Lecture 4 - Self Care Deficit Theory (:

Question 1

Grand theories are often composed of relatively abstract concepts, such as…

Answer 1

Health, caring, self-care

Question 2

What are the main categorizations of grand theories?

Answer 2

Human Needs Theories (particulate-deterministic)

Interactive Theories (Integrative, reciprocal)

Unitary Process Theories (Unitary, simultaneity)

Question 3

Human Needs Theories are a category of Grand Theory.

What is their main view of nursing and key characteristics?
What is their practice application?

Answer 3

View nursing as being responsible for helping individuals meet their basic needs - nurses help people maintain and restore health.

Particulate - needs broken down into fields
Deterministic - Assumes that meeting needs will determine health outcome. Needs aren’t met = deterioration of health

Practice application: Clear and structured, useful in providing guidance and prioritizing care needs.

Question 4

Human Needs Theories are a category of Grand Theory.

What worldview do they draw from? How do they view human change?

Answer 4

Positivist
–> Humans are reducible (sum of parts) where change is linear and causal.

Question 5

Human needs theories are said to be particulate-deterministic. What is meant by this?

Answer 5

Particulate - needs broken down into fields
Deterministic - Assumes that meeting needs will determine health outcome. Needs aren’t met = deterioration of health

Humans are reducible and change is linear and causal

Question 6

Interactive Theories are a category of Grand Theory.

What is their main view of nursing and patients?
What is their practice application?

Answer 6

Focus on relationships between the nurse, patient, and environment. Views humans holistically, and emphasizes their ability to act reciprocally with their environment. Integrative and reciprocal.

Practice Application: Emphasize importance of communication and relationships between nurse-client. Patients are not passive recipients but active participants in their health outcomes.

Question 7

From which kind of theory did interactive grand theories develop?

Answer 7

Human Needs Grand theories

Question 8

Unitary Process Theories are a category of Grand Theory.

What is their main view of people, health, and change?
What is their practice application?

Answer 8

Health is the process in which individuals are constantly maintaining balance with a constantly changing environment. Views individuals as whole beings (irreducible).
Change is unpredictable

Practice Application: Encourages holistic view that recognizes uniqueness of individual and fluid nature of health.

Question 9

What is self care, according to Orem?

Answer 9

An acquired action that is performed deliberately to promote health

Question 10

According to Orem’s self care deficit theory, when do people need nurses?

Answer 10

When they are unable to provide for themselves or depend on another.

Question 11

What is the responsibility of nurses, according to Orem?

Answer 11

To compensate for self-care deficits with the aim to assist people to achieve the highest level of self care possible or to assist them in meeting their needs when they cannot do so themselves.

Question 12

Where did Orem get the ideas for her Self-Care Deficit Theory?

Answer 12

Clinical experience - inspired by no theory in particular
–> Cited works from other nurses and other disciplines

Question 13

What are self-care requisites? What are the two elements of them?

Answer 13

Insight about actions that are needed to maintain functioning and development.

2-elements: The factor to control, and the action

Question 14

What are the three kinds of self care requisites, as described by Orem?

Answer 14

Universal
–> Needed by all humans throughout all stages of life

Developmental
–> Maturational: Related to universals, but adjusted to age or developmental needs (like nutrition)
–> Situational: Effects of life events or experiences (like education deprivation, moving, death)

Health Deviational
–> Those who are ill, injured, or disabled

Question 15

What are the two kinds of developmental self-care requisites described by Orem?

Answer 15

Maturational: Related to universals, but adjusted to age or developmental needs (like nutrition)

Situational: Effects of life events or experiences (like education deprivation, moving)

Question 16

What is the therapeutic self-care demand?

Answer 16

All of the care measures necessary to meet all of an individual’s known self-care requisites

Question 17

What is self-care agency?

Answer 17

A person’s ability to recognize and meet their self-care needs.

Question 18

What are the three components are the self-care agency pyramid?

Answer 18

Foundational
–> Necessary for deliberate action like moving the body, self-awareness

Power Components
–> Necessary motivation and empowering capabilities to engage in self-care

Abilities
–> Determine how to maintain health
–> Decide what to do with information obtained on how to do so
–> Actually perform self-care action

Question 19

What three theories are included in Orem’s ideas about self-care?

