The process through which nurses help individuals to deal with health and social problems is complex and difficult. In terms of physical and mental states, lifestyles, environments, choices and social habits, the definition of key concepts is an imperative process in the application of nursing theory to practice. In most cases, the ambiguity of concepts exists between the care providers and the recipients of the provided care. For instance, in the application of the self- care concept to nursing practice, the interactive process between the nurses and the care recipients can be nuanced with differences in meaning and approaches between the nurses and the patients.
Concept analysis can be instrumental in nursing theory development for the purpose of distinguishing between the attributes that describe a concept and the structures considered irrelevant to a case. In addition to this, concept analysis can help in nursing theory development by breaking down the concept into simpler elements in order to determine its internal structure. Furthermore, concept analysis is relevant to nursing through its capability to enhance the development of a common comprehension among nursing colleagues, to clarify an ambiguous or overused concept and to help in the development of tools and nursing diagnosis.
There are many methods through which concept analysis can be carried out. In this paper, the Self-care concept presented in Dorothea Orem’s self-care deficit theory will be analyzed through the Walker and Avant concept analysis procedure as described by Brush et al (2011). The proposed concept analysis procedure entails concept selection; determination of the aims and purposes of the concept as defined previously; identification of the concept uses; determination of the concept’s attributes; model case construction; construction of borderline; related and contrary cases; description of antecedents and precedents and definition of the empirical referents of the concept (Brush et al., 2011). The sections of the paper therefore include all these aspects and will be based on previous literature on the subject.
Definition of the self-care concept
Each person has an innate ability to carry out self-care and hold responsibility for their health as well as the health of their dependents. In this context, self-care is defined as the practices which individuals initiate and carry out on their own behalf for the maintenance of their health, life and wellbeing (Cardinal and Stritch University Library, 2011). The self-care concept as described in Orem’s theory entails several aspects. The key definition of self-care as given by Dorothea Orem’ theory is the ability of an individual patient to perform basic roles that help them to achieve certain needs in life. As such, the self care theory defines a nursing patient as in self-care deficit when one is incapable of carrying out any of the functions associated with self-care. It further asserts that when one cannot meet all the self-care needs or when the demands for self-care exceed the capabilities of the individuals, there is need for nursing (Wayne, 2014). With such a description it can be argued that the concept of self-care in nursing is a mandatory origin of the application of Orem’s nursing theory. This is further seen from the outlays of the theory in that is required of a nurse to highlight the self-care deficits associated with an individual prior to theoretical application. A healthy individual is capable of carrying out all the self-care requirements. On the other hand, a sick individual needs nursing to accomplish their self-care.
According to Wayne (2014), Orem describes the concept of self-care through a portrayal of various features that can be used to identify the need for self-care nursing provision to patients. Through her work, the key aspects that define the need for self-care assistance are defined through the self-care deficit concept. For instance, various nursing models are proposed which revolve around the identification of the self-care deficits, definition of the nurse’s roles in providing this care and application of the appropriate framework for the achievement of the treatment objectives. The key objective is to overcome individual limitations (Wayne, 2014).
Several studies discuss the relevance of self-care, particularly in the context of the theory published by Dorothea Orem. The key aspects of self- care as postulated by the theory can be said to be the origin of the theory itself. While explaining the key concepts presented by Orem’s theory, Wayne (2014) elucidates the meaning of self care as postulated by Orem. In this context, self-care is defined as entailing individual capacity to carry out various roles that help them to maintain their health and wellbeing independently. The self-care concept as presented by Wayne from Orem’s theory is defined through self-care requisites categorized as universal, health deviation and developmental. Each of these categories includes various features of mental and physical health which can be accomplished independently (Wayne, 2014). Other studies have also been carried out by researchers such as Ann (2014) and Orem and Taylor (2011). According to these studies, Orem’s self care deficit theory explains the self-care aspects sufficiently and through them, it is possible to plan and execute nursing interventions in various fields of the nursing profession. This clearly brings out the image that self-care is one of the key objectives of nursing interventions in some cases.
From the work of Richards (2013), self care is a concept that has to be explored throughout one’s life. This implies that once a person is alive, there will always be self care needs to be attended to. The only way one can effectively address these needs is through understanding where the self care deficits are and addressing them through one’s capabilities as well as through asking for help where there is need. This finding is also reiterated by Blum (2013) who discusses the effects of various stressors on the lives of nursing students and nursing practitioners. While discussing stressors in nursing, Blum asserts that the role of identification of deficits and assistance of others is one of the stressors associated with the profession. The findings from these studies resonate with Orem’s argument regarding the role of nursing in self-care i.e. that nurses have to identify deficit areas and work towards attaining the self-care requisites associated with the observed deficits (Orem and Taylor, 2011). According to an article by Renpenning et al (2011), the sole objective of the nursing profession, is to provide assistance to patients in situations where patients experience deficits in their lives. This is achieved through encouraging measures that can help patients to take care of their own needs. From the arguments of the various authors, it can be said that the objective of self-care then, is to achieve a desirable level of independence in the performance of daily activities associated with the health and wellbeing of individuals.
From the analysis of the available literature on the self-care concept, it can be argued that the key attribute of the concept is its focus on the self. This implies that the concept entails consideration of what an individual can achieve on their own rather than what nurses can do for them. It is only after the consideration of the capabilities of the individual that deficits in the concept can be identified. The level of intervention that can be provided by a nurse depends on the limits of the patients. Apart from this, self-care is also characterized by the presence of various perspectives to it. The concept of self-care is conditioned by the individual life experiences, health, socio-cultural orientations, resource availability, and age and development state among other factors. Thirdly, Orem categorizes self-care into requisites such as developmental, universal, and health deviation. This means that self-care has to take into consideration the capability of an individual to effectively perform all the roles associated with self-care. Without considering all the requisites, it is impossible to identify the need for self-care and to intervene appropriately.
