Full Answer Section

• Virginia Henderson’s Need Theory: Defines nursing in terms of assisting individuals to perform those activities that they would perform unaided if they had the necessary strength, will, or knowledge. It identifies 14 basic human needs.
• Dorothea Orem’s Self-Care Deficit Theory: Centers on individuals’ abilities to perform self-care activities. Nursing is required when there is a self-care deficit, meaning the individual cannot meet their own self-care needs. It includes three related theories: self-care, self-care deficit, and nursing systems.
• Imogene King’s Goal Attainment Theory: Focuses on the nurse and patient working together to identify goals and the means to achieve those goals. It emphasizes interaction, perception, communication, transaction, role, stress, growth and development, time, and personal space.
• Betty Neuman’s Systems Model: Views the patient as a system (individual, family, group, community) that is constantly interacting with internal and external stressors. Nursing focuses on maintaining system stability through primary, secondary, and tertiary prevention.
• Sister Callista Roy’s Adaptation Model: Views the patient as an adaptive system constantly interacting with internal and external stimuli. Nursing aims to promote the patient’s adaptation in four adaptive modes: physiological-physical, self-concept-group identity, role function, and interdependence.
• Jean Watson’s Theory of Human Caring/Caring Science: Emphasizes the human-to-human relationship in nursing care and the importance of carative factors, such as forming a humanistic-altruistic value system, instilling faith-hope, cultivating sensitivity to one’s self and to others, and assisting with basic human needs.
• Martha Rogers’ Science of Unitary Human Beings: Views the individual as a unified whole, constantly interacting with the environment. Nursing focuses on promoting health and well-being by recognizing the person’s inherent potential and the interconnectedness with their surroundings.
• Rosemarie Rizzo Parse’s Human Becoming Theory: Focuses on the lived experience of health as a process of becoming. Nursing practice centers on guiding individuals and families in their process of becoming through three principles: meaning, rhythmicity, and transcendence.

Application of Dorothea Orem’s Self-Care Deficit Theory in a Healthcare Scenario for a Patient with Complex Needs:

Let’s consider Dorothea Orem’s Self-Care Deficit Theory and its application to a patient with complex needs.

Scenario:

Mrs. Eleanor Vance is an 82-year-old woman recently discharged from the hospital following a stroke. She has right-sided hemiplegia (weakness/paralysis), expressive aphasia (difficulty speaking), and a history of well-controlled hypertension and osteoarthritis. She lives at home with her retired husband, Mr. Vance, who is her primary caregiver. However, Mr. Vance is also experiencing increasing frailty and has limited ability to provide all the necessary care. Mrs. Vance requires assistance with many aspects of her daily living.

Application of Orem’s Self-Care Deficit Theory:

Orem’s theory posits that nursing is required when an individual experiences a self-care deficit, meaning they cannot independently perform the self-care activities necessary to maintain life, health, and well-being. Applying this theory to Mrs. Vance’s situation involves a systematic assessment of her self-care requisites and her ability to meet them.

1. Identifying Self-Care Requisites:

Orem identifies several universal self-care requisites, which are needs common to all individuals. For Mrs. Vance, these include:

• Maintenance of sufficient intake of air, water, and food: Due to her stroke and potential swallowing difficulties (dysphagia, which needs assessment), she may require assistance with feeding and ensuring adequate hydration.
• Provision of care associated with elimination processes: Her mobility limitations may make it difficult to manage toileting independently, requiring assistance with hygiene and potentially bowel and bladder management.
• Maintenance of a balance between activity and rest: Her hemiplegia limits her mobility and ability to engage in previous activities. Nursing interventions would focus on facilitating safe mobility within her capabilities and ensuring adequate rest to prevent fatigue.
• Maintenance of a balance between solitude and social interaction: Her expressive aphasia may limit her ability to communicate and engage socially, potentially leading to isolation. Nursing care should consider strategies to facilitate communication and social interaction.
• Prevention of hazards to human life, human functioning, and human well-being: Her weakness and mobility issues increase her risk of falls. The environment needs to be assessed for safety hazards, and assistive devices and strategies implemented to prevent injury.
• Promotion of human functioning and development within social groups in accord with human potential and known human limitations: Nursing can support Mrs. Vance in adapting to her new limitations and maximizing her remaining abilities to participate in social activities and pursue personal interests.

