The Self-Care Nursing Theory is a model that can be applied to any area of nursing. I have specifically chosen it to represent clients in the cardiac rehabilitation area of hospitals, as that would be my area of specialty. According to Zerwekh and Claborn (2009), Orem describes “three interwoven theories of self care, self-care deficit, and nursing system help the nurse to identify strategies to meet the client’s self-care needs.” Orem basically feels that it is first necessary to do what a patient can or can’t do before you establish your actual nursing care.
One of the reasons I was attracted to this particular theory is the fact that I see it in use all of the time. When patients return from surgery they often times want to do very little to care for themselves. The patients do not want to use coughing techniques, incentive spirometers, or to get up and ambulate. A lot of times the patients don’t want to do these things because they make them uncomfortable, but it doesn’t necessarily mean that they simply cannot do it. To help promote the healing process, we often times have to determine what the patients can do and upon deciding what those things are, we then encourage them. When we do find that a patient has an inability to care for themselves or perform a specific action, then it becomes our responsibility to help them do so.
As for breaking down the Nursing Metaparadigm in Orem’s theory, Zerwekh and Claborn (2009) have done so in this fashion: in regards to the person, Orem recognized four different parts integral in terms of self-care; those four parts are physical, psychological, interpersonal, and social aspects. As for nursing, Orem described that the actions to overcome or prevent self-care limitations or provide self-care to be of the utmost importance. In regards to health, Orem recognized these as being the conditions that permit self-care. Orem’s description of the environment was somewhat more vague and expansive than some of the other theorists, simply stating that “(t)he environment is anything outside of or external to the person,” (Zerwekh & Claborn, 2009).
In cardiac rehabilitation, the physical, psychological, interpersonal, and social aspects can all be affected. Cardiac patients generally have physical limitations, either due to their current condition or as the result of a surgery. The psychological effect of cardiac disease can be profound, causing patients to question what their physical limitations will change about their current lives. Interpersonally, especially amongst family and close friends, cardiac patients often find it difficult to convey their limitations for fear of hurting or disappointing others. And as for social aspects, cardiac patients often times find themselves unable to return to the same level of social involvement that they once had.
As for the nursing and health areas of the Nursing Metaparadigm, we as nurses must help remedy any self-care deficits those cardiac patients have, or otherwise provide proper care for them if their limitations cannot be relieved. As for their environments, we as nurses will generally need to help the patients identify risk factors that could cause another cardiac event to occur and to teach and guide the patients to avoid those risk factors. This theoretical model can be molded to fit any area of nursing, but I felt that I could most easily relate this particular theory to my specific area of nursing.
References
Zerwekh, J. Claborn, J. (2009). Nursing Today: Transitions and Trends. St. Louis, Mo. Saunders Elsevier.
