Dorothea Orem’s self-care deficit nursing theory implies that a patient is capable of dealing with many healthcare issues on their own, and nurses should assist them at the point when these capabilities reach their limit (Denyes et al., 2001). Such ideas seem to be directly related to the concept of autonomy that can be considered as nurses’ authority and abilities to make independent decisions (Skår, 2010), for instance, in terms of determining patients’ capabilities of self-care. The below discussion aims to define the theory’s and the concept’s essentials, similarities, and differences, as well as their common application in practice, education, leadership, and further research.
Self-care Deficit Nursing
Orem’s self-care deficit nursing theory is closely related to Henderson’s nursing need theory. Like the latter, Orem considers nursing as compensation for actions performed in a healthy state (self-care) in situations where the patient is not able to carry them out, emphasizing that the main goal of nursing is to help the patient become independent in their actions in that degree as far as possible (Renpenning & Taylor, 2003). Orem’s theory expresses “the view of human beings as at- tending to and dealing with themselves” (Denyes et al., 2001, p. 48). In the works of Orem, Henderson’s ideas about exactly what forms of activity (requirements for self-care) are necessary for a person to maintain health and an active lifestyle were further developed, and highlighted the problems that may arise in connection with this (impossibility of self-care) (Taylor et al., 2000). She has developed in detail the terminology that allows one to designate any concept in the field of nursing.
The theory of self-care includes three central concepts: self-care, the need for self-care, and the need for therapeutic self-care. Orem defines the concept of self-care as the performance of actions that a person performs on his own initiative and on his own in order to maintain his life, health and well-being (Renpenning & Taylor, 2003). All these actions are voluntary and conscious, represent a certain stereotype and are performed in a certain sequence. In her theory of self-care deficit, Orem introduces new concepts: the ability to self-care, the limited ability of self-care and the impossibility of self-care (Taylor et al., 2000). It is implied that the self-care deficit theory is a description and justification of the need for nursing care in a particular case when the ability to self-care is less than the need for therapeutic self-care.
The theory of self-care deficit nursing has been used in diverse areas of the field. For example, Kumar (2007) explores the application of Orem’s self-care deficit theory and standardized nursing languages in a case study of a woman with diabetes. The research question in this study was whether the mentioned theories could enhance the client’s abilities to self-manage type 2 diabetes. Orem’s self-care deficit ideas and standardized nursing language, NANDA, NIC, and NOC served as a foundation for the investigation. A clinical nurse specialist assessed and cared for the woman with the chronic disease being guided by these frameworks. It was found that theory-based nursing care and standardized nursing language contributed to the patient’s capacity to deal with type 2 diabetes to a significant extent (Kumar, 2007). The findings of this study suggest that Orem’s theory and standardized nursing language advance communication among the specialists and maintain the abilities of a patient to self-care.
Moreover, Orem’s ideas seem to have a notable application within the scope of pediatrics. In particular, Haas (1990) aims to address the question of how Orem’s self-care deficit theory can be applied to the pediatric chronically ill population. The author conducted qualitative research appealing to theoretical publications and statistics through the lens of the grounded theory analysis to determine specific ways in which Orem’s ideas can be used in the area. It was found that nurses can use self-care deficit theory to “develop an understanding of the components of parental care capabilities” to assist families with children with long-term healthcare needs (Haas, 1990, p. 263). It seems apparent that Orem’s approach has gained population in the academic and practical dimensions.
In summary, Orem’s theory proposes that if a person, under some circumstances, is not able to maintain life, ensure their health and well-being, then this becomes the responsibility of the nurse. Orem weaves concepts of the ability to self-care, the limited ability of self-care, and the impossibility of self-care to form a comprehensive approach to nursing within this theory. The utility of this theory is evident in the studies of Kumar (2007) and Haas (1990) that demonstrate the application of Orem’s ideas within the scope of dealing with type 2 diabetes and pediatrics, respectively.
Concept of Autonomy
In the framework of nursing, the concept of autonomy seems to have a pivotal role. It may be defined as “authority of total patient care, the power to make decisions in a relationship with the patient and next of kin and the freedom to make clinical judgments, choices and actions” (Skår, 2010, p. 2233). The scholarly dimension shows that this concept seems to divide the autonomy of nurses into two types – clinical autonomy and control over practice. The former can be viewed as the authorities, abilities, and discretion of a nurse to make a judgment regarding patient care. The latter is the authorities, abilities, and discretion of nurses to make a decision about the practice setting (Weston, 2008). Then, Skår (2010) finds that there are two primary requirements for autonomy in nursing – knowledge and confidence – that may be considered as critical attributes of the concept. At this point, it would be reasonable to turn to the examples of operationalization of this concept.
