Dorothea Orem’s Theory of Self-Care

Introduction

For the majority of the 20th century, nursing care was characterized by being nurse centered (Alligood, 2017). Patients were treated as passive observers and were not expected to take an active role in deciding their healthcare outcomes. Such an approach overburdens nurses while robbing patients of their agency. A theory that incorporates both nurses and patients while promoting sustainable health habits must be developed. In this paper, I will describe the core tenets of my theory.

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Theorizing

Nowadays, a task-oriented approach to nursing continues to be practiced by many practitioners. It involves the performance of several practices and activities that are primarily aimed to maintain patient health (Alligood, 2017). The problem is that such an approach is expensive, inefficient, and neither considers patients’ interests nor provides them with tools for self-care. Nursing does not mean simply catering to the patient’s needs without teaching them to help themselves. Nor does nursing mean providing help and instruction only within the walls of the hospital. My role is to enable the patient to take an active part in restoring their health. Considering this, I identify nursing as a process of empowering patients to engage in better self-care as it allows fulfilling individuals’ basic needs for maintaining and promoting health, especially in the context of limited access to healthcare (Hasanpour-Dehkordi, Mohammadi, & Nikbakht-Nasrabadi, 2016).

In this framework, nursing involves patient education on how to actively engage in restoring their health. Since instructing individuals on this subject implies the understanding of their life situations and their overall background, a holistic care approach must be implemented. Holistic nursing is defined as “a behavior that recognizes a person as a whole and acknowledges the interdependence among one’s biological, social, psychological, and spiritual aspects” (Zamanzadeh, Jasemi, Valizadeh, Keogh, & Taleghani, 2015, p. 214). This perspective also refers to respecting the patient’s role in the process of health maintenance and recovery and encouraging them to engage in self-care. Thus, the theoretical concepts of self-care and holism are deeply interrelated.

Syntax

Identifying and providing definitions to key concepts of the theory would help avoid ambiguity during theorizing and implementation. The term “care recipients” will be one of the central in the theory and will refer to individuals subjected to nursing care and acting as social units in the context of psychological and home care (Saeedifar, Memarian, Fatahi, & Ghelichkhani, 2018). Since the success of nursing care depends on the quality of a nurse’s understanding of patient needs, there should be a term for their evaluation. Thus, a “holistic assessment system” will imply the evaluation of biological, environmental, social, psychological, and spiritual aspects of care recipients’ well-being (Masters, 2015; Zamanzadeh et al., 2015). The goal of such an evaluation is the development of tools for the promotion of “self-care proficiency.” The latter term is based on Orem’s definition of self-care agency and means “the human capacity to carry out specific kinds of actions” (Waki et al., 2016, p. 480). Overall, these definitions would add to the already defined concept of nursing and will help to inform potential applications in practice.

Theory Testing

The suggested theory of self-care can be used to improve patient outcomes in a hospital setting. Thus, a quantitative study can test the efficacy of tools for the promotion of individuals’ self-care proficiency, such as patient education and assisted movement, which would enable low-mobility individuals to perform daily activities without or with limited assistance from nurses (Younas & Quennell, 2019). To increase the validity of findings, it is appropriate to utilize the case-control study design and compare a sample assessed by using the holistic assessment system and exposed to individualized interventions aimed at the development of self-care proficiency and attainment of sustainable behavioral changes. For convenience, it can be suggested to focus on a population with the same disease, for example, diabetes or hypertension. Evidence from previous research demonstrates that improvement of self-care capacities in people with these adverse health conditions is correlated with better quality of life and overall health outcomes (Lin, Yang, Yin, & Lin, 2015). Thus, the evaluation of theory application to the management of these diseases can help both advance the nursing practice and contribute to further theory development.

A qualitative study may focus on the evaluation of professionals’ perceptions of the tools developed following the suggested theoretical framework, including the holistic assessment system and contextualized/individualized interventions. For instance, the use of these tools may be studied within distinct clinical settings associated with different levels of work intensity: general care, acute care, and so forth. It is well-known that the rate of time-limiting and stressful situations in critical care settings can be much higher than in primary care hospitals (Yang, Thompson, & Bland, 2014) and, therefore, it may be more feasible to apply the holistic theoretical framework in one clinical environment than another. In this regard, the evaluation of professional perceptions can help identify major barriers to the use of the theory in practice, as well as its overall scope of implementation. In addition, a qualitative study may focus on the assessment of care recipients’ perceptions of the practical effectiveness of the theory. Noteworthily, the theory can be tested in the context of social work as it involves the assessment of vulnerable population needs and aims to promote their well-being through knowledge and skill development as well.

