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, Catholic University of America 1945- MSN Ed, Catholic 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 OF THEORY
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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.

o Conceptualized as a total being with universal. o 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.Person o Orem·s theory addresses client·s self-care needs. . developmental needs and capable of contionous self care. o The theory is aimed towards making the clients perform self-care activities in order to live independently.

It is a distinguished human service since its focus is on persons with inabilities to maintain continuous provision of health care. Nursing actions are geared towards the independence of the client. Orem defines nursing as human service. . Nursing is based on values.Nursing o o o o o o o Nursing is helping clients to establish or identify ways to perform self-care activities. To maintain a state of health. Goal of nursing ² to render the patient or members of his family capable of meeting the patient·s self care needs.

µ o Orem presents health based on preventive health care. and the prevention of complications. the treatment of disease or injury.Health o Orem supports the World Health Organization·s definition of health as the ´ state of physical. Environment o 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. o The model of health care includes the promotion and maintenance of health. . mental and social well-being and not merely the absence of disease or infirmity.

continuing personal dev·t and a healthy functional living. It is performed by persons who are aware of the time frames on behalf of maintaining life. Universal Self-care Requisites o o o o o o o o 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.Self-Care Deficit Theory of Nursing Self-Care ² is an activity that promotes a person·s well-being. . human functioning and human well-being Promotion of human functioning and development.

Orem·s theory was being used in defining the roles of the nurse in multiple settings. cancer. especially those having chronic-illnesses. This theory had been widely used in dealing with geriatric cases. and mental illnesses.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. .

. 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. Her theory is used as a strong and effective framework for curricular design. This theory is used at all levels of curriculum and in continuing education.To Nursing Education € € € The use of Orem·s theory in curriculum development was reported in the late 1970s.

Specifies when nursing is needed.CRITICS Strengths € € € € € Provides a comprehensive base to nursing practice It has utility for professional nursing in the areas of nursing practice. Limitations € € . a system is viewed as a single whole thing while Orem defines a system as a single whole thing. In general system theory. Appears that the theory is illness oriented rather with no indication of its use in wellness settings. nursing curricula. 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. nursing education administration and nursing research.

MARTHA ROGERS UNITARY HUMAN BEINGS .

1952 € Doctorate in nursing: John Hopkins University. Baltimore. 1945 € MPH : John Hopkins University. Columbia University. Division of Nursing. Speaker € Died: March 13. TN. New York. George Peabody College. 1937 € MA : Teacher·s College. Texas € Diploma : Knoxville General Hospital School of Nursing (1936) € Graduated in Public Health Nursing. New York University. 1954 € Position: Professor Emerita. Dallas. 1914.Born: May 12. 1994 € . Consultant. Baltimore.

€ The purpose of nurses is to promote health and well-being for all persons wherever they are. € 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. lies in the phenomenon central to its focus. .ROGER·S NURSING THEORY € Nursing is both a science and art. like that of any other science. the uniqueness of nursing.

An organized body of kowledge which is specific to nursing is arrived at by scientific research and logical analysis. both a science and an art. She defines unitary human being as an ´irreucible.µ The people has the capacity to participate knowingly and probabilistically in the process of change. .METAPARADIGM Person € € € € Defines person as an open system in continuous process with the open system that is the environment. indivisible. Man is a unified whole possessing his own integrity. pandimensional energy field identified by pattern and manifesting characteristics that are specific to the whole. Nursing € € Nursing is a learned profession.

pandimensional energy field pattern and manifesting characteristics different from those of the parts. Environment € Rogers defines environment as ´an irreducible. .µ Health and illness are the part of the sane continuum.Health € € € Rogers defined health as an expression of the life process. they are the ´characteristics and behavior emerging out of the mutual. Health and illness are manifestations of pattern and are considered ´to denote behaviors that are of high value and low value. simultaneous interaction of the human and environmental fields.

humor. Irreducible. mediation focusing on health potential of the person. € . music. use of color.ROGERS CONCEPT of NURSING Nursing is a learned profession ² it is a science and art € Nursing is the study of unitary. guided imagery. € Rogers proposes a nursing practice of noninvasive modalities. such as therapeutic touch. € The art of nursing involves the imaginative and creative use of nursing knowledge. € The health services should be community based. € 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. light. indivisible human and environmental energy fields.

It is rooted in intellectual judgment. and human compassion. . Rogers discusses structuring nursing education programs to each nursing as a science and as a learned profession.IMPLICATIONS To Nursing Practice € € € € The Rogerian model is an abstract system of ideas from which to approach the practice of nursing. abstract knowledge. To Nursing Education € € Rogers clearly articulated guidelines for the education of nurses within the Science of Unitary Human Beings. The professional practice of nursing is creative and imaginative and exists to serve people. Nursing is based on theoretical knowledge that guides nursing practice.

patterning changes with dev·t from lower to higher frequency with varying degrees of intensity. Principle of resonancy . provides broad principles that conceptually direct theory development. Emerging from Rogers· model are theories that explain human phenomena and direct nursing practice. resonancy and integrality. The Rogerian model. nonrepeating and innovative patterning. THEORETICAL ASSERTIONS € € € € The principles of hemodynamics postulate a way of perceiving unitary human beings. Rogers identified the principles of change as helicy. The helicy principle describes spiral dev·t in continuous.To Nursing Research € € € Rogers· conceptual model provides a stimulus and direction for research and theory development in nursing science. with its implicit assumptions. .

Principles of Homeodynamics Resonancy Helicy Integrality Midrange Bultemeier (1993) Barrett (1990a) Floyd (1983) .

