Assignment 4 Nursing Metaparadigm
Foundations of Healthcare 112 (Singapore)
Assignment 1 – Nursing theories (30%)
Marking Guide
Requirement
Marks Allocated
Marks gained
Comment by tutor
Presentation of assignment
Language expression, grammar and spelling
2
Format and presentation
2
Structure of assignment
Introduction clearly defines the topic
2
Logical flow of argument/ideas throughout
2
Conclusion draws the main points together
2
Content
Reflects and explores the relationship of the four nursing metaparadigms to the selected theorist
6
Demonstrates critical thinking skills identifying limitations of current theory to nursing practice today.
4
Discusses the Application of selected theory to a clinical setting providing …show more content…
examples to emphasise application
4
Referencing
Appropriate use of APA 6th referencing system including correct presentation of quotes
3
Evidence that a variety of relevant literary sources have been explored to support discussion
3
TOTAL
30%
Comments by tutor:
Content page
Introduction…………………………. 4
Health……………………………….. 4
Person………………………………. 5
Environment………………………... 7
Nursing……………………………… 7
Strengths……………………………. 8
Limitations……………….....……..... 8
Conclusion………………………….. 9
References………………………….. 10
Total word count: 1826
Introduction
Dorothea Orem was one of the most influential nursing theorists where her wisdoms and enthusiasm continue on throughout the world by others (Hartweg & Fleck, 2010). Orem produced a general theory, which is the self-care deficit theory. It consists of three affiliating theories: the theory of self-care, the theory of self-care deficit, and the theory of nursing systems (Foster, 2010). Orem derived this theory through her countless experiences, her knowledge and proficiency, and her strong passion in pursuing life-long education in nursing. In this theory, Orem concentrates mainly on self-care which she defines as “the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health, and well-being” (Foster, 2010). Therefore, this theory encourages an individual’s participation in sustaining his or her own health.
As discussed by Fawcett (2005), nursing models revolves around four metaparadigms of nursing: health, person, nursing and environment. In this paper, we will discuss Orem’s self-care deficit theory pertaining to the four metaparadigms and also the application of this theory to current clinical settings.
Health
Health is denoted by the World Health’s Organization as “a state of physical, mental, and social well-being and not merely the absence of disease or infirmity” (“WHO definition of health 1948,” 2013, para.1). Orem agreed with the definition but she remarks that as an individual’s mental and physical state changes, the individual’s description of health changes as well (Foster, 2010). Sonata (2010) mentions that Orem views health as a state of well-being, which indicates an individual’s perceived state of existence, defined by contentment, pleasure, happiness and advancing towards self-ideals. Therefore, if any of these psychological and physical conditions are not fulfilled, health will not be present in an individual, leading to the incapability to sustain self-care. According to David & Lynn (1997), Orem emphasizes on the importance of fulfilling self-care requirements in order to maintain or improve health because if self-care is not sustained, diseases and death will arise. This is further reiterated by Orem whom described “the condition that validates the existence of a requirement for nursing in an adult is the health associated absence of the ability to maintain continuously the amount and quality of therapeutic self-care in sustaining life and health, in recovering from disease or injury, or in coping with their effects” (Slideshare, n.d.).
For instance, if a person were to suffer from an injury or illness, by which there is an absence of health, he or she will most likely need to undergo some nursing activities that is necessary for self-care. This is to help prolong their health, to boost the ideal health for them and have them be responsible for their own health and comfort. Some examples of the nursing activities are cleaning and changing of wound dressings, education on the care of tubes/catheters, such as indwelling catheter or Ryle’s tube.
Person
“The person, being the focus of nursing care, refers to the individual as a whole” (David & Lynn, 1997). For Orem, a person is a unique individual that has the capability to ponder about themselves and how the environment has an impact on them, to construct and use symbols such as words and concepts in comprehension and communication to be beneficial to themselves and to others (Foster, 2010). A person who has restrains to reflect, symbolize and make use of symbols will face limitations in the maintenance of well-being, therefore facing self-care deficit. Orem mentions in order for a person to fulfill self-care needs, he or she will need to learn how to fulfill and not base on instincts, hence, if a person cannot master the ways to provide self-care, others will have to become versed and provide the care (Foster, 2010). Therefore, a person who requires nursing care but has problems in learning the skills, nurses will have to provide caregiver training to others who will help maintain the person’s well-being.
