Self-Care Deficit Theory of Nursing

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One of Americas foremost nursing theorists Born in Baltimore, Maryland in 1914 Earned her diploma at Providence Hospital Washington, DC 1939- BSN Ed, Catholic University of America 1945- MSN Ed, Catholic University of America Involved in nursing practice, nursing service, and nursing education During her professional career, she worked as a staff nurse, private duty nurse, nurse educator and administrator and nurse consultant Received honorary Doctor of Science degree in 1976 Published first formal articulation of her ideas in Nursing Concepts of Practice in 1971, second in 1980, and in 1995 Orem retired in 1984 and resides in Savannah, Georgia.

DEVELOPMENT OF THEORY
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1949-1957 Orem worked for the Division of Hospital and Institutional Services of Indiana State Board of Health Her goal was to upgrade the quality of nursing in general hospitals throughout the state. During this time she developed her definition of nursing practice. 1959 Orem subsequently served as acting dean of the School of Nursing and as an assistant professor of nursing education Orems Nursing Concept of Practice was first published in 1971 and subsequently in 1980, 1985, 1991, 1995, and 2001.

Person o Orems theory addresses clients self-care needs. o It is defined as goal-oriented activities that are set towards generating interest in the part of the client to maintain life and health devt. o The theory is aimed towards making the clients perform self-care activities in order to live independently. o Conceptualized as a total being with universal, developmental needs and capable of contionous self care.

Nursing
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Nursing is helping clients to establish or identify ways to perform self-care activities. Nursing actions are geared towards the independence of the client. Orem defines nursing as human service. It is a distinguished human service since its focus is on persons with inabilities to maintain continuous provision of health care. Nursing is based on values. Goal of nursing to render the patient or members of his family capable of meeting the patients self care needs. To maintain a state of health.

Health o Orem supports the World Health Organizations definition of health as the state of physical, mental and social well-being and not merely the absence of disease or infirmity. o Orem presents health based on preventive health care. o The model of health care includes the promotion and maintenance of health, the treatment of disease or injury, and the prevention of complications. Environment o Orems view of health as a phenomenon affected by inseparable entities shows her view of the surrounding environment as an external source of influence in the internal interaction of a persons different aspects.

Self-Care Deficit Theory of Nursing

Self-Care is an activity that promotes a persons
well-being. It is performed by persons who are aware of the time frames on behalf of maintaining life, continuing personal devt and a healthy functional living.

Universal Self-care Requisites

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Maintenance of a sufficient intake of airs Maintenance of a sufficient intake of food Maintenance of a sufficient intake of water Provisions of care associated with elimination Maintenance of balance between activity & rest Maintenance of balance between solitude and social interaction Prevention of hazards to human life, human functioning and human well-being Promotion of human functioning and development.

ASSUMPTIONS

People should be self-reliant and responsible for their own care and others in their family needing care People are distinct individuals Nursing is a form of action interaction between two or more persons A persons knowledge of potential health problem is necessary for promoting self-care behaviors Self-care and dependent care are behaviors learned within a socio-cultural context

IMPLICATIONS
To Nursing Practice

Orems Self-care deficit has been used in studies in patients having heart problems, cancer, and mental illnesses. This theory had been widely used in dealing with geriatric cases, especially those having chronic-illnesses. Orems theory was being used in defining the roles of the nurse in multiple settings.

To Nursing Education

The use of Orems theory in curriculum development was reported in the late 1970s. This theory is used at all levels of curriculum and in continuing education. Her theory is used as a strong and effective framework for curricular design.

To Nursing Research

One of the first instruments developed is the Exercise of Self-Care Agency (ESCA) which was published in 1979 Another instrument developed is the Appraisal of SelfCare Agency (ASA) Both of these instrument tools are used to assess basic conditioning factors and self-care abilities related to the care of well and the ill.

CRITICS
Strengths

Provides a comprehensive base to nursing practice It has utility for professional nursing in the areas of nursing practice, nursing curricula, nursing education administration and nursing research. Specifies when nursing is needed. Also includes continuing education as part of the professional component of nursing education Her self-care approach is contemporary with the concepts of health promotion and health maintenance. In general system theory, a system is viewed as a single whole thing while Orem defines a system as a single whole thing. Appears that the theory is illness oriented rather with no indication of its use in wellness settings.

Limitations

MARTHA ROGERS

UNITARY HUMAN BEINGS

Born: May 12, 1914, Dallas, Texas Diploma : Knoxville General Hospital School of Nursing (1936) Graduated in Public Health Nursing, George Peabody College, TN, 1937 MA : Teachers College, Columbia University, New York, 1945 MPH : John Hopkins University, Baltimore,1952 Doctorate in nursing: John Hopkins University, Baltimore, 1954 Position: Professor Emerita, Division of Nursing, New York University, Consultant, Speaker Died: March 13, 1994

ROGERS NURSING THEORY

Nursing

is both a science and art, the uniqueness of nursing, like that of any other science, lies in the phenomenon central to its focus. Nurses long established concern with the people and the world they live is in a natural forerunner of an organized abstract system encompassing people and the environment The integralness of people and the environment that coordinate with multidimensional universe of open systems points to a new paradigm. The purpose of nurses is to promote health and well-being for all persons wherever they
are.

