depending on the conditions and the level of self-care needed by the patient. The theory views the nursing practice as being designed at an individual level based on patient factors like environment, family set up and other psychosocial factors that may affect the patient. The relationship between the nurse and the patient is supposed to progress from total self-care to agent and lastly to a self-care teacher who assists the patient to meet the intended needs as they progress back into the society. The theory therefore offers one way that nursing practitioners can follow when addressing patient situations and the process of restoring self-care.

References

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