Concept Comparison and Analysis

The caring, supportive, sympathetic features of nursing, is immeasurable. Theories are essential to have. They provide a description of what nurses do and give meaning and purpose. When nursing theories are developed this new knowledge can greatly impact the future of nursing practice (McCrae, 2012).

I chose to do a concept analysis on ‘Self-Care.’ The nursing theory that uses this concept is Orem’s theory of nursing. This theory is a grand theory and consists of three minor interrelated theories; self-care,

“Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles” (ICN 2010)

The theory focuses on the ability of a person to meet his or her own needs. Developed in the year 1970, Orem’s theory focused on the three various concepts, namely self-care, self-care deficit, and the nursing system. Self-care is a group of activities or processes that a person performs to maintain health, life, and wellbeing (Orem, 2001). For instance, self-care is being demonstrated when a chronic heart failure patient checks his or her weight daily, takes prescribes medications, and avoids salty foods. Self-care deficit happens when an individual is not able to provide effective self-care (Orem, 2011). Nurses are able to assist patients in this state by educating them with their disease condition and treatment compliance. A nursing

The nursing process does not merely treat the patient as a physical body, but rather treats the patient holistically. The central philosophy of Dorothea Orem's self-care deficit nursing theory "is that all patients want to care for themselves, and they are able to recover more quickly and holistically by performing their own self-care as much as they're able" (Dorothea Orem, 2012, Nursing Theory). However, although self-care may be the core of Orem's theory, the decision to engage in self-care must be facilitated by the patient's social and physical environment, of which the family can play a critical role in shaping.

General Criteria: Self-care theory is abstract to the degree that it is applicable to persons of all ages regardless of degree of wellness. An aspect of self-care is considered to be "dependent care" which expands the degree of application ofthe model. The concepts in the theory of self-care are delineated in terms of sub-components and recognizable attributes. The definitions ofthe major constructs and their interrelationships enable one to explain, within the boundaries of the model, the relationship between the patient's self-care abilities and level of wellness, the relationship between diminished self-care abilities and the need for nursing support and the relationships among nursing agency, patient agency, therapeutic self-care demands and maximizing self-care abilities. Probably, one of the attractions Orem's theory has for many nurses is its utility in practice. This is highly

Dorothea Orem’s Self Care Model states, “Nursing care is required when an adult is unable to perform self-care sufficiently to sustain life, maintain health, recover from disease or injury, or cope with the effects of disease or injury” (Orem, 1991). Orem also takes into account that caregivers also need nursing care.

Orem is credited with being one of the first major nursing theorists to link theory to practice in an explicit fashion. "The notion of being able to 'think' nursing to be able to move from an abstract general perspective representative of nursing in all situations as a basis for analyzing nursing cases in order to 'do' nursing in a variety of particular situations seemed essential if nursing was ever to move ahead as a separate scientific discipline of knowledge" (Allison 2008:49).

Dorothea Orem’s self-care deficit theory is based upon the idea that individual’s require a set of actions to maintain self-care and independence. When an individual is unable to perform an action required for daily care then that individual has a deficit. In order for the person to regain or acquire the skills needed to overcome this deficit they must first be willing to seek help and take the steps and measure needed (Orem, 1991). Nurse’s play a key role is this process by evaluating what the deficit is, formulating the steps needed, implementing the process and evaluating the results. Some of the concepts to this theory are that of, dependency, nursing, health, person, environment,

In 1957, Dorothea Orem participated in the U.S. Department of Health, Education, and Welfare as a consultant to improve the training of nurses (Johnson & Weber, 2008). From there she attempted to explain the role of nurses in patient care. Through a philosophical lens, according to Banfield (2008), the nature of human beings are the foundation of Orem’s self-care deficit theory. Nature of human beings include the individual’s relationship with the environment, the individual’s capability of developing, the individual’s free will and freedom, and the relationship of the individual with others (Banfield, 2008). The human-environmental relationship emphasizes that patients interchangeably connect with the environment and are never separate from each other. The developmental process includes the importance of the individual reaching their

Orem’s self care deficit model is model that encompasses self care requisites, self-care deficit and health care professional systems (Berman et al., 2012). These three theories together constitute the general theory of nursing (Taylor, Geden, Isaramalai, & Wongvatunyu, 2000). Self-care requisites are the needs that Orem identified; Universal self care, developmental self-care and health deviation requisites (Hartweg, 1991). Orem’s theory is based on the theory that all patients wish to take care for themselves (Denyes, Orem, & Bekel, 2001). It theorises that a patient will be able to recover more holistically and quickly if they are allowed to manage themselves productively and to the best of their ability (Taylor et al., 2000). When patients are unable to meet their own demands and provide for themselves a ‘self-care deficit’ occurs (Hartweg, 1991). By using this model, a medical professional is able to establish these deficits, and identify areas, which need attention (Closson, Mattingly, Finne, & Larson, 1994).

In Orem’s theory, nursing care is necessary when self-care deficit exists. The nurse can analyze the reason for the inability to meet self-care need, set a goal and implement necessary nursing intervention. Individuals have the ability to think, learn and function by themselves independently or through others. According to Orem, health is a state of physical, social well being, mental health and not only the lack of diseases. Individuals interact with their environment (George, 2011). The role of nursing in society is to allow individuals to mature and use their self-care capabilities to the extent that they can look after themselves.

According to Potter and Perry (2013), “Dorothea Orem defines self­care as a learned, goal­oriented activity directed toward the self in the interest of maintaining life, health, development, and well being” (p. 44). The theory is centered around the patient’s needs. The goal is to help the patient take care of themselves and take control over their health. The theory is not only used for the needs of patients, but also as a learning tool for nursing students. In most nursing schools, Orem’s theory is the bloodline of the program. Orem’s theory of nursing is made up of three other theories: the theory of self care, theory of self care deficit, and the theory of nursing systems, which is more specifically classified into wholly compensatory, partial compensatory, and supportive­educative.

Dorothea Orem’s Self-Care Deficit Theory discusses how in certain situations a patient may not be able to care for themselves. This causes a self-care deficit and that is when the nurse helps the patient until they are able to take care of themselves once again. Assisting patients with deficits are skills that nurses are required to possess. In my practice as a nurse my job is to coordinate services to maximize the independence of the patient and to ensure that the environment in which the patient lives in is safe and supportive for their needs. Daily I apply Orem’s theory. The purpose of this paper is to show how Orem’s Self-Care Theory is important and how it relates to my nursing practice.

The theory of the nursing systems developed guidelines for nurses to know the extent in which to intervene. Within the nursing systems, there are three levels: wholly compensatory system, partially compensatory system, and supportive-education system (Figure 1). Wholly compensatory system is used when the patient is unable to perform any self-care activities and solely relies on the nurse to perform the care. Partially compensatory system is used when the patient and the nurse participate in the self-care activities with the goal of shifting the activities from the nurse to the patient as the self-care demand changes. Supportive-educative system is used when the patient can care for oneself but requires assistance from the nurse in decision making, knowledge, or skill acquisition to maintain self-care (Masters, 2012).