In addition to universal self-care requisites, Mrs. Vance also has health deviation self-care requisites arising from her stroke and other health conditions. These include:

• Seeking and securing appropriate medical assistance.
• Being aware of and attending to the effects and sequelae of her stroke (e.g., hemiplegia, aphasia).
• Carrying out medically prescribed diagnostic, therapeutic, and rehabilitative measures (e.g., attending physical therapy, taking medications for hypertension and osteoarthritis).
• Modifying self-concept and self-image as a result of the stroke.
• Learning to live comfortably with the effects of her health conditions.

2. Assessing Self-Care Abilities and Deficits:

The nurse’s role is to assess Mrs. Vance’s ability to meet these self-care requisites independently. Due to her right-sided weakness and expressive aphasia, she has significant limitations in performing many of these activities. For example, she may be unable to dress or bathe her right side, communicate her needs effectively, or safely ambulate without assistance. Mr. Vance’s abilities as a caregiver also need to be assessed to determine the extent to which he can meet Mrs. Vance’s needs. His increasing frailty may create a caregiver self-care deficit as well.

3. Designing a Nursing System:

Based on the assessment of self-care deficits, the nurse designs a nursing system to meet Mrs. Vance’s needs. Orem describes three types of nursing systems:

• Wholly Compensatory System: The nurse performs all required self-care actions for the patient (appropriate when the patient has almost no ability to perform self-care).
• Partially Compensatory System: Both the nurse and the patient perform care measures, with the nurse assisting where the patient has limitations (most likely scenario for Mrs. Vance).
• Supportive-Educative System: The nurse’s role is primarily to provide education, guidance, and support to enable the patient to perform self-care activities (less applicable in the immediate post-stroke period but a long-term goal).

For Mrs. Vance, a partially compensatory nursing system would be implemented. This would involve:

• Direct Assistance: The nurse (and potentially home health aides) would assist Mrs. Vance with activities she cannot perform independently, such as bathing, dressing, mobility, and potentially feeding.
• Guidance and Support: The nurse would work with Mrs. Vance and Mr. Vance to develop strategies for communication (e.g., using picture boards, yes/no questions), safe transfers, and environmental modifications to promote independence.
• Education: The nurse would educate both Mrs. Vance (using accessible methods) and Mr. Vance on stroke recovery, medication management, skin care, fall prevention strategies, and available resources.
• Coordination of Care: The nurse would collaborate with other healthcare professionals, such as physical therapists, occupational therapists, and speech therapists, to ensure a holistic and coordinated approach to Mrs. Vance’s rehabilitation and care.

4. Evaluating Nursing Care:

The nurse would continuously evaluate the effectiveness of the nursing system in meeting Mrs. Vance’s self-care requisites and promoting her well-being. This involves ongoing assessment of her abilities, her progress in rehabilitation, Mr. Vance’s capacity to provide care, and adjustments to the care plan as needed. The goal is to empower Mrs. Vance to achieve the highest possible level of independent self-care within her limitations and to support Mr. Vance in his caregiving role.

In conclusion, Orem’s Self-Care Deficit Theory provides a structured and patient-centered approach to caring for individuals with complex needs like Mrs. Vance. By systematically assessing her self-care requisites and abilities, the nurse can design and implement a nursing system that compensates for her deficits, supports her remaining capabilities, and promotes her overall health and well-being. The theory emphasizes the importance of the nurse’s role in enabling the patient to meet their own needs to the greatest extent possible, fostering independence and improving quality of life.