Theory Application Paper -Orem’s Self-Care Deficit Theory
Theoretical Foundations for Nursing
Theory Application Paper -Orem’s Self-Care Deficit Theory
The concept of Nursing Theory began in the days of Florence Nightingale when she first stepped on the battlefield to help wounded soldiers. Nightingale had a systematic approach to caring for the wounded and sick, and documented her findings, leading her to realize certain trends in the nurse-patient relationship. Florence was the first nursing theorist, and since then, there have been many more to follow in her steps, each one bringing their own perspective to the art of nursing. This paper will focus on the Self-Care Deficit Nursing Theory that was developed by Dorothea Orem. The Self-Care Deficit Nursing Theory (SCDNT) is simple in concept and was designed with various levels of nursing experience to support it. Orem received her BSN degree, then her Master’s degree, held honorary Doctoral degrees, was a private duty nurse, floor nurse, educator, then Director of nursing schools, and finally, she held a position the Board of Health in Indiana (McEwen & Wells, 2019, p. 142). The various levels of Orem’s experiences and expertise in patient cares lends strength and applicability to the theory.
It is the purpose of this paper to highlight the universal applicability of the Self-Care Deficit Nursing Theory in all nursing areas, and lend insight as to ways it can be implemented and put into practice regardless of the nursing setting or the experience level of the nurse.
Orem’s SCDNT is a grand theory, which is described as a theory that explains a broad area within the discipline of nursing, and her relatively abstract concepts lack operational definitions (McEwen & Wells, 2019, p. 37). Because it lacks operational definitions, the SCDNT is easily applied not only in numerous settings, but at every level of nursing experience. The constructs are easily understood, as its main focuses are the individual’s self-care (what an individual can do for themselves), self-care deficit (what an individual can not do for themselves), and the nursing system (cares delivered by a nurse), and how those interact with each other (McEwen & Wells, 2019, p. 143). Orem’s definition of health is “being structurally and functionally whole or sound” (McEwen & Wells, 2019, p. 144). In regards to the self-care deficit, that is when a person is not able to tend to themselves at full capacity, and by Orem’s definition of health, the individual would no longer be whole or sound. It is the role of the nurse to fill in the deficits, in a way that maintains or improves the individual’s ability to help themselves.
The rationale for selecting this theory is that in the acute care setting, it is easy to focus on the problem at hand, and neglect a patient’s “wholeness”, as viewed by Orem, and studies are reflecting the importance of her theory in practice. Orem views humans as men, women and children who are cared for by the nurse and others providing direct care, and their environment is everything physical, chemical and any biological features, to include the family, culture, and the individual’s community (McEwen & Wells, 2019, p. 144). A literature search for how the SCDNT has been implemented in various nursing settings shows that in adolescents that are primiparous, self-care deficit is addressed in the education of those adolescents, enabling them to care for themselves better (Soares de Lima et al., 2017). Another group, Kongsuwan, Suttharangsee, Isaramalai and Weiss (2012), implemented Orem’s SCDNT in the treatment of violent high school boys in Thailand to reduce unfavorable behavior and foster better self-care decision making, and not only did the violence reduce, the students all rated the program as a positive experience. When it comes to diabetes management, two studies utilized the SCDNT and found that family support yielded positive increases in an individual’s self-care management, but that in some cultures, if “nagging“ was perceived, the individual was less inclined to participate (Dalton & Matteis, 2014). However, in the study by Hanucharurnkul (2009), a national campaign in Thailand utilized Orem’s SCDNT in the treatment of diabetes and made it the core of their nursing education, with the mandation of it at the Master’s level courses (Hanucharurnkul, 2009). In working with patients with schizophrenia, motivation is a major barrier to treatment, and the foundations of treatment coincide with the precepts of the SCDNT, because external support surrounding the patient is needed, to include family, but the authors recognize that not one single construct applies to successful treatment (Pickens, 2012). In these studies, Orem’s theory repeatedly shows positive results in the treatment of patients across different areas of nursing, even nationally.
