Nursing is a difficult profession to hack, particularly in the absence of operational and/ or educational frameworks upon which to base decision making. Nursing theories are described as nursing models which represent reality in the theoretical realm. Through connection with the nursing theory, nursing practitioners, leaders and educators can effectively apply the proposed models and assertions towards improved quality of life for all the patients in the healthcare system. A wide range of nursing theories have been developed over the years by different authors and classified as either grand theories, middle range or practice theories (Hartweg, 1991). Each of these categories includes several theories that can be applied in a variety of nursing settings. For instance, Dorothea Orem proposed the Self Care Deficit theory as a grand theory to be used in all settings. The theory is based on the philosophy that all patients have the intrinsic desires to cater for their own needs and nurses can only assist through identifying the areas of deficit.
This paper delves into the concept of self care deficit theory. The paper is structured such that it provides an overview of the importance of nursing theories in various areas of nursing. This is followed by a description of the particular nursing theory to be discussed and finally through the areas in which I have individually had an opportunity to engage in during my volunteer work.
Importance of nursing theory
Nursing models are explained by Eun-Ok and Ju (2012) as the simple ways of making explanations of complex phenomena in nursing. Nursing, especially practice is difficult to successfully carry out without any guiding practice principles and examples. Because of this, studying nursing theories at the degree level or at Master’s is essential for the development of nursing efficiency. While practice experience can be gained during service, it is impossible to gain theoretical knowledge in the field. Nursing theory is only accessible via a classroom setting where all the pertinent information can be provided. In addition to this, the range of nursing theories applicable in the profession today, demands that the practitioners and other nursing professionals be made aware of them. The only place where this can be done is through the master’s studies.
According to a book by Masters (2011), nursing theories are also referred to as nursing models. The frameworks are constructed based on three key components. The nursing models have to include a statement of the specific nursing goals relating to a particular patient, setting of personal, organizational and general nursing values and beliefs upon which to base intervention and creation of awareness, skills and knowledge concerning the applications of nursing theories. The nursing theories developed subsequently have various importances with respect to the profession. First, when used in practice, nursing theory gives a plan for the practitioner to reflect during situational examinations. In this regard, nursing theory gives the practitioners a tentative outlook to particular problem situations.
Apart from this, nursing theory also provides the practitioners with an arrangement for investigating organizational management and for decision making. This makes it easier for the nursing professionals to make informed decisions regarding patient health. The third role played by nursing theory in practice is that it enables the nurses and other healthcare representatives to communicate freely based on common foundation between them. From these findings it can be deduced that nursing theory is an essential as well as critical part of nursing training and practice. Nursing theory can thus help to distinguish the nursing profession from other professions in healthcare as it gives a framework for the accomplishment of the roles that are specifically nursing aligned. Through providing an easy understanding of the complex phenomena, nursing theory enables nurses to comprehend their roles effectively in study, leadership as well as practice. Nursing theory makes the mandates of nursing profession clear enough and also makes it easy for nurses to adhere to the practice code of ethics in the nursing profession. Despite its roles and the distinguishing features of nursing theory, the use of nursing theory in practice still raises significant concern particularly on the ethical considerations of the aspect. While there are arguments that nursing theory helps nurses to accomplish roles, there is also the fear that the use of text book procedures and recommendations, particularly disease management cases may not be ethical (Masters, 2011). This makes it necessary to apply the theories with caution while paying regard to the effects of the theories on the patient perceptions.
Dorothea Orem’s Self Care deficit Theory
The self care deficit theory was published by Dorothea Orem between 1959 and 2001. The theory is among a series of other nursing theories developed by the same author which include the self care theory and nursing theory among others (Orem, 1991). The self care deficit theory is also referred to as Orem’s nursing model. It is constructed on the philosophical basis that all patients have the desire to take care of themselves even though they may not be able to do so. Although the self care deficit theory is a grand theory and relevant to a variety of nursing contexts, it most commonly finds use in nursing practice. It is therefore the responsibility of the nursing personnel to find ways through which the patients can be helped where they face deficits in caring for themselves. The self care deficit theory is centered on three key self care requisites which help the nursing practitioners to plan their actions accordingly.
According to Orem and Taylor (2011), the self care requisites can be categorized as universal requisites, developmental self care requisites and health deviation requisites. These requisites are what guide the nursing practitioners on the course of actions to take in case any deficit is felt in any of the three key areas. The universal requisites include: maintaining balance between solitude and social interactions, air, water, food, activity and rest and hazard prevention. The developmental requisites on the other hand are requisites for maturation and situational requisites while the health deviation requisites are those that are possessed by patients as a result of the demands of their health conditions. These include requisites such as gaining access to health care and medication and living with the effects of diagnosis among other things (Hartweg, 1991). The self care deficit theory further provides three main intervention procedures for dealing with nursing problems in the work place. These include total compensation, partial compensation and educational supportive intervention.
Application to selected Practice Cases
I found the self care deficit theory most relevant in the clinical setting where I had to intervene in cases of chronic illness. During practice, I managed to apply the self care deficit theory to various cases. However, the most outstanding included the cases of a miscarriage and a HIV positive patient. In the first case, a patient, whom I will refer to using a code E, came into the facility with reported spotting. Being three months pregnant, the first instinct that came to mind was the probability that the patient was experiencing a spontaneous abortion. In trying to manage this issue, I tried to identify the possible areas of deficit after placing the patient on rest in an assigned bed. From the universal requisites, the most relevant to this context was the imbalance between activity and rest. The patient had been engaging in many roles which placed a lot of pressure on her and the unborn baby. As a result, she experienced contractions leading to the premature expulsion of the fetus from the uterus. The health deviation requisite conditions recognized included the need to access medical assistance and to deal with the impacts of her condition. I recommended flushing to wash out the remains of the fetus, to provide the necessary medical assistance and to provide counseling for the patient to deal with the aftermath of the miscarriage. As such, the deficits in self care were filled through partial compensation in the case of accessing medical care and recommending rest. Additionally, education and support was used in advising the patient concerning hope for a future conception.
In the case of the patient with HIV, the same diagnostic procedure that describes the self care deficits was used. In this case, the support given was mainly educative. The HIV patient was mostly counseled on living positively and going for the necessary medication for the management of his condition. The partial compensation approach also proved to be beneficial in this case.
Nursing theory is one of the greatest distinguishing factors of the nursing profession. The roles played by nursing theory in nursing leadership, education and practice. Through providing frameworks for the accomplishment of nursing objectives, theories set the profession apart and also help nurses to accomplish responsibilities marred with complexities. The self care deficit theory developed by Dorothea Orem is one of the many nursing theories in the world today. The theory is classified as a grand nursing theory and thus applicable in a wide range of contexts. In particular, nursing practice immensely applies Orem’s theory. I for instance, applied in several practice cases during my placement. The most outstanding of these applications were in cases of HIV and miscarriage.
Eun- Ok, I. and Sun, J.C. (2012). Current Trends in Nursing Theories. Journal of Nursing Scholarship, 44(12): 156-164
Hartweg, D. (1991). Dorothea Orem: Self Care Deficit Theory. Notes on Nursing Theories. Sage Publications.
Masters, K. (2011). Nursing theories: A framework for Professional practice 2nd Ed. Sage Publications.
Orem, D.E. (1991). Nursing: Concepts of Practice 4th Ed. St. Louise, Mo: Moshy.
Orem, D.E. and Taylor, S.G. (2011). Reflections on Nursing Practice Science: The Nature and Meaning of Nursing Diagnosis. Nursing Science Quarterly, 24(2): 130-136.