Self-Care Deficit Theory of Nursing
Self-Care Deficit Theory of Nursing
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One of America·s foremost nursing theorists Born in Baltimore, Maryland in 1914 Earned her diploma at Providence Hospital ² Washington, DC 1939- BSN Ed, Ed, Catholic University University of America 1945- MSN Ed, Ed, Catholic Catholic University University of America Involved in nursing practice, nursing service, and nursing education During her professional career, she worked as a staff nurse, private duty nurse, nurse educator and administrator and nurse consultant Received honorary Doctor of Science degree in 1976 Published first formal articulation of her ideas in Nursing Concepts of Practice in 1971, second in 1980, and in 1995 Orem retired in 1984 and resides in Savannah, Georgia.
DEVELOPMENT DEVELOP MENT OF THEOR THEORY Y o
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1949-1957 Orem worked for the Division of Hospital and Institutional Services of Indiana State Board of Health Her goal was to upgrade the quality of nursing in general hospitals throughout the state. During this time she developed her definition of nursing practice. 1959 Orem subsequently served as acting dean of the School of Nursing and as an assistant professor of nursing education Orem·s Nursing Concept of Practice was first published in 1971 and subsequently in 1980, 1985, 1991, 1995, and 2001.
Person Orem·s theory addresses client·s self-care needs. It is defined as goal-oriented activities that are set towards generating interest in the part of the client to maintain life and health dev·t. The theory is aimed towards making the clients perform self-care activities in order to live independently. Conceptualized as a total being with universal, developmental needs and capable of contionous self care. o
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Nursing o
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Nursing is helping clients to establish or identify ways to perform self-care activities. Nursing actions are geared towards the independence of the client. Orem defines nursing as human service. It is a distinguished human service since its focus is on persons with inabilities to maintain continuous provision of health care. Nursing is based on values. Goal of nursing ² to render the patient or members of his family capable of meeting the patient·s self care needs. To maintain a state of health.
Health o
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Orem supports the World Health Organization·s definition of health as the ´ state of physical, mental and social well-being and not merely the absence of disease or infirmity.µ Orem presents health based on preventive health care. The model of health care includes the promotion and maintenance of health, the treatment of disease or injury, and the prevention of complications.
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Orem·s view of health as a phenomenon affected by inseparable entities shows her view of the surrounding environment as an external source of influence in the internal interaction of a person·s different aspects.
Self-Care Deficit Theory of Nursing Self-Care
² is an activity that promotes a person·s well-being. It is performed by persons who are aware of the time frames on behalf of maintaining life, continuing personal dev·t and a healthy functional living.
Universal Self-care o
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Requisites
Maintenance of a sufficient intake of airs Maintenance of a sufficient intake of food Maintenance of a sufficient intake of water Provisions of care associated with elimination Maintenance of balance between activity & rest Maintenance of balance between solitude and social interaction Prevention of hazards to human life, human functioning and human well-being Promotion of human functioning and development.
ASSUMPTIONS
People should be self-reliant and responsible for their own care and others in their family needing care People are distinct individuals Nursing is a form of action ² interaction between two or more persons A person·s knowledge of potential health problem is necessary for promoting self-care behaviors Self-care and dependent care are behaviors learned within a socio-cultural context
IMPLICATIONS To Nursing Practice Orem·s Self-care deficit has been used in studies in patients having heart problems, cancer, and mental illnesses. This theory had been widely used in dealing with geriatric cases, especially those having chronic-illnesses. Orem·s theory was being used in defining the roles of the nurse in multiple settings.
To Nursing Education The use of Orem·s theory in curriculum development was reported in the late 1970s. This theory is used at all levels of curriculum and in continuing education. Her theory is used as a strong and effective framework for curricular design.
To Nursing Research One of the first instruments developed is the Exercise of Self-Care Agency (ESCA) which was published in 1979 Another instrument developed is the Appraisal of SelfCare Agency (ASA) Both of these instrument tools are used to assess basic conditioning factors and self-care abilities related to the care of well and the ill.
CRITICS Strengths
Provides a comprehensive base to nursing practice It has utility for professional nursing in the areas of nursing practice, nursing curricula, nursing education administration and nursing research. Specifies when nursing is needed. Also includes continuing education as part of the professional component of nursing education Her self-care approach is contemporary with the concepts of health promotion and health maintenance.
Limitations In general system theory, a system is viewed as a single whole thing while Orem defines a system as a single whole thing. Appears that the theory is illness oriented rather with no indication of its use in wellness settings.
MARTHA ROGERS
UNITARY HUMAN BEINGS
Born: May 12, 1914, Dallas, Texas Diploma : Knoxville General Hospital School of Nursing (1936) Graduated in Public Health Nursing, George Peabody College, TN, 1937 MA : Teacher·s College, Columbia University, New York, 1945 MPH : John Hopkins University, Baltimore,1952 Doctorate in nursing: John Hopkins University, Baltimore, 1954 Position: Professor Emerita, Division of Nursing, New York University, Consultant, Speaker Died: March 13, 1994
ROGER·S NUR SING THEORY Nursing is both a science and art, the uniqueness of nursing, like that of any other science, lies in the phenomenon central to its focus. Nurses long established concern with the people and the world they live is in a natural forerunner of an organized abstract system encompassing people and the environment The integralness of people and the environment that coordinate with multidimensional universe of open systems points to a new paradigm. The purpose of nurses is to promote health and well-being for all persons wherever they are.