It should be said that the concept of autonomy is applicable in several areas. For instance, Rou et al. (2017) explored the autonomy of nurses and its influence on the quality of care and 30-day mortality indicators. The study showed that hospitals with a greater extent of nurse autonomy had diminished 30-day mortality rates. Then, Maurits et al. (2017) conducted another research and figured out that higher levels of nurse autonomy in the home care settings contributed to better job satisfaction for BSN-prepared nurses. This job satisfaction is crucial for a significant working environment, as well as for smooth and consistent decision-making.
Thus, the critical attributes of nurse autonomy, as noted by Skår (2010), are apparent both in the development of further theories and in practice. The critical aspects of the concept – particularly, knowledge and confidence – are useful to further research. Autonomy serves as a foundation for the improvement of nurses’ job satisfaction (Maurits et al., 2017). Additionally, autonomy has been found to be essential to advance patient outcomes (Rou et al., 2017).
Relationship of Self-Care Deficit Nursing Theory to Concept of Autonomy
The theory of self-care deficit is closely related to the concept of autonomy in nursing. First, both of them clearly emphasize the importance of nurses’ activities in various fields of healthcare. Second, they imply that a nurse should possess the necessary authority, knowledge, and skills to help patients through the lens of defining and understanding their needs autonomously. Third, the theory and the concept recognize significant patient outcomes are considerably founded on the nurse-patient relations and interactions.
Although closely related, the theory of self-care deficit and the concept of autonomy retain qualities that are unique. In particular, the former seems to define the appropriacy of nurse intervention from the patient’s perspective and their abilities to self-care. Meanwhile, the latter determines the exceptionality of nurses’ role through the prism of general nursing practice and ethics.
Application of Self-Care Deficit Nursing Theory and Concept of Autonomy
Both the theory of self-care deficit and the concept of autonomy are applicable to nursing in practice, education and leadership, in addition to opportunities to create new knowledge through scholarship. In the framework of practice, Orem’s ideas and nurse autonomy are a significant guideline of what actions a practitioner can undertake independently, with clearly defined opportunities in this vein (Renpenning & Taylor, 2003; Skår, 2010). A nurse can realize when their assistance would be the most appropriate and determine this on their own.
Then, within the scope of education, nurses can use the theory and concept as a basis for shedding light on self-care activities for patients. By understanding the boundaries of clients’ abilities in terms of self-care, a nurse can spread them by educating them properly (Hartweg, 1991). It should be noted that a great extent of knowledge and confidence is important in this vein, which, again, shows a great range of interconnection between the theory and concept.
In terms of leadership, self-care deficit nursing and autonomy may be useful as well. Specifically, autonomous decision-making in conjunction with understanding patients’ self-care needs seems to contribute to great communication between nurses (Kumar, 2007). Hence, this independence and advanced interactions may serve as a vital foundation for the implication of the best leadership qualities of a nurse. Solid theoretical background and confidence are essential in the context given.
Furthermore, the theory of self-care deficit and the concept of autonomy provide opportunities for further theory development and research. According to Hartweg (1991), “Some researchers use the beliefs or definitions in the model [self-care deficit theory] as a basis for research” and “other investigators select theoretical concepts, such as self-care or therapeutic self-care demand, to guide the research” (p. 40). Self-care is directly related to nurses’ ability to make independent decisions, and autonomy only complements the theory as a foundation for various studies. Moreover, both the theory and concept can be applied in a specific research area; for example, the issue of patient autonomy can be explored through the prism of self-care deficit and nurse autonomy in conjunction.
In conclusion, the theory of self-care deficit and the concept of autonomy are valuable to the nursing profession. There are shared key ideas of the importance of nurses’ activities in various fields of healthcare, possession of the necessary authority to help patients, and recognition that significant patient outcomes are considerably founded on the nurse-patient relations. The unique qualities of the theory add to a deeper understanding of the appropriacy of nurse intervention from the patient’s perspective and their abilities to self-care. The concept of autonomy contributes to a unique perspective on the exceptionality of nurses’ roles through the prism of general nursing practice and ethics. Orem’s ideas and the mentioned concept can be useful in developing further scholarship. Future implications for the use of both include their utilization as a foundation for various studies, as well as for the exploration of patient autonomy from the new theoretical perspective.
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