Kimberly Velez

BSN-2

Critique 3 nursing theory of your choice, as to its applicability in the nursing practice, education and
research.

Dorothea Orem’s Self-Care Deficit Theory

A simple definition of self-care is anything you do to keep or improve your physical, mental, or other
health. It is done to alleviate stress and improve mood. Healthy eating, exercise, skin care routines, and
drinking water are all examples of self-care. Basically, self-care is giving yourself what's best for your
body, skin, and mind. It all comes down to loving yourself. Not really expecting anything from anyone.
recognizing and valuing the fact that "you only have yourself at the end of the day" with courage. Be
kind when you set boundaries. always having your own backup plan. regardless of how close you get to
the other person; you will never lose your original self. Learning to ignore others. Recognizing when to
back off. Knowing when to leave any relationship or situation that is no longer serving you well. The
most important thing of all is to be rock-solid for yourself because you are the only hero, savior, and
knight in shining armor.

Certain theories can redefine the ways professionals approach their fields. The ideas of Isaac Newton,
Marie Curie, and Immanuel Kant made lasting impacts on their disciplines. In the nursing field, Dorothea
Orem was one such influential thinker. Born in 1914, Orem worked all over the country as an expert
nurse until her death in 2007. Her 1971 theory of self-care deficit is still taught today in nursing schools,
and she helped shape the holistic approach nurses now take toward patient care. The theory helps
nurses determine what aspects of patient care they should focus on in a given situation, and it stresses
the importance to patients themselves of maintaining autonomy over their self-care processes.

Orem’s theory of self-care deficits explains how nurses can and should intervene to help patients
maintain autonomy. She became widely acclaimed within her field, and she served as a consultant for
numerous universities and government organizations throughout her career. The Orem International
Society was founded in 1991 to continue the legacy of Orem’s research and advocacy. Experimentation
with this theory continues today, with many studies published each year that assess its effectiveness in
patient treatment. One study published in the Iranian Red Crescent Medical Journal demonstrated a
statistically significant difference in fatigue levels among multiple sclerosis patients when nurses used
Orem’s self-care model. Moreover, hundreds of other studies have examined Orem’s model applied to
all different kinds of patients and syndromes.

A self-care deficit is an inability to perform certain daily functions related to health and well-being, such
as dressing or bathing. Self-care deficits can arise from physical or mental impairments, such as surgery
recovery, depression, or age-related mobility issues. Nurses play an important role when it comes to
addressing self-care deficits through assessment and intervention. For assessment, nurses must be
aware of the patient’s strengths, weaknesses, environment, and situational needs. Intervention can
include, but is not limited to, helping patients create short-term goals, spurring motivation, creating
opportunities for independence, and offering help with daily activities.

Orem’s self-care deficit theory suggests patients are better able to recover when they maintain some
independence over their own self-care. This theory, which is applied often in the field of nursing, is
studied in Doctor of Nursing Practice (DNP) programs. Later, we will discuss the application of this
theory. Now, we will examine how nurses diagnose self-care deficits.

The theory of self-care deficit is a grand theory1 and a combination of theory of self-care, theory of
self-care deficit and the theory of nursing systems.2 As the theory is revised many times, to make it
appropriate for the change in time and context, the nested concepts were developed which are
more organized but somehow complex. According to the assumptions1 of the theorist, individuals
should be independent and responsible for their own care and their family members should help
them if they need help. People are unique individuals and nursing is a form of interaction
between people. Successful meeting of the universal and developmental requisites are important
aspects of preventive and promotive care. A person should know about potential health problems
as obligatory for the promotion of self-care attitudes. Self-care and dependent care are the
behaviors learned by society and culture. According to the metaparadigm of this theory,1 man is a
reasonable organism with rational powers, environment includes the components external to man but
she reflected that man and environment are the combination of a system related to self-care; goal of
nursing is to make the client or his family member capable of meeting self-care needs, and health,
in her view, is the responsibility of the whole society. The general concepts of the Orem’s theory
consist of self-care, self-care agency, therapeutic self-care demand and self-care requisites.3 Self-care
is explained as the activities carried out by oneself.1 The self-care agency is one’s innate ability to
do self-care and it will be affected by some factors e.g. age, gender, health care system and social
system, etc.4 The therapeutic self-care demand is the holistic self-care measures needed. Self-care is
performed to satisfy the self-care requisites. (Naz S. Application of Dorothea Orem’s theory into nursing
practice. [General Article]. J Rehman Med Inst. 2017 Jul-Dec;3(3-4):46-50)
 Lydia Hall’s Core Care Cure