In Orem’s theory, she identifies three types of self-care requisites: universal self-care requisites, developmental self-care requisites and health deviation self-care requisites. They are described as actions directed towards provision of self-care (Current nursing, 2013). Eight elements have been identified under universal self-care requisites: air, food, water, elimination, activity & rest, solitude, harm prevention and promotion of normality (Sonata, 2010). Orem further explains that these elements are found in everyone and are affiliated factors necessary in maintaining the structure and function of the person as well as general well-being, and these elements influence each other and are also termed as “activities of daily living” (Foster, 2010). For example, when a worker is admitted with multiple fractures sustained from industrial accident requiring multiple operations and intensive care, his activities of daily living are now greatly disrupted. He may face problems in fulfilling the universal self-care requisites. Hence, the nurse will focus on whether he will survive the multiple operations, aid his recovery to regain normal functions so as to maintain his health and well-being. The nurse will have to follow up and identify the issues that the worker will face such as wound dressings, rehabilitation, and pain management.
Developmental self-care requisites are more definitive as compared to universal self-care requisites as they specify on how events happened during life cycle stages can affect the processes of growth and development (Foster, 2010). For example, a newly diagnosed end-stage renal failure patient will have to readjust his diet, readapt to body changes and lifestyle due to dialysis needs. He will have to learn to care for the dialysis catheter, how to control his fluids intake and he will not be able to work daily as he needs to go for his dialysis routinely. The nurse will have to educate him on care of catheter and referral to dietician with regards to diet changes.
Health deviation self-care requisites are needs that a person has to fulfill resulting from the aim to diagnose and treat the illness or disease (Slideshare, n.d.). For example, a man with poorly controlled diabetes mellitus who needs to undergo a lower limb amputation due to poor wound healing will experience problems in learning how to ambulate again. The nurse will need to refer him to physiotherapist and occupational therapist so as to help him learn how to mobilize on wheelchair and home safety awareness. This is to make sure that he can be community ambulant and maintain his well-being.
Environment
Orem (1995) mentions that environment is divided into four factors: physical, chemical, biological and social, and they are affiliated. According to Winters (1989), the eight elements under Orem’s universal self-care requisites are part of the environmental factors that affects a person’s health, life and well-being. As nurses, we should analyze and comprise such influencing factors in the care plans of the patient. From Orem’s angle, environment helps to drive the patient to constitute goals and alter behaviors to accomplish goals (David & Lynn, 1997).
For instance, a person newly admitted to the hospital, will usually feel lost and anxious as they are unfamiliar and have no control over the new environment. A nurse’s role is to provide reassurance, orientate and provide assistance to relieve the anxiety. Actions such as placing belongings near within reach and educate patients on call bell system. Another example is the natural disasters that certain countries face resulting in shortage of food and water, hence inhibiting health maintenance, thus the reduced potential to provide self-care.
Nursing
Orem states that in this society, adults are assumed to be independent and are obligated to care for the dependent but there are helpless, sick or disabled people that need help in their acute circumstances and maintaining of well-being thereafter, hence, self-help and providing help to others are two values and nursing is a distinctive type of duty provided based on these two values thus nursing is often deemed as desirable and mandatory (Foster,2010). Orem described nursing as series of actions done for a reason to improve life, health and well-being (Hartweg & Fleck). It is an act that a distinctively skilled individual provide to those disabled or sick whereby their daily needs cannot be fulfilled with general help (Slideshare, n.d.).
Orem classified nursing into three systems: wholly compensatory system, partly compensatory system and supportive-educative system.