METAPARADIGM
Person

Defines person as an open system in continuous process with the open system that is the environment. She defines unitary human being as an irreucible, indivisible, pandimensional energy field identified by pattern and manifesting characteristics that are specific to the whole. The people has the capacity to participate knowingly and probabilistically in the process of change. Man is a unified whole possessing his own integrity.

Nursing

Nursing is a learned profession, both a science and an art. An organized body of kowledge which is specific to nursing is arrived at by scientific research and logical analysis.

Health

Rogers defined health as an expression of the life process, they are the characteristics and behavior emerging out of the mutual, simultaneous interaction of the human and environmental fields. Health and illness are the part of the sane continuum. Health and illness are manifestations of pattern and are considered to denote behaviors that are of high value and low value.

Environment

Rogers defines environment as an irreducible, pandimensional energy field pattern and manifesting characteristics different from those of the parts.

ROGERS CONCEPT of NURSING

Nursing is a learned profession it is a science and art Nursing is the study of unitary. Irreducible, indivisible human and environmental energy fields. The art of nursing involves the imaginative and creative use of nursing knowledge. The purpose of nurses is to promote health and well-being for all person and groups wherever they are using the art and science of nursing. The health services should be community based. Rogers proposes a nursing practice of noninvasive modalities, such as therapeutic touch, humor, guided imagery, use of color, light, music, mediation focusing on health potential of the person.

IMPLICATIONS To Nursing Practice

The Rogerian model is an abstract system of ideas from which to approach the practice of nursing. Nursing is based on theoretical knowledge that guides nursing practice. The professional practice of nursing is creative and imaginative and exists to serve people. It is rooted in intellectual judgment, abstract knowledge, and human compassion.

To Nursing Education

Rogers clearly articulated guidelines for the education of nurses within the Science of Unitary Human Beings. Rogers discusses structuring nursing education programs to each nursing as a science and as a learned profession.

To Nursing Research

Rogers conceptual model provides a stimulus and direction for research and theory development in nursing science. Emerging from Rogers model are theories that explain human phenomena and direct nursing practice. The Rogerian model, with its implicit assumptions, provides broad principles that conceptually direct theory development.

THEORETICAL ASSERTIONS

The principles of hemodynamics postulate a way of perceiving unitary human beings. Rogers identified the principles of change as helicy, resonancy and integrality. The helicy principle describes spiral devt in continuous, nonrepeating and innovative patterning. Principle of resonancy , patterning changes with devt from lower to higher frequency with varying degrees of intensity.

Principles of Homeodynamics Resonancy Helicy Integrality

Midrange

Bultemeier (1993)

Barrett (1990a)

Floyd (1983)

Imogene King was born in 1923 Completed her Bachelor in Science of Nursing from St. Louis University in 1948 Completed her Master of Science in Nursing from St. Louis University in 1957 Completed her doctorate degree from Teachers College, Columbia university

METAPARADIGM To Nursing Practice

King described a person existing in an open system as a spiritual being and rational thinker who makes choices. Selects alternative courses of action, and has the ability to record their history through their own language and symbols, unique, holistic and have different needs, wants and goals.

METAPARADIGM
Person King described a person existing in an open system as a spiritual being and rational thinker who makes choices. Selects alternative courses of action, and has the ability to record their history through their own language and symbols, unique, holistic and have different needs, wants and goals. Nursing Nursing is an act wherein the nurse interacts and communicates with the client. The nurse helps the client identify the existing health condition. The goal of the nurse in this theory is to help the client maintain health through health promotion and maintenance, restoration and caring for the sick and dying.

Health
King viewed health as the ability of a person to adjust to the stressors that the internal and external environment exposes to the client Adjusting to the environment bring the client back to their usual roles before the reaction occurred.

Environment
Environment is the background for human interactions. It involves: Internal environment transforms energy to enable person to adjust to continuous external environmental changes. External environment involves formal and informal organizations. Nurse is a part of the patients environment.

Interacting Systems Framework

King proposed that the nurse interacts in the system simultaneously at three different levels, namely Personal, Interpersonal and social Frameworks. Personal how the nurse views and integrates self based from personal goals and beliefs. Interpersonal - how the nurse interrelates with a co-worker or patient particularly in a nursepatient relationship. Social - how the nurse interacts with coworkers, superiors, subordinates and the client environment in general.

ASSUMPTIONS
Basic assumption of goal attainment theory is that nurse and client communicate information, set goal mutually and the act to attain those goals, is also the basic assumption of nursing process.

IMPLICATION
To Nursing Practice
Professional have used Kings theory in different specialized area with the use of dynamic interactive communication between the nurse and the client as a proof. Professional need communication to successfully and correctly make decisions for their plan of care. The significance of Kings theory have been applied to different professional practice setting such as in nursing administration, theory based practice in the emergency department, in tertiary hospitals and in the community.