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Evaluation

Evidence obtained from the discussed research projects may be used in practice to create and improve tools for the evaluation of a patient’s self-care needs depending on their health condition. For instance, introducing a patient to a regimen of personal hygiene would reduce the symptoms of health defects associated with insufficient cleanliness. In the case of a person with diabetes, self-care needs may include diet change, engagement in more physical activity, proper adherence to medication, and so forth (Smith & Parker, 2015). Secondly, theory can be applied to forecast patient outcomes similar to Orem’s self-care theory that provides nurses with the potential to prognosis a patient’s recovery with the consideration for their ability to take care of themselves (Smith & Parker, 2015; Yang, Xie, Song, Nie, & Chen, 2018).

Thirdly, the proposed theory can be also used to develop patient support strategies based on the evaluation of patients/care recipients’ self-care proficiency. It is appropriate to introduce a term that would denote the lack of necessary self-care abilities – “self-care deficiency.” Similar to Orem’s concept of self-care deficit it will signify a gap in one’s general self-care capacity that prevents them from fulfilling all self-care demands and maintaining good health (Kaur, Vati, & Kaur, 2006). When the level of self-care deficiency is identified, a nurse will select necessary intervention and support tools within the holistic, patient-centered care model.

The theory can also be implemented to modify environments and reduce adverse influences. For example, for patients who suffer from partial or total immobility, installing special rails, ramps, and call buttons would significantly improve patient autonomy inside and outside the hospital (Smith & Parker, 2015). However, modifications can relate to intangible environmental factors as well, for instance, family relationships and support. As research evidence demonstrates, a greater level of family engagement in patients’ self-care improvement endeavors increases a chance for attaining more sustainable, positive outcomes (Pamungkas, Chamroonsawasdi, & Vatanasomboon, 2017). Lastly, the theory can be applied during post-hospitalization care to formulate and promote preventive interventions for patients transferred to home care (Smith & Parker, 2015). These would involve the development of exercising interventions, education of safety techniques, drug adherence, and so forth.

Conclusions

The presented theory will help shift the spotlight of care from the nurse and towards the patient. From a passive recipient of care, a person would become a full-fledged partner with personal agency and will to improve their well-being (Alligood, 2017). Patient-centered care ought to provide better outcomes while empowering patients and reducing costs. It should replace the current nurse-centered paradigm. Orem’s theory of self-care is best applied in long-term care settings, mental care facilities, and triage organizations facing limited amounts of materials and resources.

References

  1. Alligood, M. R. (2017). Nursing theorists and their work. New York, NY: Elsevier Health Davis.
  2. Hasanpour-Dehkordi, A., Mohammadi, N., & Nikbakht-Nasrabadi, A. (2016). Re-designing Orem’s self-care theory for patients with chronic hepatitis. Indian Journal of Palliative Care, 22(4), 395-401.
  3. Kaur, M., Vati, J., & Kaur, S. (2006). Self care deficits of admitted patients. Nursing and Midwifery Research Journal, 2(1), 10-15.
  4. Lin, K., Yang, X., Yin, G., & Lin, S. (2015). Diabetes self-care activities and health-related quality-of-life of individuals with type 1 diabetes mellitus in Shantou, China. Journal of International Medical Research, 44(1), 147-156.
  5. Masters, K. (2015). Nursing theories: A framework for professional practice (2nd ed.). Burlington, MA: Jones & Bartlett Learning.
  6. Pamungkas, R. A., Chamroonsawasdi, K., & Vatanasomboon, P. (2017). A systematic review: family support integrated with diabetes self-management among uncontrolled type II diabetes mellitus patients. Behavioral Sciences, 7(3), 62.
  7. Saeedifar, E. S., Memarian, R., Fatahi, S., & Ghelichkhani, F. (2018). Use of the Orem self-care model on pain relief in women with rheumatoid arthritis: A randomized trial. Electronic Physician, 10(6), 6884-6891.
  8. Smith, M. C., & Parker, M. E. (2015). Nursing theories and nursing practice. London, UK: FA Sciences.
  9. Waki, S., Shimizu, Y., Uchiumi, K., Asou, K., Kuroda, K., Murakado, N., … Ishii, H. (2016). Structural model of self-care agency in patients with diabetes: A path analysis of the Instrument of Diabetes Self-Care Agency and body self-awareness. Japan Journal of Nursing Science, 13(4), 478-486.
  10. Yang, H., Thompson, C., & Bland, M. (2014). Do nurses reason ‘adaptively’ in time limited situations: The findings of a descriptive regression analysis. BMC Medical Informatics and Decision Making, 14, 96.
  11. Yang, H., Xie, X., Song, Y., Nie, A., & Chen, H. (2018). Self-care agency in systemic lupus erythematosus and its associated factors: A cross-sectional study. Patient Preference and Adherence, 12, 607-613.
  12. Younas, A., & Quennell, S. (2019). Usefulness of nursing theory‐guided practice: An integrative review. Scandinavian Journal of Caring Sciences, 0(0), 1-16.
  13. Zamanzadeh, V., Jasemi, M., Valizadeh, L., Keogh, B., & Taleghani, F. (2015). Effective factors in providing holistic care: A qualitative study. Indian Journal of Palliative Care, 21(2), 214-224.
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