Dissertation on Nursing

Introduction

The four concepts of the nursing metaparadigm as described in Orem's theory are: Person Environment Health Nursing My perspective of the four concepts has changed somewhat after studying Orem's theory. My thoughts of the "Person" have become more focused on to one that is the recipient of nursing care only when they cannot administer self-care. My view of the "Environment" now includes a developmental environment. My previous understanding of "Health" did not include such emphasis on health promotion and health maintenance. My view of "Nursing" now includes the understanding of the importance of nursing theory as applied to practice settings and in the development of nursing as a profession. Person Orem describes the person as a patient; an individual functioning biologically, socially and symbolically. She describes the person as having the capacity to learn and develop, has the capacity for self-knowledge and is capable of engaging in deliberate actions to meet their self- care requirements for the maintenance of health.

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She also states that if the individual is incapable of taking care of him / herself, then others must provide the care. The others in this case can be the nurse or a family member. She states that individuals are subject to the forces of nature. Orem through her theory self care deficit has put forth the idea that people can benefit from nursing because they are subject to health related limitations that render them incapable of continuous self-care. Wesley (1992).

In other words when the individual's health breaks down for whatever reason, the nurse is there to come to the rescue by doing what is in her power to help the health related problem either on her own or with the collaboration with other health care professionals. Orem's definitions have crystallized my own thoughts on treating patients as intelligent people who are much more capable of learning about how to deal with their illness than often given credit for by health care professionals. It emphasizes the need for communication and patient education with regard to administering self care and that receiving hospital help is a supplement to the patient's own self-care efforts.

In the past when people entered hospital they were treated as passive recipients of care. Orem's theory supports the shift in emphasis to the "Person" and self-empowerment towards self-care. Environment Orem's concept for the "Environment" not only covers the actual physical surroundings and social or psychosocial elements but also addresses developmental aspects. My original thoughts concerning the "Environment" were mainly along physical and social surroundings and that the developmental element was really another concept.

However, on further reflection it does seem appropriate to include these three aspects under one concept since they all impact on the "Person" to various degrees. Orem's theory presents a more comprehensive definition of the environment. Traditionally care for the patient's environment focused on physical and social aspects, such as noted in Florence Nightingale's theory. Orem conveys the importance of creating a developmental environment for the patient, which establishes goals and the desire to achieve them.

These goals can include improved attitude and physical development, which ultimately can have a profound impact on the potential recovery of a patient. Health One can not discuss health without mentioning health care, which has become a major concern for Canadians today, with health costs spiraling out of control. There is an increasing need to explore alternative methods to deliver care. This growing population in need of health care forces a shift from the traditional medicine, where the patient is passively cared for, to a more proactive recipient who is informed and capable of making decisions, which affect the direction of their care.

This self-responsibility is a new movement in health promotion today. This is not a new concept to nursing theorist Orem who states that human beings have the potential to develop their cognitive and psychomotor skills as well as the motivation essential for the actions required maintaining health. McBride (1999). One of the concepts that is consistent throughout her theory is the emphasis on self care, where the individual takes responsibility for his or her own health and takes actions to promote health and maintain it to prevent illness. Hartwig (1989).

She views health as the opposite to illness, where the individual can help prevent illness by participating in the universal self care requirements. In recent years there has been a shift in the role of the nurse from predominantly caring for the sick to one of health promotion and disease prevention. The nurses are placed in a role of assessing strengths and limitations and implementing appropriate measures that will allow the individual to return to health and well being. My view of health did not incorporate the concept of health promotion and maintenance.

Orem views health as something one must not take for granted, but rather one where the individual must participate in a process of self-care activities for the maintenance of health and well being. Having studied her deblockedion of health, I find it much more applicable to the nursing paradigm since it refers to health maintenance. It also refers to health as being a process that requires continual maintenance. Therefore the status of health is never stagnant but rather an active process of growth which varies with the individual throughout their life.

For example, in Orem's developmental theory, she notes processes such as reproduction and aging cause an alteration in the universal self care requirements. Her theory also guides the nursing education to further the clarification of health promotion using her model. Her model is in tune with the present day health needs of our society, with a strong emphasis on prevention, which promotes self-care. The promotion of health must become an essential part of the individual's life, which includes being physically active, eating healthy and having a supportive network to assist the individual in handling stressful situations.

She states that self-care is an adult's continuous contribution to his or her continued existence of health and well being. Hartweg (1989). Nursing Orem identifies the role of the nurse through her theory, which has three related constructs: self-care theory, self-care deficit and nursing systems theory. Her central idea is the belief that people can benefit from nursing because they are predisposed to disease, which can interfere with their ability to participate in self-care on an on-going basis. She believes that the ability to care for ones self is not inherent but must be learned. These behaviors must be regulated through development and integrity. Marriner 1998.

I accept her deblockedion of the nurse, which is a practical one. The nurse is used as a facilitator of care for the patient through the Nursing Systems Theory, which establishes the structure and content of nursing, by using the nursing process to help individuals meet therapeutic, self-care demands for those with limitations to engage in self-care or dependent care. Her theory has been used in many practice settings not only in North America but also in Europe and Asia.

Her theory was used for purposes of patient education for post-surgical patients, the self-care concept was growth producing for the nurse and the patients, as well as having the potential for cost-effectiveness. Rehabilitation centers found her theory useful in the evaluation of patient outcomes, where the focus of the units was the fostering of maximum self-care. Orem s theory also guided practice in discharge planning for self-care with the help of method-specific interventions that assist in discharge readiness. Alligood (1997).

The focus on community based health care today, where patients are discharged from hospital early requires, that patients become more self-sufficient with regard to self-care. Her general theory is not only useful in guiding and developing practice; it is also useful in nursing research both using qualitative and quantitative methodologies. The theoretical entities are well defined and lend themselves to be measured because their empiric indicators have semantic clarity and simplicity. Her theory is also useful in the design of graduate nurses as well as continuing education.

It has provided an invaluable tool in the development of computer based systems used in the structuring of and the delivery of care. Orem's theory of nursing could be viewed as timeless in that it is continually evolving to meet the changing needs of our society. She believes that nurses should be educated in theory development thus creating a relationship between what they do and what they know, thus leading to a heightened level of professionalism. Marriner (1989) Orem's Self-Care Deficit Nursing Theory put nursing in the unique position of being differentiated from other disciplines by the development of the Nursing Systems Theory. Other disciplines have used the self-care theory and contributed to its development but the Nursing Systems Theory is unique to nursing only.

It gives direction to nursing specific outcomes related to knowing and meeting the therapeutic self-care demand. Orem is not only one of the most accomplished nursing theorists of the 20th century, she also has a visionary view of nursing for the 21st century with regard to education, practice and knowledge. I now have a deeper understanding and appreciation of what Orem's theory has contributed to nursing both in the practice setting and the development of nursing as a profession.

I now have a more optimistic outlook for the future of nursing and the further development of nursing through Orem's theory. Conclusion Having studied Orem's theory I have a new insight into the four concepts of the nursing metaparadigm. I see how these concepts interrelate to form the paradigm of nursing. I see the Person as a patient who has been empowered towards self-care. I see the Environment with the extra dimension of developmental theory that can impact on the patient's recovery. I see Health as requiring continual maintenance and promotion of disease prevention by the Person. I see how understanding Nursing theory can improve patient care and lead to ongoing development of the nursing profession.

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