This assignment consists of choosing a theory from 1955 to the present and conducting a theory critique. The theorist chosen for this assignment is Dorothea Orem. Orem’s Self-Care Theory is predominantly used in primary and rehabilitation care areas in which the client is motivated to be as self-sufficient as possible. To effectively critique this theory, the background of the theory, theory description, evaluation, and application of the theory must be examined.
Background
Self-care can be defined as the care of oneself without medical, professional, or other assistance or oversight. Orem’s Self-Care Model designates a structure in which the nurse supports the client to retain a sufficient level of self-care. The amount of nursing intervention depends on the ability or inability to achieve self-care needs.
Dorothea Orem’s Self-Care Deficit Theory, is one of the most extensively used models in nursing. While working at Indiana University Orem’s goal was to upgrade the quality of nursing in facilities throughout the state of Indiana. Orem recognized that nurses had trouble expressing desires to facility administrators of demands concerning matters outside of the realm of patient care. Consequently, Orem realized the necessity to search for the uniqueness of nursing and the boundaries of nursing as a field of practice and a field of knowledge. Furthermore, Orem wanted to know what meaning should be attached to circumstances, conditions, events, persons, and things encountered. According to Fawcett, 2005 Orem mentioned that this task required identification of the nursing field and limitations of nursing as a science and an art. Retrospectively, Orem says the answer came to her as an intuition that the reason why individuals could benefit from nursing was the existence of self-care limitations” (Fawcett, 2005, p. 230). Concepts that facilitated the modeling of the self-care framework were conveyed as Orem experienced an era of great exposure to nurses and their actions from 1949 to 1957 (Fawcett,2005).
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Theory Description
Orem’s Self Care Deficit Theory of Nursing is a conceptual model made up of 3 related theories; Theory of Self-Care, Theory of Self-Care Deficit, and Theory of Nursing Systems. According to Orem, “the three-part theory centers not on individuals, but on persons in relations. Each of the three theories has as its emphasis a precise measurement of the person: the theory of self-care focuses on the self, the I; the theory of self-care deficit focuses on you and me; and the theory of nursing system focuses on we, persons in community” (1990, p. 49). The three theories are uniquely related. The Theory of Self-Care outlines the demands of self-care fundamentals that a person is required to meet to remain healthy or recover from illness. When an individual is unable to achieve these self-care ultimatums, or when self-care stipulations surpasses self-care capabilities, nursing is required. Nurses can assist patients to attain their self-care needs by making use of the techniques in the Theory of Self Care Deficit. Nonetheless, the nurse must accurately evaluate the level of self-care a patient needs so as to apply the nursing system that fits the patient’s ability to accomplish self-care. Ultimately, the nurse supports the patient in accomplishing self-care needs to facilitate a healthy, illness free situation.
Orem described self-care as the practice of activities that persons individually initiate and accomplish on their own behalf for the preservation, renewal, or upgrade of health in order to retain well-being. The conceptual framework comprises major concepts and supporting concepts. The major concepts are self-care deficits, self-care needs, and nursing systems. Individuals complete deliberate self-care actions in to achieve self-care requirements for health preservation, well-being, and the conservation of life. These needs are altered by a person’s age, incentive, development, experiences, resources, socioeconomic, and cultural background. A self-care deficit occurs when a person is unable to meet self-care needs. Subsidiary concepts consequent to the self-care deficit are Therapeutic Self-Care Demand, which entails self-care activities that must be implemented in order to accomplish needs for the maintenance of life or advancement of well-being and Self-Care Agency, which focuses on the ability to meet one’s requirements for self-care.
Figure 1 best describes the Orem’s Self-Care Model
R=relationship, <= deficit relationship, current or projected
http://1.bp.blogspot.com/_c2VIUh4psKE/TE0R3xBuPNI/AAAAAAAAAY4/JYDtClHsG5s/s400/orem03.jpg
Evaluation
Orem’s theory is grounded on explicit and implicit assumptions. Orem’s theory is based on explicit and implicit assumptions. Meleis (2012) summarizes the explicit assumptions as:
(1) Nursing is a measured, focused helping service accomplished by nurses for the sake of others over a period of time. This behavior involved a self-originated, self-engaged, results generating activity.(2) Individuals (human agency) are adept and prepared to achieve self-care for self or for needy members of the family. (3) Self-care is a part of life that is essential for well-being, human growth, and health (4) Learning and culture impact persons. (5) Self-care is learned through human collaboration and communication. (6) Self-care comprises careful and methodical activities executed to meet recognized needs for care. (7) Human agency is used in discerning, evolving and conveying to others ways and means to ascertain needs of self and others.
In brief, Meleis (2012) states the implicit assumptions as: (1) Individuals must be independent and accountable for their care needs in addition to others in the household who are unable to care for themselves. (2) People are divergent from others and from their environment (Meleis, 2012).