Implementation on the unit will begin with the approach of the ACC chair for approval to present the proposal at the next unit ACC meeting. Education will be presented on the importance of structuring our cares on the Self-Care Deficit Nursing Theory, and give examples of how successful it has been in increasing patients’ self-care advocacy, not only in various areas of nursing (Dalton & Matteis, 2014; Kongsuwan, Suttharangsee, Isaramalai, & Weiss, 2012; Pickens, 2012) but nationally as well (Hanucharurnkul, 2009). It would be my recommendation to emphasize education to increase any knowledge deficit that would hinder self-care, for both the patient and the family/support system. Also, while a patient is in the hospital, encourage self-care, by having them do simple tasks for themselves that they can do, including bathe to the best of their ability and only wash what is left, have them order their own meals instead of relying on us. These are just a few ways we can encourage self-care advocacy and still fulfill the necessary nurse role in the self-care deficit. Once approval is granted, an announcement will be written up, outlining the implementation and how it will be applied, and it will be distributed via email in our weekly updates.
Barriers to Implementation
The largest barrier to implementation, that is foreseeable, is that by having patients do more for themselves, it will take longer to complete tasks. Currently, there are time barriers to when certain tasks are to be done, and those would need to be adjusted if we are to truly have patients doing more for themselves. The second obstacle is that it is a change, and no matter how positive it could be, it is indeed a change, and very few people like change. One barrier, as discovered in a study by J. Jenny. (1991), nursing students had difficulty diagnosing true self-care deficits in the application of NANDA. She goes on to say that studies indicate that nurses have difficulty making accurate diagnoses, and that it requires more “extensive conceptual understanding than nurses have the opportunity to acquire” (Jenny, 1991, p. 231). Perhaps, barriers involve staffing levels as well.
When it comes to nursing theories, Dorothea Orem’s Self-Care Deficit Nursing Theory has shown over time that it is a sound and applicable approach to patient cares, regardless of the healthcare setting. Research has shown its effectiveness in areas of diabetes care, psychiatric/mental health care, adolescent healthcare, and Thailand has embraced the theory as the foundation of their care for diabetes and also for nursing school education due to the reproducible positive outcomes of patient care. Research needs to have reproducible outcomes and apply to various situations, and Orem’s Theory of Self-Care Deficit has proven its value as a basis for patient cares with positive outcomes.
Dalton, J. M., & Matteis, M. (2014, Fall). The effect of family relationships and family support on diabetes self-care activities of older adults: A pilot study. Self-Care, Dependent-Care & Nursing, 21(1), 12-22. Retrieved from Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=103908764&site=ehost-live
Hanucharurnkul, S. (2009, October). Self-care deficit nursing theory in research and practice in Thailand. Self-Care, Dependent-Care & Nursing, 17(1), 16-20. Retrieved from Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=105435206&site=ehost-live
Jenny, J. (1991, May). Self-care deficit theory and nursing diagnosis: A test of conceptual fit. Journal of Nursing Education, 30(5), 227-232. Retrieved from Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=107505205&site=ehost-live
Kongsuwan, V., Suttharangsee, W., Isaramalai, S., & Weiss, . J. (2012). The development and effectiveness of a violence prevention program for Thai high school adolescents. Pacific Rim International Journal of Nursing Research,, 16(3), 236-249. Retrieved from Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=104437386&site=ehost-live
McEwen, M., & Wells, E. M. (2019). Theoretical basis for nursing (5th ed.). Philadelphia, PA: Wolters Kluwer.
Pickens, J. (2012, Fall). Development of self-care agency through enhancement of motivation in people with schizophrenia. Self-Care, Dependent-Care & Nursing,, 19(1), 47-52. Retrieved from Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=104432018&site=ehost-live
Soares de Lima , G. K., Pereira dos Santos, A. A., Marques de Oliveira, J., Silva, E., Comassetto, ., Correia, S. ., & da Silva Ferreira, D. C. (2017). Self-care of adolescents in the puerperal period: Application of the Orem theory. Journal of Nursing UFPE / Revista de Enfermagem UFPE, 11(10), 4217-4225. http://dx.doi.org/10.5205/reuol.10712-95194-3-SM.1110sup201727
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