Wholly compensatory is where the individual is unable to fulfill self-care needs due to either failure to be self-directed or medical prescription (Foster, 2010). Therefore, the nurse will have to take control over the care of the person. For instance, a tetraplegic patient will be totally dependent on the nurses to help in his/her daily activities. In partly compensatory system, it incorporates the patient and the nurse to share responsibilities in accomplishing self-care (Hartweg & Fleck, 2010). For instance, a patient that has fractured his leg due to an accident, will need help in ambulating and wound care but he can still manage some of his needs such as eating independently. A supportive-educative system is where the individual is able to perform all tasks in meeting self-care but he/she needs to learn how to do so (Foster, 2010). For example, a patient that needs to go home with an indwelling catheter will need to learn how to care and prevent infection. The nurse will have to educate on how to empty the bag of urine, catheter care and when to change the catheter and the urine bag. Therefore, these three nursing systems will allow the nurse to provide support, guide and educate the …show more content…
patient.
Strengths and limitations of Orem’s theory to current nursing practice
Strengths
Orem’s theory provides a comprehensive base for nursing practice. The theory is beneficial to different areas of nursing such as education, clinical practice and research. The theory is simple and very easy to apply in nursing, thus, junior nurses can understand terms such as self-care deficit and explore the theory further as they gain more knowledge and experiences (Foster, 2010). Another strength of Orem’s theory is that she specifies when nursing is needed (Current nursing, 2013). Orem emphasizes on the responsibilities that both the individual and nurses have to fulfill self-care to maintain well-being. This is especially relevant to current practices in early discharge, home care services and outpatient services (Foster, 2010).
Limitations
One of the limitations is that it is very time-consuming. Orem stresses a lot on self-care. Nurses need abundant amount of time to plan, communicate and educate the patient and caregiver. In today’s nursing settings, nurses are already very tied up with overwhelming workload, and will have very limited time to design such plans for patients. Another limitation is that fulfilling patient’s self-care demands require efforts from other allied healthcare professionals such as physiotherapist, social workers and dieticians. But in Orem’s theory, she emphasizes solely on nursing and what role nurses play in meeting self-care needs. Last but not least, Orem’s theory is also very illness-orientated, there is limited recognition to patient’s emotional needs (Foster, 2010).
Conclusion
In conclusion, Orem’s theory is applicable to most clinical settings and is suitable for beginner practitioners as it is very easy to understand. Her theory points out the importance of nursing, roles of the nurses in self-care deficit individuals and how individuals can share the responsibilities in meeting self-care needs so that health can be maintained. She has provided us with better understanding of nursing systems and which to use for meeting different individuals’ needs. With Orem’s theory, nurses can now design and carry out distinctive care plans to meet different individuals’ needs by knowing the various factors influencing their well-being and aid them to attain better lifestyle and maintain their health.
References:
Current nursing. (2013). Nursing theories: a companion to nursing theories and models. Retrieved from http://currentnursing.com/nursing_theory/self_care_deficit_theory.html
David, C. Y., & Lynn T. L. L. (1997). Nursing theories – Orem’s model. The Professional Nurse, 24, 36-37.
Fawcett, J.
(2005). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories (2nd ed.). Philadelphia: F. A. Davis.
Foster, P. C. (2010). Self-care deficit nursing theory. In J. B. George (Ed.), Nursing theories: The base for professional nursing practice (6th ed., pp. 116-121). Lakestreet, NJ: Julie and Regina.
Hartweg, D. L., & Fleck, L. M. (2010). Dorothea Orem’s self care deficit theory. In M. E. Parker & M. C. Smith (Eds.), Nursing theories and nursing practice (3rd ed., pp 121-143). Philadelphia, PA: F. A. Davis.
Orem, D. E. (1995). Nursing concepts of practice (5th ed.). St. Louis: C. V. Mosby.
Slideshare. (n.d.). Dorothea Orem & Imogene King: Nursing theorists in focus. Retrieved from http://www.slideshare.net/macluvniam/dorothea-orem-imogene-king#btnNext
Sonata, M. (2010, July 11). Orem’s self care deficit theory. [Web log post]. Retrieved from http://juneyou-doroteaoremstheoryofselfcare.blogspot.sg/
WHO definition of health 1948. (2013). Retrieved from http://www.who.int/about/definition/en/print.html
Winters, R. K. V. (1989). Adapting the environment to age-related sensory losses. Journal of the American academy of nurse practitioners, 1,
106-111.