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. holistic and have different needs. and has the ability to record their history through their own language and symbols. Selects alternative courses of action. 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.€ € € € Imogene King was born in 1923 Completed her Bachelor in Science of Nursing from St. Columbia university METAPARADIGM To Nursing Practice € € King described a person existing in an open system as a spiritual being and rational thinker who makes choices. unique. wants and goals.

€ 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.METAPARADIGM Person € King described a person existing in an open system as a spiritual being and rational thinker who makes choices. Nursing € Nursing is an act wherein the nurse interacts and communicates with the client. unique. . and has the ability to record their history through their own language and symbols. € Selects alternative courses of action. wants and goals. holistic and have different needs. restoration and caring for the sick and dying.

Nurse is a part of the patient·s environment. € External environment ² involves formal and informal organizations. .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.

Interpersonal . Social . . superiors. Personal ² how the nurse views and integrates self based from personal goals and beliefs. subordinates and the client environment in general.how the nurse interacts with coworkers. namely Personal.Interacting Systems Framework King proposed that the nurse interacts in the system simultaneously at three different levels.how the nurse interrelates with a co-worker or patient particularly in a nursepatient relationship. Interpersonal and social Frameworks.

set goal mutually and the act to attain those goals. . is also the basic assumption of nursing process.ASSUMPTIONS Basic assumption of goal attainment theory is that nurse and client communicate information.

theory based practice in the emergency department. € . € Professional need communication to successfully and correctly make decisions for their plan of care. in tertiary hospitals and in the community. € The significance of King·s theory have been applied to different professional practice setting such as in nursing administration.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.

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. € 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. . € It provides a systematic means of viewing the nursing profession. organizing nursing knowledge and clarifying the nursing discipline.

Generality King·s theory has been said to have limited application for the nursing practice. Her research literature was based on the existing evidences during her study. It was stated that the interaction between the nurse and the client also comprises non-verbal communication that cannot be clearly defined and evaluated.ANALYSIS Simplicity King·s theory was as a result of careful research study. She maintains the simplicity of her theory even if she presented different complex concepts. .

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INTRODUCTION Born in Reading. 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 € . Pennsylvania 1909 € Graduated from a diploma program in Pottstown.

productive and community living. . Health € She considers ´healthµ as a word that symbolizes movement of the personality and other ongoing human processes that directs the person towards creative. A developing organism that tries to reduce anxiety caused by needs. constructive.METAPARADIGM Person € Peplau defines person as a man who is an organism that lives in an unstable balance of a given system.

customs and beliefs. from which vital human social processes are derived such as norms. . € 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. therapeutic interpersonal process.Nursing € Peplau described Nursing as a significant.

€ Each phase is unique and has distinguished contributions on the outcome of the nursepatient intreaction. € Phases of Nurse-Patient Relationship are 1. Resolution . Exploitation 4. € One can view them as separate entities. Identification 3. Orientation 2.Theory of Interpersonal Relations € Peplau described the nurse-patient relationship as a four phase phenomenon.

explains roles to client. ƒ Nurse responds. . helps to identify problems and to use available resources and services.Orientation phase ƒ Problem defining phase ƒ Starts when client meets nurse as stranger ƒ Defining problem and deciding type of service needed ƒ Client seeks assistance. ask questions. conveys needs. shares preconceptions and expectations of past experiences.

Factors influencing orientation phase .

Identification Phase   Selection of appropriate assistance. Nurse aids the patient in exploiting all avenues of help and progress is made towards the final step. Use of professional assistance for problem solving alternatives Advantages of services are used is based on the needs and interest of the patients. Nurse must be aware about the various phases of communication. Individual feels as an integral part of helping environment. Patient may fluctuates on independence. Exploitation Phase       . Patient begins to have a feeling of belonging and a capability of dealing with the problem which decreases the feeling of helplessness and hopelessness.

Patient drifts away and breaks bond with nurse and healthier emotional balance is demonstrated and both becomes mature individuals. with end purpose of meeting the patients needs.Resolution Phase      Termination of professional relationship. INTERPERSONAL THEORY AND NURSING PROCESS € € € . Both are sequential and focus on therapeutic ralationships Both use problem solving techniques for the nurse and patient to collaborate on. Both use observation communication and recording as basic tools utilized in nursing. 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.

IMPLICATIONS To Nursing Practice € € Some of Peplau·s ideas were not widely accepted at the time they were introduced. as the concepts that form her Interpersonal Relations Model were applied and tested. Hildegard Peplau·s book. many nursing experts now recall Peplau as the one who brought a new perspective. a new approach and a theoretical foundation for nursing practice. such as the concepts of learning through experiences between the patients and the students. 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. Interpersonal Relations in Nursing (1951). To Nursing Education € . However.

Cannot be used in a patient who doesn·t have a felt need eg. unconscious patients Some areas are not specific enough to generate hypothesis. personal space considerations and community social service resources are considered less. . nursing researchers follow the major assumption that patient problems were within the person phenomena and were dealt inside the nurse-patient interaction studies. With drawn patients. Health promotion and maintenance were less emphasized. LIMITATIONS: € € € € Intra family dynamics.To Nursing Research € At the arrival of the Interpersonal Model.

Martha Raile Alligood) ‡Current Nursing@yahoo. Balita) ‡Nursing Theorists and Their Works.‡Theoretical Foudations of Nursing: The Philippine Perspetive (Eufemia f Octaviano.com . Carl E. Sixth Edition (Ann Marriner Tomey.

Lani Luz Villasin .

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