METAPAR ADIGM
Person Defines person as an open system in continuous process with the open system that is the environment. She defines unitary human being as an ´irreucible, indivisible, pandimensional energy field identified by pattern and manifesting characteristics that are specific to the whole.µ The people has the capacity to participate knowingly and probabilistically in the process of change. Man is a unified whole possessing his own integrity. Nursing
Nursing is a learned profession, both a science and an art. An organized body of kowledge which is specific to nursing is arrived at by scientific research and logical analysis.
Health
Rogers defined health as an expression of the life process, they are the ´characteristics and behavior emerging out of the mutual, simultaneous interaction of the human and environmental fields.µ Health and illness are the part of the sane continuum. Health and illness are manifestations of pattern and are considered ´to denote behaviors that are of high value and low value. Environment
Rogers defines environment as ´an irreducible, pandimensional energy field pattern and manifesting characteristics different from those of the parts.
ROGERS CONCEPT of NURSING Nursing is a learned profession ² it is a science and art Nursing is the study of unitary. Irreducible, indivisible human and environmental energy fields. The art of nursing involves the imaginative and creative use of nursing knowledge. The purpose of nurses is to promote health and well-being for all person and groups wherever they are using the art and science of nursing. The health services should be community based. Rogers proposes a nursing practice of noninvasive modalities, such as therapeutic touch, humor, guided imagery, use of color, light, music, mediation focusing on health potential of the person.
IMPLICATIONS To Nursing Practice The Rogerian model is an abstract system of ideas from which to approach the practice of nursing. Nursing is based on theoretical knowledge that guides nursing practice. The professional practice of nursing is creative and imaginative and exists to serve people. It is rooted in intellectual judgment, abstract knowledge, and human compassion.
To
Nursing Education
Rogers clearly articulated guidelines for the education of nurses within the Science of Unitary Human Beings. Rogers discusses structuring nursing education programs to each nursing as a science and as a learned profession.
To Nursing Research Rogers· conceptual model provides a stimulus and direction for research and theory development in nursing science. Emerging from Rogers· model are theories that explain human phenomena and direct nursing practice. The Rogerian model, with its implicit assumptions, provides broad principles that conceptually direct theory development.
THEOR ETICAL ASSERTIONS The principles of hemodynamics postulate a way of perceiving unitary human beings. Rogers identified the principles of change as helicy, resonancy and integrality. The helicy principle describes spiral dev·t in continuous, nonrepeating and innovative patterning. Principle of resonancy , patterning changes with dev·t from lower to higher frequency with varying degrees of intensity.
Principles of Homeodynamics Resonancy
Helicy
Integrality
Midrange
Bultemeier
(1993)
Barrett
(1990a)
Floy d (1983)
Imogene King was born in 1923 Completed her Bachelor in Science of Nursing from St. Louis University in 1948 Completed her Master of Science in Nursing from St. Louis University in 1957 Completed her doctorate degree from Teacher·s College, Columbia university
METAPAR ADIGM
To Nursing Practice King described a person existing in an open system as a spiritual being and rational thinker who makes choices. Selects alternative courses of action, and has the ability to record their history through their own language and symbols, unique, holistic and have different needs, wants and goals.
METAPAR ADIGM Person King described a person existing in an open system as a spiritual being and rational thinker who makes choices. Selects alternative courses of action, and has the ability to record their history through their own language and symbols, unique, holistic and have different needs, wants and goals. Nursing
Nursing is an act wherein the nurse interacts and communicates with the client. The nurse helps the client identify the existing health condition. The goal of the nurse in this theory is to help the client maintain health through health promotion and maintenance, restoration and caring for the sick and dying.
Health
King viewed health as the ability of a person to adjust to the stressors that the internal and external environment exposes to the client Adjusting to the environment bring the client back to their usual roles before the reaction occurred. Environment
Environment is the background for human interactions. It involves: Internal environment ² transforms energy to enable person to adjust to continuous external environmental changes. External environment ² involves formal and informal organizations. Nurse is a part of the patient·s environment.
Interacting Systems Framework King proposed that the nurse interacts in the system simultaneously at three different levels, namely Personal, Interpersonal and social Frameworks.
Personal ² how the nurse views and integrates self based from personal goals and beliefs. Interpersonal - how the nurse interrelates with a co-worker or patient particularly in a nursepatient relationship. Social - how the nurse interacts with coworkers, superiors, subordinates and the client environment in general.
ASSUMPTIONS Basic
assumption of goal attainment theory is that nurse and client communicate information, set goal mutually and the act to attain those goals, is also the basic assumption of nursing process.