A proposition is a declaration or proclamation of the connection between concepts. There are seven propositions in Orem’s theory of self-care. (1) Age, experiences, progressive state, and sociocultural upbringing effects self-care capabilities. (2) Abilities to take care of self and care for others are learned and remembered (3) Self-care proficiencies and self-care demands should be balanced by self-care deficits (4)Life involvements, health, sociocultural alignment, resources, developmental stage, and age intercedes self-care or dependent care (5)Nurses, patients and others are involved in therapeutic self-care by meeting self-care needs and regulating self-care abilities (6)Nurses measure patients’ capabilities and skills in meeting and carrying out their self-care needs. (7)Nurses select dependable and effective processes, actions, and skills in meeting needs for self-care.
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Nursing theories have four concepts relative to their metapardigm: person, environment, health, and nursing. Nonetheless, every nurse theorist describes these concepts inversely, contingent on the concept suitability for the theory. The patient is the chief emphasis of nursing care. According to Orem, the person’s health state is mediated by his/her environment. A person, who is healthy, is capable of self-care. When there is illness in the person’s health state, the person is not able to complete all self-care requisites. When this occurs, nursing care is needed to assist the person in completing his/her self-care. Nurses must assess the person’s ability to provide his/her own self- care and the environmental context of the person in order to overcome health-associated limitations. In 1971, Orem defined a human being (humanity) as “…an integrated whole composed of an internal physical, psychological, and social nature with varying degrees of self-care ability” (Chinn& Kramer, 2004). Ultimately, Orem defined a human being as a considerable or physical unity whose parts are designed and accomplish excellence through the variation of the whole during the course of development. Human beings have the ability to reflect and symbolize. When discussing humans, Orem uses the expressions dependent-care agent, individual, multi-person unit, patient, and self-care agent.(Fawcett, 2005).
In referring to the perception of health, Orem denoted health and healthy as expressions used to describe living things as fundamentally and functionally complete including those things that which make a person human, functioning in concurrence with physiological and psychophysiological mechanisms, a biologic state, and interaction with other human beings. She additionally defined health as not only the nonexistence of sickness or frailty, but a state of physical, mental, and social well-being. Orem also viewed health as a state of comfort, which refers to an individual’s perceived state of existence, categorized by experiences of gratification, pleasure, cheerfulness, and movement in the direction of self-ideals and ongoing personalization (Chinn & Kramer,2004).
As defined in the metaparadigm of nursing, environment refers to the individual’s physical surroundings and significant others, in addition to the venue in which nursing transpires, ranging from the person’s home to society as a whole (Fawcett, 2005). According to Orem, environment is tri-dimensional, including the community, physical, and socioeconomic features. Community features are inclusive of the populace and its structure by family units, public units, and by legislative opinions. The physical features comprise preserving the human structure, functioning, and welfare. Socioeconomic features center on the family, as well as structure by roles and ages, responsibilities, and privileges for the family unit. (Fawcett, 2005).
The metaparadigm concept of nursing is symbolized in the Self-Care Framework by the concept Nursing Agency. Nursing Agency is the action of nurses in shaping the needs for, scheme of, and production of care for individuals with a range of diverse self-care deficits. Nursing Agency contains three scopes which are the interpersonal system, professional-technologic system, and social system. The interpersonal system comprises touching base, relationship, and communication amongst the nurse and the patient. The professional technological system is the system of action productive of nursing. The presence of the professional-technological system is reliant on the presence of the interpersonal system, which consecutively, is dependent on the presence of the social system. The social system consist of the association between the nurse and the patient establishing a contract for the purpose of procuring nursing care when an existent or probable self-care deficit has evolved. (Fawcett, 2005).
In view of clarity, the dialectal component of the theory is steady with the linguistic style used in philosophy. There are no created words. The vocabulary is consistent throughout. The term self-care has various meanings through disciplines; Orem defined the term and expounded the functional arrangement of the concept that is distinctive but also compatible with other interpretations.
Application
There is sufficient proof in the literature that the theory is beneficial in developing and managing practice and research. It gives guidelines to specific outcomes interrelated to distinguishing and accomplishing the therapeutic self-care demands, regulating the growth and exercise of self-care agency and instituting self-care and self-management systems. The theory is likewise valuable in the scheme of core curriculum for graduate and continuing nursing education. Furthermore, the theory provides direction to nursing administration. The development of theory-based computer systems, assessment forms, and the whole forming of the delivery of care confirms to the practicality of the theory (Tomey & Alligood,2002). Orem’s theory does have discrepancies, but proves to be coherent in the view represented of the world of nursing and the activities of people in it. There are several terms that can be confusing in the beginning until each concept is understood. This multifaceted theory is viewed as balanced between intricate and inadequate. The components are recognized but there is opportunity for development and addition of other fundamentals.
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