Answer 19

Theory of Nursing Systems
Theory of Self-Care
Theory of Self-Care Deficit

Question 20

What are the three levels of self-care deficits as described by Orem’s self care deficit theory?

Answer 20

No Self-Care Deficit
Partial
Complete

Question 21

What is a partial self-care deficit?

Answer 21

The self care agency is less than the therapeutic self-care demand

Question 22

What is meant by no self-care deficit?

Answer 22

When the persons self-care agency is greater than the therapeutic self-care demand

Question 23

What is meant by a complete self-care deficit?

Answer 23

When there is no adequate agency and complete support is necessary.

Question 24

What is the theory of nursing systems?

Answer 24

The theory that nurses have the ability to determine if nursing help is necessary and to legitimate it

Question 25

What are the three basic nursing systems described by Orem?

Answer 25

Wholly compensatory Partial compensatory Supportive Developmental

Question 26

What person needs a wholly compensatory system? What are the nursing roles?

Answer 26

A patient experiencing a complete self-care deficit --> Accomplishes patient's therapeutic self-care, compensates for patient's inability to engage in self-care, supports and protects patient.

Question 27

What person needs a partially compensatory nursing system? What are the nursing roles? What about client roles?

Answer 27

Someone with a partial self-care deficit --> Compensates for self-care limitations and supports patient, regulates patient's self care agency. The client also regulates and performs some self-care measures. Accepts care from nurse.

Question 28

What kind of person needs a supportive developmental nursing system? What is the nurse's role in this case?

Answer 28

A person with no self-care deficit. --> The nurse helps regulate exercise and development of self-care agency

Question 29

What is an implicit assumption of Orem's theory?

Answer 29

People have a natural drive to improve well being The goal of nursing is to improve independence, and maintain dignity and drive for self-determination.

Question 30

What are some critiques of Orem's self care theory?

Answer 30

Does not address systemic barriers Does not account for values of the individual Lacks intervention tools Does not account for health care goals that do not want to restore health/wellbeing Complex - 3 nested theories Some say central concepts are not clearly and logically differentiated

Question 31

Is Orem's theory highly generalizable?

Answer 31

Yes, has been used in various settings, countries and across lifespans and social groups.

Question 32

What are some strengths of Orem's theory?

Answer 32

Good description of purpose of nursing Recognizes various degrees of intervening Encourages tailoring and individualization Allows for application through various worldviews

Question 33

How is Orem's self care model still relevant to nursing?

Answer 33

Promotes autonomy and individual approaches to care - empowers patients to build independence. (Waazni & Glifford, 2017) - schizophrenia)

Question 34

In what ways does Orem's self care model need refinement?

Answer 34

Places too much emphasis on the individual and does not account for sociocultural factors and community variables which effect client health. We need upstream intervention! (Hartweg & Metcalf, 2021)

Question 35

How was Orem's self-care theory used to improve independence for patients with schizophrenia?

Answer 35

By encouraging nurses to inquire beyond their worldview and address both physical and mental condition, application of the self care theory can minimize barriers to care, maximize quality of care, and empower people with schizophrenia to achieve the highest level of independence while improving their health and quality of life.

Question 36

What is another term for unitary process theory?

Answer 36

Also called Simultaneity theories.

Question 37

What are other terms for interactive theories?

Answer 37

Integrative or reciprocal

Question 38

What is another term for human needs theories?

Answer 38

Particulate-deterministic

Question 39

What philosophical system does Orem's theory use?

Answer 39

Moderate realism --> Acknowledges that there is an objective reality independent of human perception, but also that our understanding of that reality is influenced by our experiences, interpretations, and contexts

Question 40

What are the 5 explicit assumptions in Orem's theory?

Answer 40

1. Humans need continuous, deliberate input to themselves and their environment to remain functional 2. Human agency is exercised by identifying self care needs and performing actions 3. Mature human beings experience privation and limitations to self care action 4. Human agency is exercised in learning and communicating ways to identify and meet needs of self and others 5. Humans have structured relationships and cluster responsibilities to group members unable to do so themselves.

Question 41

Is Orem's theory testable?

Answer 41

It is mainly descriptive and does not have a hypothesis - and is thus not directly testable. However, it has been used as a source of testable hypotheses