The purposefulness of a plan and its implementation in assisting a client with diabetes helped fill in her self-care deficit (Kumar 2007). The interpersonal relationship between a nurse and her client minimizes the stress experienced by the latter and her family. This enables the client or patient and her family to act more responsibly in health matters. An assessment and plan of care may use Orem's client-related concepts -- of self-care, self-care agency, therapeutic self-care demand and self-care deficit --, the concepts of nursing agency and nursing system and the basic conditioning factors. Integrating these concepts into other theories on health promotion and family systems may guide effective health assessment, health outcomes and nursing interventions (Kumar).

The particular goal of managing chronic diabetes is self-care (Kumar 2007). Orem's theory provides direction to the diabetes educator in guiding the client in self-management. A recent study found that theory-based nursing care and standardized nursing language reduced a client's self-care deficit and improved his capability to care for himself (Kumar).

Blood Glucose

Monitoring blood glucose by a diabetic is also difficult and frustrating (Aldridge 2005). The specialist nurse must, therefore, exert effort to encourage and empower the patient in the regular performance of this routine process. She needs to explain how skillful monitoring can make him understand that it will help improve quality of life. Self-monitoring of blood glucose is basic to proper diabetes care. Patient education should, therefore, be central to diabetes care. Mere monitoring blood glucose is useful but quality of life will improve only with skillful monitoring (Aldridge).

Kidney Disease

Orem's Self-Care Theory may be integrated into all the aspects of the care of kidney disease (Graham 2006). It is useful from the early detection of renal impairment up to the end stage, which requires renal replacement. Orem's concept can be a basic component in an approach to meet the need for the longest life expectancy and the highest quality of life (Graham).

Stroke

Orem's self-care deficit nursing theory is part of the essential education basic to a successful transition of stroke patients and their caregivers from the hospital to home (Cook et al. 2006). This was the conclusion of a survey recently conducted among therapists of stroke patients at home in eastern United States. Most of them sought information on safe transfer techniques. The therapists or caregivers also gave importance to the acquisition and use of assistive and adaptive devices. Healthcare teams can provide comprehensive information programs needed and sought by stroke patients and their therapists or caregivers (Cook et al.).

Another research found physical assistance and emotional support from family and friends were essential in helping the stroke survivor cope with his condition (Steiner et al. 2008). The survivor's family and friend normally bond with caregivers. As a result, they develop a sense of responsibility to care for the survivor. When the caregiver receives emotional support from the survivor's family and friends, her perception of physical help connects with emotional support (Steiner et al.).

The study surveyed 73 caregivers from the Midwest on their first 12 months after their patients suffered a stroke (Steiner et al. 2008). Results revealed that the caregivers set up a responsive self-care system with their clients. This system provides both physical help and emotional support. The study also disclosed the need for nurses to evaluate the caregivers' health at some later time in the caring process. The connection between their health condition and emotional support provided them should also be investigated. The findings underscored the importance of informal social networks to provide the emotional support needed for caregivers of stroke survivors. The positive relationship between emotional support and the health of caregivers seems to conclude that care-giving is a long-term process. This implies the need for sustained emotional support throughout the draining and challenging provision of care to fill in the survivor's self-care deficit (Steiner).

Heart Failure

Promoting or improving self-care behavior among congestive heart failure patients can cut down on huge costs of hospitalization (Aliha et al. 2006). Assessing their self-care behaviors, needs and abilities is, therefore, paramount. A study conducted on 125 patients, using Orem's self-care theory, said that more than half of the patients had satisfactory self-care behavior. More than half of the respondents had good working knowledge about self-care. At the far end, there were those who said that they had high or very high learning needs about self-care. The study concluded that nurses' knowledge about their patients' self-care behaviors, learning needs, limitations of knowledge and their knowledge about self-care and basic conditioning factors will help them in performing supportive-educative intervention function. This function was derived from Orem's self-care deficit theory (Aliha et al.).

Autonomy and Decision-Making in Adolescence

The ability to make proper decisions about self-care produces healthy attitudes and behavior in an entire lifespan (Dickey and Deatrick 2000). Helping adolescents become individual self-care agents will help them develop proper health care decisions by themselves....

This is part of Orem's self-care theory. The adolescent is best cared for and trained within the family framework. But confidential health promotion information and services is also an important tool of adolescent care. Research found that most adolescents are able to form appropriate decisions on self-healthcare when provided with adequate information on healthcare decision-making (Dickey and Deatrick).
Theoretical and Operational Definition/s

Self-care in the nursing arena has long existed but is not always tied up with Orem's self-care model (Watkinson 2006). The connection was only recently made by a document, which described the place of self-care in local intervention strategies and good practice. It gave a useful definition of self-care beyond the vague interpretation of merely doing something good for others. The definition includes the impact of long-term condition on the patient's life. It covers the training of health professionals, which enables them to comprehend the principles of self-care. It identifies needed information as well as assures access to it. It ensures health professionals of information on available community support. It makes patient education programs available. It also ensures the accessibility of self-monitoring devices and technologies. And it provides access to all services, including health and social care and transport (Watkinson).

Among the changes in the culture of health care is the integration of Orem's concepts of self-care and empowerment (Watkinson 2006). One action is the creation of a self-care framework. Another is the incorporation of self-care into the core curricula for health professional education. These initiatives will definitely, though not immediately, have a strong emphasis on the educational role of the diabetes specialist in particular. Efforts are exerted to assure that similar education programs incorporate the principles of self-care (Watkinson).

These changes are projected to be most strongly felt by diabetes nurses (Watkinson 2006). Those extending diabetic care may already be feeling the impact. Skills and training with long-term conditions are the recent emphasis of action and debate. This is likely to persist in the near future. The document mentioned listed the Dose Adjustment for Normal Eating and Diabetes Education and Self-Management for Newly Diagnosed. This disease appears to be leading the trend. A strong action is ensuring that self-monitoring devices are available. This hints at the use of technologies to insure that the concerned persons use the results for self-care. It also insures they have access to all the information they need. These include costs and choices for their decision-making (Watkinson).

Bibliography

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