To Nursing Education
Kings interacting system has been used to design the nursing curriculum in different schools and universities and framework for nursing education. It provides a systematic means of viewing the nursing profession, organizing nursing knowledge and clarifying the nursing discipline.

To Nursing Research

Kings theory has been one of theoretical basis of some researchers that helped in formulating a system view of the application of the nursing practice.

ANALYSIS
Simplicity
Kings theory was as a result of careful research study. Her research literature was based on the existing evidences during her study. She maintains the simplicity of her theory even if she presented different complex concepts.

Generality
Kings theory has been said to have limited application for the nursing practice. It was stated that the interaction between the nurse and the client also comprises non-verbal communication that cannot be clearly defined and evaluated.

INTRODUCTION
Born in Reading, Pennsylvania 1909 Graduated from a diploma program in Pottstown, Pennsylvania in 1931 Done BA in interpersonal psychology from Bennington College in 1943 MA in psychiatric nursing from Colombia University New York in 1947 EdD in curriculum development in 1953 Professor emeritus from Rutgers University Started first post baccalaureate program in nursing Published Interpersonal Relations in Nursing in 1952 Became a member of the Army Nurse Corps Died in 1999

METAPARADIGM
Person
Peplau

defines person as a man who is an organism that lives in an unstable balance of a given system. A developing organism that tries to reduce anxiety caused by needs.

Health
She

considers health as a word that symbolizes movement of the personality and other ongoing human processes that directs the person towards creative, constructive, productive and community living.

Nursing
Peplau

described Nursing as a significant, therapeutic interpersonal process. It functions cooperatively with human processes that present health as a possible goal for individuals

Environment
She

defines Environment as forces outside the organism and in the context of the sociallyapproved way of living, from which vital human social processes are derived such as norms, customs and beliefs.

Theory of Interpersonal Relations

Peplau

described the nurse-patient relationship as a four phase phenomenon. One can view them as separate entities. Each phase is unique and has distinguished contributions on the outcome of the nursepatient intreaction; Phases of Nurse-Patient Relationship are 1. Orientation 2. Identification 3. Exploitation 4. Resolution

Orientation phase
Problem

defining phase Starts when client meets nurse as stranger Defining problem and deciding type of service needed Client seeks assistance, conveys needs, ask questions, shares preconceptions and expectations of past experiences. Nurse responds, explains roles to client, helps to identify problems and to use available resources and services.

Factors influencing orientation phase

Identification Phase
 

Selection of appropriate assistance. Patient begins to have a feeling of belonging and a capability of dealing with the problem which decreases the feeling of helplessness and hopelessness. Use of professional assistance for problem solving alternatives Advantages of services are used is based on the needs and interest of the patients. Individual feels as an integral part of helping environment. Patient may fluctuates on independence. Nurse must be aware about the various phases of communication. Nurse aids the patient in exploiting all avenues of help and progress is made towards the final step.

Exploitation Phase


    

Resolution Phase
    

Termination of professional relationship. The patients needs have already been met by the collaborative effect of patient and nurse Now they need to terminate their therapeutic relationship and dissolve the links between them Sometimes may be difficult for both a psychological dependence persists. Patient drifts away and breaks bond with nurse and healthier emotional balance is demonstrated and both becomes mature individuals. Both are sequential and focus on therapeutic ralationships Both use problem solving techniques for the nurse and patient to collaborate on, with end purpose of meeting the patients needs. Both use observation communication and recording as basic tools utilized in nursing.

INTERPERSONAL THEORY AND NURSING PROCESS

IMPLICATIONS
To Nursing Practice

Some of Peplaus ideas were not widely accepted at the time they were introduced, such as the concepts of learning through experiences between the patients and the students. However, as the concepts that form her Interpersonal Relations Model were applied and tested, many nursing experts now recall Peplau as the one who brought a new perspective, a new approach and a theoretical foundation for nursing practice. Hildegard Peplaus book, Interpersonal Relations in Nursing (1951), is being used as a manual of instruction to help graduate nurses and nursing students alike in creating a significant nurse-patient relationship in any setting they are into.

To Nursing Education

To Nursing Research

At the arrival of the Interpersonal Model, nursing researchers follow the major assumption that patient problems were within the person phenomena and were dealt inside the nurse-patient interaction studies.

LIMITATIONS:

Intra family dynamics, personal space considerations and community social service resources are considered less. Health promotion and maintenance were less emphasized. Cannot be used in a patient who doesnt have a felt need eg. With drawn patients, unconscious patients Some areas are not specific enough to generate hypothesis.

Theoretical Foudations of Nursing: The Philippine Perspetive (Eufemia f Octaviano, Carl E. Balita) Nursing Theorists and Their Works, Sixth Edition (Ann Marriner Tomey, Martha Raile Alligood) Current Nursing@yahoo.com

Lani Luz Villasin