Assignment 1 – Nursing theories (30%)
Marking Guide
Requirement
Marks Allocated
Marks gained
Comment by tutor
Presentation of assignment
Language expression, grammar and spelling
2
Format and presentation
2
Structure of assignment
Introduction clearly defines the topic
2
Logical flow of argument/ideas throughout
2
Conclusion draws the main points together
2
Content
Reflects and explores the relationship of the four nursing metaparadigms to the selected theorist
6
Demonstrates critical thinking skills identifying limitations of current theory to nursing practice today.
4
Discusses the Application of selected theory to a clinical setting providing …show more content…
examples to emphasise application
4
Referencing
Appropriate use of APA 6th referencing system including correct presentation of quotes
3
Evidence that a variety of relevant literary sources have been explored to support discussion
3
TOTAL
30%
Comments by tutor:
Content page
Introduction…………………………. 4
Health……………………………….. 4
Person………………………………. 5
Environment………………………... 7
Nursing……………………………… 7
Strengths……………………………. 8
Limitations……………….....……..... 8
Conclusion………………………….. 9
References………………………….. 10
Total word count: 1826
Introduction
Dorothea Orem was one of the most influential nursing theorists where her wisdoms and enthusiasm continue on throughout the world by others (Hartweg & Fleck, 2010). Orem produced a general theory, which is the self-care deficit theory. It consists of three affiliating theories: the theory of self-care, the theory of self-care deficit, and the theory of nursing systems (Foster, 2010). Orem derived this theory through her countless experiences, her knowledge and proficiency, and her strong passion in pursuing life-long education in nursing. In this theory, Orem concentrates mainly on self-care which she defines as “the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health, and well-being” (Foster, 2010). Therefore, this theory encourages an individual’s participation in sustaining his or her own health.
As discussed by Fawcett (2005), nursing models revolves around four metaparadigms of nursing: health, person, nursing and environment. In this paper, we will discuss Orem’s self-care deficit theory pertaining to the four metaparadigms and also the application of this theory to current clinical settings.
Health
Health is denoted by the World Health’s Organization as “a state of physical, mental, and social well-being and not merely the absence of disease or infirmity” (“WHO definition of health 1948,” 2013, para.1). Orem agreed with the definition but she remarks that as an individual’s mental and physical state changes, the individual’s description of health changes as well (Foster, 2010). Sonata (2010) mentions that Orem views health as a state of well-being, which indicates an individual’s perceived state of existence, defined by contentment, pleasure, happiness and advancing towards self-ideals. Therefore, if any of these psychological and physical conditions are not fulfilled, health will not be present in an individual, leading to the incapability to sustain self-care. According to David & Lynn (1997), Orem emphasizes on the importance of fulfilling self-care requirements in order to maintain or improve health because if self-care is not sustained, diseases and death will arise. This is further reiterated by Orem whom described “the condition that validates the existence of a requirement for nursing in an adult is the health associated absence of the ability to maintain continuously the amount and quality of therapeutic self-care in sustaining life and health, in recovering from disease or injury, or in coping with their effects” (Slideshare, n.d.).
For instance, if a person were to suffer from an injury or illness, by which there is an absence of health, he or she will most likely need to undergo some nursing activities that is necessary for self-care. This is to help prolong their health, to boost the ideal health for them and have them be responsible for their own health and comfort. Some examples of the nursing activities are cleaning and changing of wound dressings, education on the care of tubes/catheters, such as indwelling catheter or Ryle’s tube.
Person
“The person, being the focus of nursing care, refers to the individual as a whole” (David & Lynn, 1997). For Orem, a person is a unique individual that has the capability to ponder about themselves and how the environment has an impact on them, to construct and use symbols such as words and concepts in comprehension and communication to be beneficial to themselves and to others (Foster, 2010). A person who has restrains to reflect, symbolize and make use of symbols will face limitations in the maintenance of well-being, therefore facing self-care deficit. Orem mentions in order for a person to fulfill self-care needs, he or she will need to learn how to fulfill and not base on instincts, hence, if a person cannot master the ways to provide self-care, others will have to become versed and provide the care (Foster, 2010). Therefore, a person who requires nursing care but has problems in learning the skills, nurses will have to provide caregiver training to others who will help maintain the person’s well-being.
