Lecture 4 - Self Care Deficit Theory (: Flashcards
Grand theories are often composed of relatively abstract concepts, such as…
Health, caring, self-care
What are the main categorizations of grand theories?
Human Needs Theories (particulate-deterministic)
Interactive Theories (Integrative, reciprocal)
Unitary Process Theories (Unitary, simultaneity)
Human Needs Theories are a category of Grand Theory.
What is their main view of nursing and key characteristics?
What is their practice application?
View nursing as being responsible for helping individuals meet their basic needs - nurses help people maintain and restore health.
Particulate - needs broken down into fields
Deterministic - Assumes that meeting needs will determine health outcome. Needs aren’t met = deterioration of health
Practice application: Clear and structured, useful in providing guidance and prioritizing care needs.
Human Needs Theories are a category of Grand Theory.
What worldview do they draw from? How do they view human change?
Positivist
–> Humans are reducible (sum of parts) where change is linear and causal.
Human needs theories are said to be particulate-deterministic. What is meant by this?
Particulate - needs broken down into fields
Deterministic - Assumes that meeting needs will determine health outcome. Needs aren’t met = deterioration of health
Humans are reducible and change is linear and causal
Interactive Theories are a category of Grand Theory.
What is their main view of nursing and patients?
What is their practice application?
Focus on relationships between the nurse, patient, and environment. Views humans holistically, and emphasizes their ability to act reciprocally with their environment. Integrative and reciprocal.
Practice Application: Emphasize importance of communication and relationships between nurse-client. Patients are not passive recipients but active participants in their health outcomes.
From which kind of theory did interactive grand theories develop?
Human Needs Grand theories
Unitary Process Theories are a category of Grand Theory.
What is their main view of people, health, and change?
What is their practice application?
Health is the process in which individuals are constantly maintaining balance with a constantly changing environment. Views individuals as whole beings (irreducible).
Change is unpredictable
Practice Application: Encourages holistic view that recognizes uniqueness of individual and fluid nature of health.
What is self care, according to Orem?
An acquired action that is performed deliberately to promote health
According to Orem’s self care deficit theory, when do people need nurses?
When they are unable to provide for themselves or depend on another.
What is the responsibility of nurses, according to Orem?
To compensate for self-care deficits with the aim to assist people to achieve the highest level of self care possible or to assist them in meeting their needs when they cannot do so themselves.
Where did Orem get the ideas for her Self-Care Deficit Theory?
Clinical experience - inspired by no theory in particular
–> Cited works from other nurses and other disciplines
What are self-care requisites? What are the two elements of them?
Insight about actions that are needed to maintain functioning and development.
2-elements: The factor to control, and the action
What are the three kinds of self care requisites, as described by Orem?
Universal
–> Needed by all humans throughout all stages of life
Developmental
–> Maturational: Related to universals, but adjusted to age or developmental needs (like nutrition)
–> Situational: Effects of life events or experiences (like education deprivation, moving, death)
Health Deviational
–> Those who are ill, injured, or disabled
What are the two kinds of developmental self-care requisites described by Orem?
Maturational: Related to universals, but adjusted to age or developmental needs (like nutrition)
Situational: Effects of life events or experiences (like education deprivation, moving)
What is the therapeutic self-care demand?
All of the care measures necessary to meet all of an individual’s known self-care requisites
What is self-care agency?
A person’s ability to recognize and meet their self-care needs.
What are the three components are the self-care agency pyramid?
Foundational
–> Necessary for deliberate action like moving the body, self-awareness
Power Components
–> Necessary motivation and empowering capabilities to engage in self-care
Abilities
–> Determine how to maintain health
–> Decide what to do with information obtained on how to do so
–> Actually perform self-care action
What three theories are included in Orem’s ideas about self-care?
Theory of Nursing Systems
Theory of Self-Care
Theory of Self-Care Deficit
What are the three levels of self-care deficits as described by Orem’s self care deficit theory?
No Self-Care Deficit
Partial
Complete
What is a partial self-care deficit?
The self care agency is less than the therapeutic self-care demand
What is meant by no self-care deficit?
When the persons self-care agency is greater than the therapeutic self-care demand
What is meant by a complete self-care deficit?
When there is no adequate agency and complete support is necessary.
What is the theory of nursing systems?
The theory that nurses have the ability to determine if nursing help is necessary and to legitimate it
What are the three basic nursing systems described by Orem?
Wholly compensatory
Partial compensatory
Supportive Developmental
What person needs a wholly compensatory system? What are the nursing roles?
A patient experiencing a complete self-care deficit
–> Accomplishes patient’s therapeutic self-care, compensates for patient’s inability to engage in self-care, supports and protects patient.
What person needs a partially compensatory nursing system? What are the nursing roles? What about client roles?
Someone with a partial self-care deficit
–> Compensates for self-care limitations and supports patient, regulates patient’s self care agency.
The client also regulates and performs some self-care measures. Accepts care from nurse.
What kind of person needs a supportive developmental nursing system? What is the nurse’s role in this case?
A person with no self-care deficit.
–> The nurse helps regulate exercise and development of self-care agency
What is an implicit assumption of Orem’s theory?
People have a natural drive to improve well being
The goal of nursing is to improve independence, and maintain dignity and drive for self-determination.
What are some critiques of Orem’s self care theory?
Does not address systemic barriers
Does not account for values of the individual
Lacks intervention tools
Does not account for health care goals that do not want to restore health/wellbeing
Complex - 3 nested theories
Some say central concepts are not clearly and logically differentiated
Is Orem’s theory highly generalizable?
Yes, has been used in various settings, countries and across lifespans and social groups.
What are some strengths are Orem’s theory?
Good description of purpose of nursing
Recognizes various degrees of intervening
Encourages tailoring and individualization
Allows for application through various worldviews
How is Orem’s self care model still relevant to nursing?
Promotes autonomy and individual approaches to care - empowers patients to build independence.
(Waazni & Glifford, 2017) - schizophrenia)
In what ways does Orem’s self care model need refinement?
Places too much emphasis on the individual and does not account for sociocultural factors and community variables which effect client health.
We need upstream intervention!
(Hartweg & Metcalf, 2021)
How was Orem’s self-care theory used to improve independence for patients with schizophrenia?
By encouraging nurses to inquire beyond their worldview and address both physical and mental condition, application of the self care theory can minimize barriers to care, maximize quality of care, and empower people with schizophrenia to achieve the highest level of independence while improving their health and quality of life.
What is another term for unitary process theory?
Also called Simultaneity theories.
What are other terms for interactive theories?
Integrative or reciprocal
What is another term for human needs theories?
Particulate-deterministic
What philosophical system does Orem’s theory use?
Moderate realism
–> Acknowledges that there is an objective reality independent of human perception, but also that our understanding of that reality is influenced by our experiences, interpretations, and
contexts
What are the 5 explicit assumptions in Orem’s theory?
- Humans need continuous, deliberate input to themselves and their environment to remain functional
- Human agency is exercised by identifying self care needs and performing actions
- Mature human beings experience privation and limitations to self care action
- Human agency is exercised in learning and communicating ways to identify and meet needs of self and others
- Humans have structured relationships and cluster responsibilities to group members unable to do so themselves.
Is Orem’s theory testable?
It is mainly descriptive and does not have a hypothesis - and is thus not directly testable.
However, it has been used as a source of testable hypotheses
Is Orem’s theory testable?
Mainly descriptive - not tested in entirety
