Concept Comparison and Analysis across Theories

The importance of nursing cannot be gainsaid as far as safeguarding the
health of a nation is concerned. Nursing comes as one of the oldest
professions in the entire world. Of course, there has been variations in
the way in which it is carried out with change in technology used in
advancing healthcare. These technologies have enhanced the effectiveness
of provision of healthcare in the entire world. However, the
fundamentals of providing healthcare have not changed despite the
variations in technology. In fact, technological advancement has been
founded on the framework that was devised in the early times of nursing.
Of course, new frameworks and concepts have continued to be devised all
in an effort to enhance understanding of the various aspects of nursing
and healthcare provision. Two of the leading lights in nursing are
Dorothea Orem and Betty Neuman. These two theorists are recognized
mainly for the Theory of Self-care and Systems Model respectively.
These theorists had varied definitions of Self-care. Dorothea Orem
defined self-care as the practice of activities that a person initiates
and carries out on their own behalf in an effort to maintain their
health, wellbeing, as well as life. This definition is not different
from the one given by Betty Neuman on the same concept in her Systems
Model. Betty defined self care as the activities of a person, family and
society that are aimed at enhancing or restoring health, as well as
preventing and treating diseases (Neuman & Reed, 2007). The definition
only varies as far as the scope as Betty Neuman’s definition stretches
to the prevention and treatment of diseases. The central idea in
Dorothea’s Theory of Self-care revolves around the fact that self-care
is behavior that is learned one that purposely controls the structural
development, functioning and integrity of human beings (Orem, 1971). The
Neuman Systems Model refers to a distinctive, system-based perspective
that offers a unifying focus that would be used in approaching varied
nursing concerns. It is an all-inclusive guide for the administration,
education, research and practice of nursing that is open to innovative
implementation (Neuman & Reed, 2007). In addition, it incorporates the
potential for unifying different theories that are health-related,
clarifying the relationships pertaining to the nursing care variables,
as well as the definitions of roles at different nursing practice
levels. The relevance and reliability of the Neuman’s Systems Model in
varied, clinical, as well as educational settings all over the world,
has been increasingly demonstrated by its holistic, systemic perspective
and multidimensionality (Neuman & Reed, 2007).
Dorothea Orem Self-Care Theory
Dorothea Orem’s Self Care theory defines self-care as the actions by
and individual directed to himself or his environment in an effort to
adjust his own development and functioning with the aim of sustaining
life, as well as maintaining and restoring the integrated function under
changing and stable environmental conditions and bringing about or
maintaining the condition of well-being (Masters, 2011).
The key focus of the self-care model is enhancing the ability of the
individual or patient for self-care, as well as extending the care’s
ability to their dependants. The self-care model outlines a structure in
which the nurse helps the client where necessary to maintain a
sufficient, self-care level (Erickson et al, 2012). Orem outlines that
the degree of nursing intervention or care is dependent or based on the
extent or degree to which a patient is capable or incapable of meeting
his self-care needs. Four key terms have been identified as fundamental
in the description and understanding of Orem’s self-care theory
(Erickson et al, 2012). These are self-care, self-care agency, self-care
requisites and therapeutic, self-care demand. Self-care agency revolves
around the capacity of an individual to undertake self-care, which is
essentially conditioned by various factors such as gender, age, life
experience, health, developmental stage, available resources,
healthcare/family system, sociocultural factors and patterns of living
(Erickson et al, 2012). Therapeutic, self-care demand is defined as all
the self-care actions that are needed at different times in an
individual’s life to meet the self-care requisites of an individual.
Self-care requisites, on the other hand, revolve around the group of
needs or actions pertaining to self care (Masters, 2011).
The theory of self-care outlines the demands pertaining to self-care
requisites that a person has to meet so as to recover in a better manner
from illness, as well as remain healthy. Nursing is required in
instances where an individual cannot meet the self-care demands, or
cases where the self-care capabilities are less than the self-care
requisites (Masters, 2011). The theory combines three sub-theories
including self-care, theory of self-care deficit and theory of nursing
system (Erickson et al, 2012). The nurse may help patients to meet their
self-care needs through the utilization of five methods under self-care
deficit. However, it is imperative that the nurse assesses the levels of
self-care that a patient needs so as to utilize the nursing system that
appropriately fits the capacity of the patient to perform self-care
(Munn, 2008). This underlines the fact that the interaction of the four
theories or models allows for the enhancement of the self-care capacity
of the patient.