In Orem’s theory, she identifies three types of self-care requisites: universal self-care requisites, developmental self-care requisites and health deviation self-care requisites. They are described as actions directed towards provision of self-care (Current nursing, 2013). Eight elements have been identified under universal self-care requisites: air, food, water, elimination, activity & rest, solitude, harm prevention and promotion of normality (Sonata, 2010). Orem further explains that these elements are found in everyone and are affiliated factors necessary in maintaining the structure and function of the person as well as general well-being, and these elements influence each other and are also termed as “activities of daily living” (Foster, 2010). For example, when a worker is admitted with multiple fractures sustained from industrial accident requiring multiple operations and intensive care, his activities of daily living are now greatly disrupted. He may face problems in fulfilling the universal self-care requisites. Hence, the nurse will focus on whether he will survive the multiple operations, aid his recovery to regain normal functions so as to maintain his health and well-being. The nurse will have to follow up and identify the issues that the worker will face such as wound dressings, rehabilitation, and pain management.
Developmental self-care requisites are more definitive as compared to universal self-care requisites as they specify on how events happened during life cycle stages can affect the processes of growth and development (Foster, 2010). For example, a newly diagnosed end-stage renal failure patient will have to readjust his diet, readapt to body changes and lifestyle due to dialysis needs. He will have to learn to care for the dialysis catheter, how to control his fluids intake and he will not be able to work daily as he needs to go for his dialysis routinely. The nurse will have to educate him on care of catheter and referral to dietician with regards to diet changes.
Health deviation self-care requisites are needs that a person has to fulfill resulting from the aim to diagnose and treat the illness or disease (Slideshare, n.d.). For example, a man with poorly controlled diabetes mellitus who needs to undergo a lower limb amputation due to poor wound healing will experience problems in learning how to ambulate again. The nurse will need to refer him to physiotherapist and occupational therapist so as to help him learn how to mobilize on wheelchair and home safety awareness. This is to make sure that he can be community ambulant and maintain his well-being.
Environment
Orem (1995) mentions that environment is divided into four factors: physical, chemical, biological and social, and they are affiliated. According to Winters (1989), the eight elements under Orem’s universal self-care requisites are part of the environmental factors that affects a person’s health, life and well-being. As nurses, we should analyze and comprise such influencing factors in the care plans of the patient. From Orem’s angle, environment helps to drive the patient to constitute goals and alter behaviors to accomplish goals (David & Lynn, 1997).
For instance, a person newly admitted to the hospital, will usually feel lost and anxious as they are unfamiliar and have no control over the new environment. A nurse’s role is to provide reassurance, orientate and provide assistance to relieve the anxiety. Actions such as placing belongings near within reach and educate patients on call bell system. Another example is the natural disasters that certain countries face resulting in shortage of food and water, hence inhibiting health maintenance, thus the reduced potential to provide self-care.
Nursing
Orem states that in this society, adults are assumed to be independent and are obligated to care for the dependent but there are helpless, sick or disabled people that need help in their acute circumstances and maintaining of well-being thereafter, hence, self-help and providing help to others are two values and nursing is a distinctive type of duty provided based on these two values thus nursing is often deemed as desirable and mandatory (Foster,2010). Orem described nursing as series of actions done for a reason to improve life, health and well-being (Hartweg & Fleck). It is an act that a distinctively skilled individual provide to those disabled or sick whereby their daily needs cannot be fulfilled with general help (Slideshare, n.d.).
Orem classified nursing into three systems: wholly compensatory system, partly compensatory system and supportive-educative system.
