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Concept Analysis: Orem’s Self-Care Concept

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Introduction

This is a concept analysis on Orem’s concept of self-care. It will first define the concept and discuss its related elements and contributory qualities. An application of its related qualities and outcomes will also be indicated below, mostly in relation to the range of compliance of the patient and the extent by which health professionals fulfill their tasks to assist in securing self-care. The aims of self-care including its uses, attributes, as well as its applications are presented below.

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Main Body

In general, Orem’s self-care concept seeks to provide requisites for individuals who have been injured or are ill, “have specific forms of pathology, including defects and disabilities, and who are under medical diagnosis and treatment” (Orem, 2001, p. 233). Orem’s concept therefore relates to regaining self-care or independence for patients, mostly with guidance and support from the health professionals.

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Uses

Polit and Henderson point out that all people can do self-care, and are considered responsible for their health and that of their family. Self-care refers to the practice of initiating and carrying out in one’s behalf activities which maintain life and wellness. Orem (1959, p. 3) also discusses that the focus of nursing is on “man’s need for self-action and the provision and management of it on a continuous basis in order to sustain life and health, recover from disease or injury, and cope with their effects”. In short, the goal of nursing based on Orem’s model is on how to one’s limitations can be overcome. The self-deficit theory by Orem also discusses that the need for self-care is present where family members of the patient cannot provide supportive care for him and therefore the need to ensure self-care for the patient is imperative on the part of the nurse. Sitzman and Eichelberger (2004) point out that Orem’s self-care concept relates to a structure in which the nurse can help the client where it is needed, in order to ensure sufficient self-care. The extent of nursing care and intervention is very much based on the degree by which the client can or is unable to fulfill his self-care needs.

Defining attributes

Orem’s theory is based on the theory of self-care, of self-care deficit, and the theory of nursing systems (Current Nursing, 2012). These theories focus not so much on individuals, but on individuals in relation to other individuals (Current Nursing, 2012; Edney, Jaime & Young, n.d). These theories focus on specific dimensions of a person, with the theory of self-care mostly focusing on the self (the “I”), the self-care deficit highlights the “you and me,” and the theory of the nursing system relates more to the community (the “we”) (Orem, 1990, p. 49; Current Nursing, 2012; Edney, Jaime & Young, n.d). The foundational qualities of this model are personal capacities related to sensation, memory, perception, as well as orientation with issues on such capacities impacting on a person’s intended actions (Orem, 1990; Current Nursing, 2012; Edney, Jaime & Young, n.d). Enabling traits cover the self-care agency power aspects which include particular personal capacities to take part in self-care, as in knowledge, health value, energy, motivation, persistence, and interpersonal skills (Orem, 1990; Current Nursing, 2012; Edney, Jaime & Young, n.d). For operational traits, these include personal qualities which help recognize personal as well as environmental elements relevant to self-care actions, and the actual conduct of self-care actions (Orem, 1990; Current Nursing, 2012; Edney, Jaime & Young, n.d).

Self-care agency is a major element in Orem’s self-care theory and it is acquired within the life span (Sousa, 2002). Orem (1990) highlighted how personal, including environmental basic conditioning elements affect self-care agency and self-care needs. He presented numerous conditioning factors such as age, gender, developmental level, sociocultural orientation, family system, heath state, patterns of living, health care system, availability of resources, and environmental factors however these factors are considered broad (Orem, 1990; Sousa, 2002). The personal, environmental, and health-related concerns may affect the developmental applications of self-care agency (Sousa, 2002). Orem (1990), in conceptualizing self-care agency expresses that individuals may not act in the way they are expected to not because they are not aware of how they are expected to act, but likely because self-care agency is different from an individual’s physical and psychosocial growth.

Application of self-care theory/concept

This concept has generally been used in nursing in order to establish the link between self-care-agency and other self-care concepts in different populations and settings (Sousa, 2002). Numerous studies have evaluated the best predictors of self-care, including goal-oriented results in various populations and related fields (Ailinger & Dear, 1993; Folden, 1993). Self-care power, capabilities, and ability are terms similar to self-agency and self-efficacy is considered to be a related concept to self-agency, with self-efficacy referring more to specific behaviors (Sousa, 2002). Self-efficacy focuses more on an individual’s beliefs or his capability to carry out specific actions to reach an objective (Sousa, 2002). Self-care relates to an individual and his power to actually identify his needs, to assess his resources, and to choose specific actions alongside appropriate behaviors which can reach a favorable outcome (Sousa, 2002).

Antecedents

Self-care calls for a need or desire to carry out related actions in order to gain desired outcomes (Chunyi, Ying & Juan, 2014). Practicing self-care includes an individual’s capabilities in recognizing personal needs, including the self-evaluation of personal and environmental resources and the conduct of related self-care actions (Sousa, 2002; Chunyi, Ying & Juan, 2014). In effect, antecedents in self-care are based on the patient’s cognitive, physical, psychosocial developmental levels as well; it is also based on the patient’s need to carry out the required self-care (Chunyi, Ying & Juan, 2014). Antecedents in self-care are also founded on goal-oriented objectives.

The effects and outcomes of self-care include the sufficient conduct of self-care actions including the fulfillment of goal-oriented objectives (Shahdadi, et al., 2017). Therefore, the effects of self-care include the conduct of self-care actions, and reaching the desired objectives.

Empirical referents

Since Orem’s theory was formulated, he set out to define and conceptualize self-care. Also, different researchers have tried to implement and assess self-care in different populations (Evers, et al., 1993). They have also set out to understand self-care in relation to specific diseases and health issues (Monsen, 1992; Lukkarinen & Hentinen, 1997). Efforts were also made to establish the link which conditioning factors have with self-care (Lukkarinen & Hentinen, 1997). Self-care is however very much complicated and involves different capabilities, resources, as well as capacities (Sousa, 2002). Therefore, this research is important in order to establish new resources and to apply current tools on to different populations and environments.

Conclusion

An assessment of Orem’s self-care concept relates primarily to the independence of the patient, his/her ability and capacity to care for him/herself following hospital discharge. Orem highlights the importance of patients gaining sufficient capacities and capabilities towards self-care, especially when they are diagnosed with chronic diseases or when they are living alone. The function of the nurse and other health professionals is to ensure that the patient is equipped with the necessary tools, resources, and information to support self-care. It is also the responsibility of the patient to attend the necessary discharge classes and other classes meant to educate or inform them about their disease and the corresponding self-care. The situations illustrated above show how failures in some aspects of self-care can lead to negative outcomes for some patients, especially for those who refuse to cooperate with the healthcare givers or those who are not sufficiently equipped with the proper resources to guide their self-care. All in all, it is important for patients and for health professionals to work with each other in order to secure self-care and generate desired outcomes.

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