To begin, you must have access to the technology required to develop the most effective diagnostic, as
well as the relevant medical knowledge required to diagnose the patient's disease. Once you know what
the patient has, you need to know how to treat it and have the resources to do so. If,for instance, you
know that a particular patient could be better treated by someone else, you should offer referring the
patient to whoever can provide him with the best results. You must discuss the options with the patient
and discuss the advantages and disadvantages of each option. You must also know the patient's
priorities and what is valuable to him or her. The most important thing is to care about the patient and
prioritize his well-being above all else. The service of a nurse denotes a great duty. It is called great since
a nurse is a person who in one duty, one always serves and cares other. This duty is usually called as the
caring service process toward a patient. The nurse denotes the main key person in the caring service
process toward the patient. She / he is also the person who becomes the nearest and always attends
together with the patient in the process of patient caring (Morrison. 2005). Nevertheless, in the fact, the
process of patient caring service is still far from the hope. There are lots of complaints either from the
society or the patients about the patient caring service. The patient complains that, in the caring service,
the nurse always behaves rude, impatient toward the patient, often be angry toward the patient who
frequently asking them and rather has no care and response toward the patient’s complaints. The nurse
rarely has time together with the patient (http://www.peran-net.com, accessed on April 2, 2014). These
facts are the same as the result of research done by Rosenstein (2005), about the perception and the
satisfaction of the patient toward the caring service with the patients who are in a hospital in the USA in
amount of 150 patients. This research shows that about 65% patient with negative perception toward
the caring service in the hospital and 53% of patients expresses the satisfaction with the service of the
nurses and the rest has dissatisfaction toward the nurses‟ service (http://www. Panellation Arief.2008:
kepuasankliententangpelayanan keperawatan.com, accessed on April 2, 2014). The research of Wirawan
(2007), about the satisfaction level of staying treatment patient toward the nursing direction in a
hospital in East Java. It is informed that it’s only 17 % of the whole staying treatment patients who
satisfied toward the nursing direction which they got, while, there are 83 % of those who experienced
dissatisfaction. The research also gave information that the main complaint is in the service of the nurse
namely the nurse did not build communication with the patient (80%), lack of care (66, 7%) and impolite
(33, 3%) (http://www. Penelitian Arief.2008: kepuasankliententangpelayanan keperawatan.com,
diaksestanggal 2 April 2014). Hereafter, the research of Damayanti who did a study about the hope and
the satisfaction of the patient in a public government hospital in Surabaya in 2002, it is gotten the result
that toward the doctors, the patient hope more in their medical technical skill (the patient said as “the
capability of doctors to treat or to heal”), meanwhile toward the nurses, the patients hope more in the
patience and attention from them. There are 48 respondents taken proportionally in interna and
pavilion wards. The other result shows that 41% respondents express their dissatisfaction toward the
hospital service and the rest about 59% express their satisfaction. (http://www.tingkat
kepuasanklienterhadappelayanankeperawatan; sebuah study pelayanankeperawatan.Com,
diaksestanggal 2 April 2014). Toward the performance of the nurses, specifically, the biggest complaint
was that the nurses rarely visited the patients if they were not asked and if they were called, they did
not come as soon as possible (They came after 10 minutes).The lack of satisfaction of the patients
happened because of the dynamic demand of the patients were not responded in balance with the
dynamic performance change and the service deed of the nurse. (http://www. Penelitian Arief.2008:
kepuasankliententangpelayanan keperawatan.com, diaksestanggal 2 April 2014). The nurse , in some
sense, preferred more focus in the performance of medical or technical nursing (dependent functional
