nursing practice, enhances critical thinking skills, helps facilitate communication between other healthcare disciplines, and helps clarify reasons and processes in practice.
Nursing theory gives nurses the opportunity to separate themselves from the rest of the healthcare professions. The use of theory in nursing give nurses more autonomy, as opposed to always relying on doctors. Theory sets nursing apart from the other professions by studying, describing, and predicting outcomes that are specific to the nursing profession. Although the use of theory in nursing is extremely beneficial, many have found and addressed concerns with it as well. One big concern that nurses have addressed with the use of theory is the gap between nursing theory and the relation to practice. According to Mao (2015), nurse practitioners view nursing theories as unrealistic doctrines rather than practical tools. More emphasis needs to be put on how the theory relates to everyday practice, so nurses and advanced practice nurses will be more receptive to the use of nursing theory.
The Self-Care Deficit Nursing Theory
Dorothea Orem was a nurse dedicated to improving the quality of nursing with a theoretical structure. She saw her ideas in both a theoretical and practical view. In 1971 her Self-Care Deficit Nursing Theory was first published, and the latest edition published was in 2001. The Self-Care Deficit Nursing Theory describes how and when nursing care is needed for patients who are unable to provide appropriate care to themselves. The SCDNT is a grand theory comprised of three interrelated theories which were the theory of self-care, the theory of self-care deficit, and the theory of nursing systems (Smith and Parker 2015).
Theory of Self-Care
According to Smith and Parker (2015), self-care is something that is learned and must intentionally be preformed to maintain life, human functioning, and well-being. Although self-care is essential to maintain life, some situations keep people from having the ability to perform their own self-care. The ability of self-care is influenced by developmental status, the person’s age, social and cultural status, the person’s health, and the resources they have available to them. The theory of self-care is separated into three different catergories of requisites: universal self-care requisites, developmental self-care requisites, and health deviation self-care requisites (Petiprin 2016). The requisites are simply or better known as activities of daily living (ADL’s). They include intake of food and water, balance between activities and rest, avoiding hazards, and seeking medical assistance when needed.
The Theory of Self-Care Deficit
According to Parker and Smith (2015), a self- care deficit exists when “the person’s self-care agency is not adequate to meet all self-care requisites.” Nursing comes into play when there is a self-care deficit. If the nurse determines there is no self-care deficit then nursing is not needed. There can be a partial self-deficit or complete self-deficit; however, both will require some form of care. At any point a person can experience a limitation in ability to provide self-care; however, this period of time may be very short term and is easily overcome with information, motivation, or assistance. The extent of the self-care deficit would need to be determined in order to obtain the appropriate assistance (Taylor, Renpenning, and McLaughlin 2011).
The Theory of Nursing Systems
This theory describes how the patient’s self-care needs will be met by the nurse or themselves. Petiprin (2015) says “Orem identifies three classifications of nursing system to meet the self-care requisites of the patient: wholly compensatory system, partly compensatory system, and supportive-educative system.” Orem also recognized specialized technologies that are used by the healthcare team. The technologies have three different catagories: interpersonal, social/contractual, and professional/technological. Parker and Smith (2015) says that interpersonal technologies consists of entering into and maintain relationships with the patients and or the patients family, and social technologies is all nursing actions used to reach agreements with the patient in order to determine the self-care demand and self-care agency. All three of the theories go hand in hand, in order to explain and determine how self-care of achieved.
Addressing the Metaparadigms
This theory addresses the person concept because we are determine the person’s self-care agency in order to provide to appropriate care to the person. It addresses the health concept by helping to improve patients’ health, who may not be able to help themselves due to a health-care deficit. The environment a patient lives in may contribute to their self-care deficit, and if a person has a self-care deficit they may have a negative impact on the environment around them. The nursing profession comes into play when someone has a self-care deficit. Without the nursing profession, there would be no one to determine and help improve all of the self-care deficits.
Potential Use of the Theory in the Nurse Practitioner Setting
The Self-Care Deficit Theory can be used in a levels, and all areas of nursing. It can be used in education and in practice as well. Nurse Practitioners have the opportunity to use this theory in their everyday practice. They have the ability to assess for a self-care deficit, and the ability to provide care for that deficit. Orem’s three steps of the nursing process is diagnosis and prescription (assessment), design and plan, and implementation (Parker and Smith 2015). This nursing process is used on every patient that a nurse practitioner sees.
Use of the Self-Care Deficit Theory in Practice
I see Dorothea Orem’s Self Care Deficit Nursing Theory used every day by emergency department nurse practitioners. For an example, we recently had an 85 year old female who was being neglected by her son and was left to take care of herself. While at home alone she sustained a ground level fall, and when she was finally found she had been lying on the ground for several days covered in urine and feces. Upon arrival to the emergency room, I completed an assessment that clearly identified a self-care deficit. I then used the theory of nursing systems in order to take care of the patient. In this particular situation patient’s age, health, support system, and resources are all factors that contribute to their deficit. When discussing the universal self-care requisites, the patient had adequate air intake but was unable to adequately provide themselves with food and water. She has very little social interaction, and she is unable to prevent hazards.
Another example of the use of the self-care deficit theory is people with addictions and mental health illnesses seen in the emergency department. These patients may not have a self-care deficit related to their health status; however, their addiction or mental illness affects their ability to appropriately care for themselves. These particular patients have times where they meet all of the self-care requisites, and they may have times where they don’t. Nursing education and outpatient resources are very important for these patients. With the appropriate rehabilitation or the appropriate medication regiment these patient may be able to overcome their self-care deficit.
Theory is essential to providing high quality evidence based care. Healthcare is a rapid changing field; therefore, theory will become even more important in the days to come. Dorothea Orem’s Self Care Deficit Nursing Theory is a theory that can be applied to all aspects of nursing education and nursing practice. Self-care is such an important factor in the world today. By ensuring that patients are able to care for themselves at home, we will ultimately be improving their quality of life. As a continuation of weeks ones discussion topic, I have learned even more about nursing theory in week two. Not only have I learned about nursing theory and it’s important to nursing practice, I have learned about specific nursing theorists and their theories. I learned how these theories can be used in my current and future profession. I think I will use theory more often, and I will encourage my fellow nurses to use theory too. Theory can help you provide the highest quality of care to our patients, while using evidence based research. I hope to see the study of nursing theory implemented sooner rather than later in nursing education.
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