IMPLICATION To
Nursing
Practice
Professional have used King·s theory in different specialized area with the use of dynamic interactive communication between the nurse and the client as a proof. Professional need communication to successfully and correctly make decisions for their plan of care. The significance of King·s theory have been applied to different professional practice setting such as in nursing administration, theory based practice in the emergency department, in tertiary hospitals and in the community.
To Nursing Education King·s interacting system has been used to design the nursing curriculum in different schools and universities and framework for nursing education. It provides a systematic means of viewing the nursing profession, organizing nursing knowledge and clarifying the nursing discipline.
To Nursing Research King·s theory has been one of theoretical basis of some researchers that helped in formulating a system view of the application of the nursing practice.
ANALYSIS Simplicity King·s theory was as a result of careful research study. Her research literature was based on the existing evidences during her study. She maintains the simplicity of her theory even if she presented different complex concepts.
Generality King·s theory has been said to have limited application for the nursing practice. It was stated that the interaction between the nurse and the client also comprises non-verbal communication that cannot be clearly defined and evaluated.
INTRODUCTION Born in Reading, Pennsylvania 1909 Graduated from a diploma program in Pottstown, Pennsylvania in 1931 Done BA in interpersonal psychology from Bennington College in 1943 MA in psychiatric nursing from Colombia University New York in 1947 EdD in curriculum development in 1953 Professor emeritus from Rutgers University Started first post baccalaureate program in nursing Published Interpersonal Relations in Nursing in 1952 Became a member of the Army Nurse Corps Died in 1999
METAPAR ADIGM
Person Peplau defines person as a man who is an organism that lives in an unstable balance of a given system. A developing organism that tries to reduce anxiety caused by needs.
Health She considers ´healthµ as a word that symbolizes movement of the personality and other ongoing human processes that directs the person towards creative, constructive, productive and community living.
Nursing Peplau described Nursing as a significant, therapeutic interpersonal process. It functions cooperatively with human processes that present health as a possible goal for individuals
Environment She defines Environment as forces outside the organism and in the context of the sociallyapproved way of living, from which vital human social processes are derived such as norms, customs and beliefs.
Theory of Interpersonal Relations Peplau described the nurse-patient relationship as a four phase phenomenon. One can view them as separate entities. Each phase is unique and has distinguished contributions on the outcome of the nursepatient intreaction; Phases of Nurse-Patient Relationship are 1. Orientation 2. Identification 3. Exploitation 4. Resolution
Orientation phase Problem defining phase Starts when client meets nurse as stranger Defining problem and deciding type of service needed Client seeks assistance, conveys needs, ask questions, shares preconceptions and expectations of past experiences. Nurse responds, explains roles to client, helps to identify problems and to use available resources and services.
Factors influencing orientation phase
Identification Phase
Selection of appropriate assistance. Patient begins to have a feeling of belonging and a capability of dealing with the problem which decreases the feeling of helplessness and hopelessness.
Exploitation Phase
Use of professional assistance for problem solving alternatives Advantages of services are used is based on the needs and interest of the patients. Individual feels as an integral part of helping environment. Patient may fluctuates on independence. Nurse must be aware about the various phases of communication. Nurse aids the patient in exploiting all avenues of help and progress is made towards the final step.
Resolution Phase
Termination of professional relationship. The patients needs have already been met by the collaborative effect of patient and nurse Now they need to terminate their therapeutic relationship and dissolve the links between them Sometimes may be difficult for both a psychological dependence persists. Patient drifts away and breaks bond with nurse and healthier emotional balance is demonstrated and both becomes mature individuals.
INTERPER SONAL THEORY AND
NUR SING
PROCESS
Both are sequential and focus on therapeutic ralationships Both use problem solving techniques for the nurse and patient to collaborate on, with end purpose of meeting the patients needs. Both use observation communication and recording as basic tools utilized in nursing.
IMPLICATIONS To Nursing Practice Some of Peplau·s ideas were not widely accepted at the time they were introduced, such as the concepts of learning through experiences between the patients and the students. However, as the concepts that form her Interpersonal Relations Model were applied and tested, many nursing experts now recall Peplau as the one who brought a new perspective, a new approach and a theoretical foundation for nursing practice.
To Nursing Education Hildegard Peplau·s book, Interpersonal Relations in Nursing (1951), is being used as a manual of instruction to help graduate nurses and nursing students alike in creating a significant nurse-patient relationship in any setting they are into.
To Nursing Research At the arrival of the Interpersonal Model, nursing researchers follow the major assumption that patient problems were within the person phenomena and were dealt inside the nurse-patient interaction studies.
LIMITATIONS: Intra family dynamics, personal space considerations and community social service resources are considered less. Health promotion and maintenance were less emphasized. Cannot be used in a patient who doesn·t have a felt need eg. With drawn patients, unconscious patients Some areas are not specific enough to generate hypothesis.
Theoretical Foudations of Nursing: The Philippine Perspetive (Eufemia f Octaviano, Carl E. Balita) Nursing Theorists and Their Works, Sixth Edition (Ann Marriner Tomey, Martha Raile Alligood) Current
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