Antecedents and Consequences of Self Care
Self-care concept involves various key attributes as described above. The antecedents of the concept can be defined as the factors that lead to the need for self-care or which initialize the concept of self-care. With regards to Orem’s nursing theory, self-care is defined through various requisites and is conditioned by various factors. Consequently, the antecedents of self-care can be described as the self-care requisites presented through various conditions. These can best be linked to the developmental, universal and health deviation needs as outlined by Orem and Taylor (2011). The developmental requisites that precede self-care are condition derived and often associated with events. On the other hand, the universal self-care deficits are those which relate to the performance of everyday functions such as maintaining a balance of rest and activity, maintaining sufficient uptake of water and food and prevention of hazards into human life among others. The health deviation requisites are caused by disease in the human body and mind. The presence of any of these requisites and the lack of matching individual capabilities for addressing the needs are the key antecedents for self-care.
The effectiveness of self-care is succeeded by changes in the key attributes of the various requisites. Self-care is followed by the shift from the deficits associated with each of the self-care deficits to the accomplishment of each of the self-care objectives. Following the identification of the deficits, appropriate nursing models are applied to make sure that the patient and the nurse achieves the nursing objectives outlined prior to treatment. For instance, accomplishments in the developmental self-care requisites include overcoming the challenges associated with the conditions that expose one to the self-care requisites in the developmental category. Similarly, the ability to accomplish self-care objectives in the universal and health deviation requisites is a consequence of self-care (Ann, 2014). It can thus be concluded that independence in universal, developmental and health are the key consequences of self-care.
With clear antecedents and consequences, evaluation of self-care can be carried out through consideration of the milestones achieved. The application of Orem’s theory depends on the identification of key self-care benefits. Consequently, it is crucial to use key measures in the evaluation of self-care. First, self-care anteceded by developmental requisites can be evaluated through effectiveness in managing the conditions that result in the developmental deficits. On the other hand, the universal context can be evaluated through reduction and elimination of the self-care deficits identified prior to the application of self-care. On health deviation, self-care can be evaluated through recognition of milestones such as successful self-medication and eventually elimination of the diseases or conditions that result in the health care deficits. From this analogy, it can therefore be said that the key empirical referents for the evaluation of self-care include reduction in self-care deficits in developmental and health deviation requisites and Elimination of health deviation and universal self-care deficits.
J is a ten-year-old boy who was born with cerebral palsy. As a result, he is incapable of carrying out various self-care practices. The condition presents through symptoms such as drooling and repeated fits and seizures and is neither curable nor progressive (NHS Choices, 2016). As such, J needs constant care from a caregiver. The case clearly presents a self-care case as outlined by the definition of the concept as well as various attributes associated with it. First, self-care is defined as the activities performed by individuals for their own benefit in terms of health and wellbeing improvement. This implies that J has some self-care deficits as he cannot perform some of the activities which require coordination due to stiff muscles. The case also presents all the attributes associated with the concept of self-care. First, self-care focuses on the individual. In this case, the focus is on J. Secondly, self-care is linked to certain conditions such as socio-cultural factors, experiences or health. For the case of J, it is difficult to clearly outline the cause of cerebral palsy, but this attribute is fulfilled since the condition is caused by factors such as maternal illness and internal bleeding in the brain which are socio-cultural and health factors respectively. The third attribute relates to the requisites such as health deviation, universal requisites and developmental requisites. J presents several of these deficits.
The antecedent for the self-care need in J can be linked to the health condition associated with the individual. In this case, J presents a case of multiple self-care deficits which need to be addressed. The application of effective self-care intervention should result in the improvement of functioning through reduction of muscle stiffness, the reduced frequency of fits and seizures and the increased ability to control drooling. From this view point, the self-care efficiency in the case of J will be evaluated through the key empirical measurements such as reduction in the severity of the symptoms which indicate self-care deficits and elimination of muscle stiffness through physical therapy and medication (NHS Choices, 2016).
Focusing on J’s mother, the ability to perform the roles required to achieve self-care for J is an indication of lack of similarity with the self-care characteristics. While the mother presents the perfect state of self-care through the activities performed on her own behalf to enhance wellbeing, the focus is on the son and not on herself. On the other hand, she does not present any conditions resulting in the need for self-care; neither does she have any of the deficits associated with healthcare. As such, there would be no self-care intervention needs unless a condition presents that contravenes her current status.
Another individual, Mr. Jones presents a case contrary to that of J. This is because Jones completely takes care of a mother with Alzheimer’s who is incapable of carrying out any of the self-care requisites. As such, he does not focus on himself; neither does she have a prevailing condition not self-care deficits.
Self-care is a concept that is significantly difficult to understand. While it is easy to describe self-care independently, placing it in the nursing context makes it a difficult aspect to grasp. This is because the nursing context mainly presents cases in need of self-care. The concept is defined as activities carried out by individuals for their own benefit in terms of health and wellbeing improvement. Self-care is described through attributes such as focus on self, availability of preconditions and the presence of requisites. Self-care is anteceded by self-care deficits in various categories and succeeded by elimination and/ or reduction of deficits. Consequently, the achievement of these consequences can be used for the evaluation of self-care.
Ann, J. (2014). Dorothea Orem’s Self- Care Deficit Theory. [Slideshare].
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NHS Choices (2016). Cerebral Palsy.
Renpenning, K.M., SozWiss, G.B., Denyes, M.J., Orem, D.E. and Taylor, S.G. (2011). Explication of the Nature and Meaning of Nursing Diagnosis. Nursing Science, 24(2), 130-136.
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