Theories are composed of definitions, concepts, propositions, and models based on assumption. A theory serves as a group of related concepts guiding a professional practice.
Nursing theory is a set of interrelated concepts, definitions, as well as statements explanatory proposing to understand nursing phenomena, assisting in predicting and explaining the nursing outcomes. Nursing theory is also a body of knowledge used to support a nursing practice. In other word, nursing theories deliver the framework linking nursing practice, nursing knowledge and nursing research. (Alligood & Tomey, 2002).
Theories are based on two principal methods: Deductive reasoning, and Inductive reasoning, and nursing theories are based on both deductive and inductive reasoning. Nursing top-down logic uses the deductive reasoning to make a critical decision on patient care. Similarly, nurses can use the bottom-up approach to apply a nursing care.
Nurses play a critical role in the promotion of health, and the role of nurses is to prevent disease and change behavior of patient with respect to positive health behavior. However, effective implementation of ethical conduct is the top priority of the nursing profession. Essentially, nursing theory guides professional conducts of nurses, and nursing theory assists professional nurses to understand the method of identifying symptoms and undertake patients' care. Professionally, nursing is built on theory and nursing theory strengthens the nursing practice. Moreover, theory assists nurses to effectively analyze and organize patients' data, which consequently assisting in the interpretation of patient's data.
More importantly, nursing theories assist professional nurses to make a clinical sound judgment with regards to a clinical practice consequently enhancing the professional practice. One of the major benefits of nursing theories is that it assists in measuring quality and building a common terminology thereby communicating concepts and terminology with other health professionals. In other word, a nursing theory serves as a common ground that professional nurses communicate with one another with respect to patients' care. Moreover, nursing theories provide a strong foundation for assessment, diagnosis as well as patient's intervention. Nursing theories also solidify nursing professionals as effective team members to provide a high quality healthcare as well as providing a valuable input to carry out patient's treatment.
2. Inter-relationships and key Points of Orem theory of Self-care
This paper identifies self-care theory as an important nursing theory. Major function of nurses in the early era is to deliver care to patients, and self-care theory is a grand-range theory that focuses on the well-being and health sustenance of patients. To meet a patient's care needs, nurses are to act, support, and guide, teach and design an environment to meet the patient's self-care. The self-care theory reveals that while some patients can meet some basic aspect of self-care, the assistance of nurses are still critical to meet the self-care activities of patients.
Renpenning, & Taylor, (2003) argue that Orem is the first pioneer of self-care theory in 1956 and her theory is used to formulate the nursing definition. Before 1950s, the function of nurses was based on social dependence on patients. However, the beginning of 1956 marked the era of the implementation of self-care concept with regard to understanding of nursing practice. In 1980, the theory of self-care became the articulated concept in the nursing theories and essential theory in human endeavors. The theoretical position of self-care theory assists nurses to validate knowledge about human function.
Jaarsma, et al. (2012) points out that despite the importance of self-care theory in a clinical setting, the theory is not included in the middle-range theory which is very critical in maintaining patient's healthcare system. Essentially, health is dynamic and those who seek for care from an organized healthcare organization do so because they want to seek for a treatment and be relieved from their diseases. When a nurse interacts with patients, his or her intention is to form a partnership to motivate patients to achieve a self-care that can enhance his lifestyle. Meanwhile, self-care occurs with regard to rewarding mutual relationships.
The concept of self-care later evolves into the "Self-Care Deficit Nursing Theory." (Renpenning, & Taylor, 2003 p 3). Essentially, when an individual is unable to care for his or herself, the nurse intervenes to provide assistance needed. Moreover, nursing care will be essential for children when guardians or parents are unable to deliver necessary quality care for children.
Orem, (2001) also develops self-care requisites influenced by several factors such as age, gender, development state, socio-cultural orientation, health care system, family system factors and pattern of living. Essentially, self-care deficit theory explains the reason an individual requires a nursing care, and the self-care requisite therapeutic is critical for an individual and ability of a person to meet a therapeutic demand depends on nursing care. The theory explains the strategy nurses will employ in assisting an individual to achieve a self-care need. The theory also identifies functions of nurses with regard to nursing practice, which include:
Expressing the focus of nursing practice in human society.
Identifying nursing as a field of knowledge.
The benefits of self-care requisites theory is that it reveals the positive aspect of nurses to patients and relationships between patients and nurses. Moreover, the theory promotes the scope and nature of nursing, and clarifies the role of nursing and the functions not relevant to a nursing profession. Moreover, the theory provides structure, focus, communication and outcomes of nursing that assist in enhancing a greater understanding of nursing actions as well as effectiveness of nursing care.
Prior to the formulation of self-care theory, there was a debate on whether nursing is a profession. However, after the formulation of self-care theory, many people accept that nursing is a profession, and Orem self-care theory leaves no doubt that nursing is a profession. Thus, nursing generally focuses on self-care between advocacy and education. Typically, patients depend on self-care activities of nurses to maintain their health and well-being. For example, when a patient has a large burn at any part of their body, he may not be able to carry out the self-care activities, and it is the responsibilities of a nurse to deliver a self-care for the patient. Another aspect of self-care is an example of a young child who does not have the ability to do toileting with her or himself, and the child will depend on his parent for toileting. If the child has diarrhea, or lost control, the parent will again need to intervene. However, if the parents want the child to be toilet trained at the end of the second birthday, the parent will need self-care assistance of a nurse because the nurses are trained in a supportive child development. As the child grows up and becomes an adult, he will need an intervention of a nursing care if he is hospitalized with a complex sickness such as stroke. In this case, the patient does not have ability to care for himself; he will need a nursing self-care intervention. With the nursing care intervention, the patient will manage to regain his health and have ability to implement the self-care activities by himself.
Despite the benefits of self-care theory to the nursing profession, the delay in implementing the self-care initiatives can lead to a costly intervention. Moreover, effective quality self-care could be costly for patients leading to a decline in quality of life for some individual who will be required to relinquish self-care activities because of high costs.
3. Selected Nursing theory with Reference to Nursing Education
Major task of nurse educators is to identify nursing curricula to be used to impact knowledge in nursing education, and the framework is critical for the development of nursing education, and scholarship. Orem theory was published, formalized in 1972 and used for the purpose of impact knowledge for nursing students. Typically, the theory of self-care deficit forms the basis of curricula for nursing education, and in many nursing schools, the theory lays out the structure of nursing education and basis for impacting knowledge. For example, the Sinclair Nursing School at Missouri uses the Orem theoretical framework to teach students because Orem's model is of one the well-developed nursing models that directs nursing study. The Nursing School at the University of Tennessee runs five semesters and self-care agency course is one of the courses used to assist knowledge development of nursing students. Typically, the nursing school at the university integrates the concept of Orem self-care in the school nursing curricula. (University of Tennessee, 2014).
Essentially, Orem theory has assisted several nursing schools to design their curricula for the implementation of nursing and pre-service graduate education. Moreover, the theory provides a direction for nursing administrators for the implementation of a nursing research. The theory also assists the nursing schools to precise techniques, skills and concepts that students' nurses must learn before becoming professional nurses. (McCormack, 2003).
Essentially, each discipline has the metaparadigm concepts that guide knowledge development. For example, metaparadigm concept for the linguistics is language. The metaparadigm concepts in healthcare profession are physiology, anatomy, pharmacology, and pathophysiology. However, the metaparadigm…