Wholly compensatory is where the individual is unable to fulfill self-care needs due to either failure to be self-directed or medical prescription (Foster, 2010). Therefore, the nurse will have to take control over the care of the person. For instance, a tetraplegic patient will be totally dependent on the nurses to help in his/her daily activities. In partly compensatory system, it incorporates the patient and the nurse to share responsibilities in accomplishing self-care (Hartweg & Fleck, 2010). For instance, a patient that has fractured his leg due to an accident, will need help in ambulating and wound care but he can still manage some of his needs such as eating independently. A supportive-educative system is where the individual is able to perform all tasks in meeting self-care but he/she needs to learn how to do so (Foster, 2010). For example, a patient that needs to go home with an indwelling catheter will need to learn how to care and prevent infection. The nurse will have to educate on how to empty the bag of urine, catheter care and when to change the catheter and the urine bag. Therefore, these three nursing systems will allow the nurse to provide support, guide and educate the …show more content…
patient.
Strengths and limitations of Orem’s theory to current nursing practice
Strengths
Orem’s theory provides a comprehensive base for nursing practice. The theory is beneficial to different areas of nursing such as education, clinical practice and research. The theory is simple and very easy to apply in nursing, thus, junior nurses can understand terms such as self-care deficit and explore the theory further as they gain more knowledge and experiences (Foster, 2010). Another strength of Orem’s theory is that she specifies when nursing is needed (Current nursing, 2013). Orem emphasizes on the responsibilities that both the individual and nurses have to fulfill self-care to maintain well-being. This is especially relevant to current practices in early discharge, home care services and outpatient services (Foster, 2010).
Limitations
One of the limitations is that it is very time-consuming. Orem stresses a lot on self-care. Nurses need abundant amount of time to plan, communicate and educate the patient and caregiver. In today’s nursing settings, nurses are already very tied up with overwhelming workload, and will have very limited time to design such plans for patients. Another limitation is that fulfilling patient’s self-care demands require efforts from other allied healthcare professionals such as physiotherapist, social workers and dieticians. But in Orem’s theory, she emphasizes solely on nursing and what role nurses play in meeting self-care needs. Last but not least, Orem’s theory is also very illness-orientated, there is limited recognition to patient’s emotional needs (Foster, 2010).
Conclusion
In conclusion, Orem’s theory is applicable to most clinical settings and is suitable for beginner practitioners as it is very easy to understand. Her theory points out the importance of nursing, roles of the nurses in self-care deficit individuals and how individuals can share the responsibilities in meeting self-care needs so that health can be maintained. She has provided us with better understanding of nursing systems and which to use for meeting different individuals’ needs. With Orem’s theory, nurses can now design and carry out distinctive care plans to meet different individuals’ needs by knowing the various factors influencing their well-being and aid them to attain better lifestyle and maintain their health.
References:
Current nursing. (2013). Nursing theories: a companion to nursing theories and models. Retrieved from http://currentnursing.com/nursing_theory/self_care_deficit_theory.html
David, C. Y., & Lynn T. L. L. (1997). Nursing theories – Orem’s model. The Professional Nurse, 24, 36-37.
Fawcett, J.
(2005). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories (2nd ed.). Philadelphia: F. A. Davis.
Foster, P. C. (2010). Self-care deficit nursing theory. In J. B. George (Ed.), Nursing theories: The base for professional nursing practice (6th ed., pp. 116-121). Lakestreet, NJ: Julie and Regina.
Hartweg, D. L., & Fleck, L. M. (2010). Dorothea Orem’s self care deficit theory. In M. E. Parker & M. C. Smith (Eds.), Nursing theories and nursing practice (3rd ed., pp 121-143). Philadelphia, PA: F. A. Davis.
Orem, D. E. (1995). Nursing concepts of practice (5th ed.). St. Louis: C. V. Mosby.
Slideshare. (n.d.). Dorothea Orem & Imogene King: Nursing theorists in focus. Retrieved from http://www.slideshare.net/macluvniam/dorothea-orem-imogene-king#btnNext
Sonata, M. (2010, July 11). Orem’s self care deficit theory. [Web log post]. Retrieved from http://juneyou-doroteaoremstheoryofselfcare.blogspot.sg/
WHO definition of health 1948. (2013). Retrieved from http://www.who.int/about/definition/en/print.html
Winters, R. K. V. (1989). Adapting the environment to age-related sensory losses. Journal of the American academy of nurse practitioners, 1,
106-111.