performance or functional duty from the doctor) whereas, the patients even hoped the normal
performance of the nurses namely in the aspects that have relationship with the non technical nursing
(independent functional performance). (Potter dan Perry, 2005). The research which was done by Herni,
Adi Suyitno, Ika Yuli Astuti about the relationship between the nursing service and the satisfaction of
non-staying treatment patient in the society health centre of Boro Selorejo Blitar Regency in 2013,
showed that the nursing service in the society health centre of Boro Selorejoin Blitar Regency was
categorized as not-good, since from 25 respondents there were 14 (56 %) respondents pointed out that
the nursing service was held in „not-good service mode. Meanwhile there were 15 (60 %) respondents
showed that they were dissatisfied toward the service which was given by the nurses.
(http://www.tingkat kepuasanklienterhadappelayanankeperawatan; sebuah study
pelayanankeperawatan.Com, diaksestanggal 2 April 2014). Daily Pos Kupang on May 4, 2013 with the
topic The Nursing Service Process toward the Patients in RSUD. Prof. Dr. W. Z. Johannes Kupang pointed
out that the nursing service process toward the patients was still disorganized and its management was
disorder. In the Daily Pos Kupangit is explained how the performance of the nurses who serve in RSUD.
Prof. Dr. W. Z. Johannes Kupang that although there are some nurses have good service performance
but there are lots of them who work in „not-good‟ and unprofessional modes. There are still lots of
nurses who are „terrible‟ and ignorant in serving toward the patients (PosKupang. Edisi: Sabtu, 4 mei
2013.com, diaksestanggal 2 April 2014). Furthermore, in The DailyPosKupang May 4, 2013, it discussed
another topic about the Complaints of Patients‟ Family toward the Nursing Service and the Attitudes of
the Nurses who Serve in RSUD. Prof. Dr. W. Z. Johannes Kupang. In the DailyPosKupangit was written
that the patients‟ family really deplored and complained the nursing service process and the attitudes of
the nurses. A nurse should serves properly with kindly heart, full-patience, sincere and responsibility in
every nursing service process toward the patients. (PosKupang. On Saturday, May 4, 2013.com, accessed
on April 2, 2014). The above facts based on the interview from the journalist with the patients and the
patients‟ family. These facts and data, even though, were confronted with the hospital managements so
that the informed data have benefits from the nursing aspect. Based on the pre-study of the researcher
in the Kelimutu Nursing Ward of RSUD Prof. Dr. W. Z. Johannes Kupang, by interviewing 7 patients, it‟s
showed that generally those 7 patients deplored some equal things in relationship with the lack of
maximum nursing service process given by the nurses in the ward namely the nurses sometimes had
lack of responds toward the complaint of the patients, sometimes they did not respond and answer the
questions from the patients. The nurses were sometimes showed unfriendly face and attitude with
patients in the nursing service process toward the patients. (Wawancara Pribadi, 30-31 Maret 2014). To
respond these problems, the researcher uses an aspect of Hall Theory by Lydia E. Hall namely care
aspect which becomes the “door” or the beginning aspect in the interaction between the nurses and the
patients in the nursing process of the patients, it is needed to give good attention by the nurses in every
nursing process. The nurses have to realize that the application of care aspect denotes an issue that
must be given serious attention due to the success of the care aspect, the core and cure aspects will be
successful so that through these the patients can be helped to overcome the problem in linkage with
their illness. (http://www.models and theories of nursing.com, accessed on April 2, 2014). The nurse in
the nursing process toward the patients which becomes the specific character in care application
(nursing circle) that given by the nurses to the patients namely the attempt to show the receptive
attitude to the patients, the attempt to provide the patients‟ needs sincerely and responsibly and the
attempt to create comfortable condition for the patients to support the intention to give the
comfortable direction toward the patients during the nursing process (Barbara, K., et al. Fundamentals
Of Nursing; Concepts, Process, and Practice, Six Edition: 2000).