Orem, in her Theory of self-care, outlines that nursing operates under
four concepts that are fundamental to the meta-paradigm. These are
environment, nursing, health and person. These persons get different
definitions in different theories depending on how they fit in the
Orem, nevertheless, defines human being or humanity as an integrated
whole that is comprised of an internal social, physical and
psychological nature that has varying or different degrees of self-care
capacity. A human being is defined as a real or substantial unity whose
parts are fashioned and attain perfection via the separation of the
whole in the course of development. He has the capacity to use symbols,
reflect and symbolize (Erickson et al, 2012). Orem, in reference to
human beings, uses the term patient, individual, self-care agent,
multiperson and dependent care agent.
Orem also defines health or the state of being healthy as being
functionally and structurally sound or whole. It is composed of those
things that make an individual human. Health is a state of physical,
social and physical wellbeing and is not just the absence of an ailment,
infirmity or disease (Munn, 2008). She saw health as a state of
wellbeing that underlines an individual’s existence condition that is
characterized by pleasure, contentment, happiness and the movement
towards one’s self ideals.
Nursing, on the other hand, refers to an art via which a nursing
practitioner offers specialized assistance to individuals who have
disabilities that require more than ordinary assistance so as to meet
their daily needs pertaining to self-care. The practice incorporates
actions that are deliberately selected and carried out by nurses, so as
to assist patients under their care to change or maintain the conditions
in their environment or themselves (Munn, 2008).
Orem defines environment along the physical, biological and chemical
features, and socioeconomic features. She acknowledges that the
surrounding of a patient has a bearing in their capacity to carry out
self-care activities (King & Fawcett, 1997). The biological, physical
and chemical features include the atmosphere, and pets among others
while socioeconomic features include community, family, cultural roles,
gender roles, gender, as well as cultural prescription of authority
(King & Fawcett, 1997)
As stated earlier, blending the three sub-theories and key concepts
establishes the general self-care model, which delineates Dorothea’s
nursing process. This process evaluates the deficits in self-care and
defines the role of both the patient and the nurse in meeting or
fulfilling the self-care demands (Geden et al, 2001). This process of
nursing incorporates three steps.
First in the line is the diagnosis and prescription of remedy. The step
acknowledges that the key necessity of nursing lies in the analysis,
interpretation and making of judgments pertaining to patient care (Munn,
2008). In this case, the nurse would collect data pertaining to an
individual’s status of health, requirements for self-care, as well as
the capacity to carry out self-care. In addition, information would be
collected pertaining to the patient’s and physician’s perspective
pertaining to the individual’s health, as well as the health goals in
the context of health status, lifestyle, as well as life history (King &
Fawcett, 1997).
The second step revolves around designing a nursing plan and system for
delivering care. In this case, the nurse designs or comes up with a
system that is entirely compensatory supportive educative or partly
compensatory. The goals of this step are to enhance the therapeutic
self-care demands of the patient, as well as compensate and overcome the
self-care deficits of the patient(King & Fawcett, 1997).
The third step revolves around the production and administration or
management of the systems of nursing (Munn, 2008). In this step, the
nurse or healthcare practitioner assists the patient or family in
self-care needs so as to attain goals towards positive health, as well
as health related outcomes (Munn, 2008). It is worth noting that the
actions of the nurse are guided by the rationale pertaining to nursing
diagnosis while the achieved results are evaluated or assessed by
comparing them to the planned outcomes.
This theory incorporates a broad scope as far as clinical practice is
concerned, but incorporates a lesser extent as concerning education,
administration and research. Nevertheless, the theory may be applied to
the primary, secondary and tertiary levels of preventive care
(Fitzgerald, 1980). The primary levels are when the nursing care aims at
universal or developmental self-care, as well as when they are
therapeutic. At the nursing and tertiary levels of care, nursing aims at
achieving health-deviation self-care (Fitzgerald, 1980).
In conclusion, self-care mainly revolves around the capacity of an
individual to maintain health in himself or the environment so as
maintain health. The self-care theory by Dorothea Orem encompasses three
sub theories including self-care, theory of self-care deficits, as well
as the theory of nursing systems. The three theories are blended to come
up with the nursing process, where nursing care deficits are evaluated,
and the roles of both parties defined in line with fulfilling the
self-care demands of the patient (King & Fawcett, 1997). This process of
nursing incorporates three steps. First, the nurses diagnose the patient
and come up with prescriptions of remedy. The nurses then design or come
up with a nursing plan, as well as system for delivering care to
patients. Lastly, the healthcare practitioner engages in the production,
as well as management or administration of the systems of nursing. These
steps are fundamentally different from the nursing process of
contemporary nursing.
(Munn, 2008)
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