Martha Rogers' Unitary Human Being

 Nowadays, almost everyone agrees that the personality is not fixed or long-lasting; rather, it is
frequently susceptible to events and influences. The personality has developed over time and is largely
influenced by culture. Family life is included in my definition of culture. Together, they might get a young
person or someone who isn't yet young to leave the family they were born into in order to follow
specific, but still hazy, but probably innate, tendencies. Similar to this, unfavorable beginnings in life can
cause people to withdraw and enter a similarly unformed interiority. This may result in depression or an
introverted personality, possibly manifesting as timidity or a serious lack of self-confidence, both of
which are related to and imply depression. Sociologists frequently observe a gradual change in these
individuals, such as a newfound openness to life and others, as well as an awakening of self-confidence,
in the event that they move away from their current social environment and into one that is more
suitable or desired for them. Naturally, things can go wrong, leading to negative outcomes. However,
the typical response from those who had previously established certain expectations for such individuals
is often one of surprise, such as "He is no longer the same shy, sullen, or withdrawn boy I knew." It is
believed that a person's personality and future can be altered by moving to a more welcoming
environment, people, and opportunities. Which demonstrates that our personality is not always fixed
but rather fluid.

Nursing is an art and science. Nurses use various theoretical models which guide them in practice.
Therefore, nurses select and apply various theories to focus practice (Armstrong , Kelly 1995). Theories
are said to be a set of interrelated concepts, ideas or feelings which explain some phenomena (George
2002). They give people an idea of how and why certain phenomena happen. Theories in nursing give
information on definitions of nursing, goals as well as functions of nursing and also the principles that
form the base for nursing practice. As nurses, it is very important to apply the theories in practice
because they guide in providing day today nursing care to clients. Also, they provide a framework for
practice and direct in the practical situations. There are many categories of theories in nursing and
‘systems theory’ is one among them. It views the person as a whole and not the sum of parts. Systems
theory considers human beings as open systems and they constantly interact with the environment.
Calista Roy, Emogen King, Dorothy E Johnson, Betty Newman are some of the theorists who developed
and supported their views in systems theory and Martha Rogers is one among them. Martha Rogers
developed her model of unitary human beings based on the concepts of systems theory. Rogers viewed
human being and his environment as integral that cannot be separated. She believed that human and
his environment are a single unit and therefore, must be studied together. She also felt that human
beings and their environment evolve, change, and move ahead together and after the change occurs,
both humans and their environment cannot return to their former stage (George 2002). Rogers’s model
is based on her assumption about the person and his interaction with the environment. She used energy
fields, openness, pattern, and pan dimensionality as the building blocks to develop her model. She
derived her concepts from the idea that the universe is an open system within which individuals and
their environment interact independently and continuously (Tomey & Alligod 2006). According to
Rogers, ‘energy fields’ are the basic units of both living and non-living things. These energy fields provide
guidance to perceive human being and environment as whole. She identified man and environment as
the energy fields. The energy fields continuously vary in intensity, density, and extent. The second
building block is ‘openness’ which says that the energy fields, i.e., human being and the environment are
found to be constantly exchanging their energy. The energy flow between these two fields does not
have any boundary that inhibits the flow of energy. The third building block is the ‘pattern’. Rogers
explains it as a distinguishing characteristic of an energy field. It is perceived as a single wave. Pattern is
a character that gives identity to the field. The fourth building block is ‘pan dimensionality’ which is a
non-linear domain, without any spatial or temporal attributes; its boundaries are imaginary and
fluctuate constantly. (http://currentnursing.com/nursing_theory/unitary_human_ beings.html) Rogers
stated the principles of homeodynamics are based on the above building blocks. These principles help
individuals to understand life and the mechanisms affecting life. They also provide knowledge on how to
intervene and redirect the clients. The principles of homeodynamics are resonancy, helicy, and
integrality. According to Rogers, resonancy is the continuous change from the lower to higher frequency
wave pattern in the energy fields. Human beings are perceived as wave patterns and a variety of life
rhythms like sleep – wake rhythms, hormonal levels, and fluctuating emotional states can be linked to
the wave patterns. The change occurring in these are from lower to higher frequency The slinky in Figure
1 represents that life process is continuous and it moves unidirectional from conception to birth in a
non-linear plane. Slinky toy is a spiral which moves in a particular direction only. When the spirals are
moulded they do not come back to its previous state. Similarly, the nature of human change is spiral like,
continuously progressing towards increased diversity. Rogers says that human development is not static,
and humans do not ever return to exactly the same place where they were before (Tomey & Alligod
2006). When the person follows the path along the Slinky, he may have spiralled to a place that is similar
to where he was before but is just one circuit or turn on the Slinky from that original place.
(http://www.suidoo. com/Rogerian_Theory) The principle of integrality explains that there is a
continuous and mutual process between human field and environmental field. This principle is divided
into two i.e., reciprocity (wholeness, openness, continuous, and mutual interaction between human
being and his environment) and synchrony (simultaneous change in human and environmental fields)
e.g. the child playing in the sun on a bright summer day gets a sun burn. This is the process of
interaction between sun and a child. However, the mutual process between the child and the sun occurs
simultaneously, where he gets Vitamin D along with the ongoing effects of radiation (George 2002). This
is the ongoing mutual process and is the nature of human beings and their environment. Rogers explains
the four paradigms in her model. They are human, environment, health, and nursing. She says that
human is an irreducible, pan dimensional energy field that can be identified by pattern and manifesting
characteristics and that are specific to the whole and they cannot be predicted from the parts. Rogers
defines that the environment is in constant interaction with the human being. Each environmental field
is specific to its given human field and both changes continuously and creatively. Rogers says that health
is an activity in the life process which leads to the optimum fulfilment of a person’s potential. Health is a
rhythmic patterning of energy that is mutually enhancing and expresses full life potential. According to
Rogers, nursing aims to promote symphonic interaction between the man and his environment thereby
strengthen the coherence and integrity of the human beings and to direct and redirect patterns of
interaction between the energy fields for the realization of maximum health potential. (http://
www.en.wikipedia.org/wiki/Martha_E_Rogers) So here, the author during her clinical practice has tried
to apply Rogers system model and on the basis of which nursing care was provided to Mrs Geetha
(name changed) with the diagnosis Systemic hypertension (HTN), Diabetes Mellitus (DM), old CVA
[Cerebrovascular accident (CVA)] and septicaemia.