Orem's Self-care Theory Research Articles

The structure of self-care in a group of elderly people.

According to Orem's self-care deficit theory of nursing, the structure of self-care consists of self-care agency balanced by therapeutic self-care demand. Different conditioning factors constitute these two constructs. The aim of this study was to investigate through secondary analysis the structure of self-care in a group of elderly. Data were originally collected from a total of 125 randomly chosen elderly individuals (65+ years of age) in Sweden by means of a mailed questionnaire. Confirmatory factor analysis was used to show that self-care agency was totally and significantly balanced against therapeutic self-care demand and explained by five conditioning factors.

Do Hardiness And Attitude Promote Self-care Adherence To Physical Activity Among Adults With Diabetes

A descriptive correlational study was conducted to determine the relationship between health-related hardiness (HRH), patient attitude toward compliance (PAC), and self-care adherence to physical activity (SCA) among adults (N=155) with diabetes. Data were obtained through individual questionnaires mailed to the subjects identified from local hospital database. Theory of Reasoned Action and Orem's Self-Care Theory were integrated to guide the study. HRH was significantly positively correlated with SCA. The correlation between commitment/challenge part of HRH and SCA was significant and positive, while that between control and SCA was not. The variation in SCA due to control (1.4%), and commitment/challenge (7.7%) together was 9.1% compared to 5.2% due to unified HRH. Separating the HRH into its sub-components of control, and commitment/challenge may explain the individual differences in SCA better than the unified HRH characteristic. Individuals with higher commitment/challenge characteristic may adhere to health professionals' recommendations more than those with higher control characteristic. Those with higher control characteristic may follow self-management strategies other than exercise to control diabetes.

Measurement of Orem's basic conditioning factors: a review of published research.

The purpose of this review was to examine published research on basic conditioning factors described in Orem's self-care deficit theory of nursing, in order to identify operational definitions, measurement strategies, and the results of the analyses. Thirty-five research articles published between 1987 and 1997 met the criteria for inclusion in the review. Consensus or lack of consensus in operational definitions for specific factors was determined and successful measurement methods were identified. Recommendations are made for revising conceptual and operational definitions. Suggested measurement strategies for the factors are discussed.

Sociocultural influences and self-care practices of middle adolescents

The purpose of this study was to describe general self-care practices of middle adolescents. In addition, the relation between general self-care practices and specific sociocultural characteristics including socioeconomics and church attendance were explored. Orem's self-care theory and developmental theory provided the framework for the investigation. Findings from the sample of 15- and 16-year-old adolescents (n = 425) showed that they are engaging in self-care practices. The influence of sociocultural characteristics on self-care practices was supported. Implications from the study include the need to continue research endeavors that describe, explain, and predict health behavior in child and adolescent populations. Practicing nurses in diverse health care settings should consider the results of this study when working with adolescents and their families from diverse sociocultural backgrounds. Results from this investigation should be incorporated into the planning of health education programs for the adolescent population.

Self-care Activity as a Structure: A Phenomenological Approach

Self-care activity is traditionally viewed as a goal directed activity with the aim to maintain, restore or improve health and well-being. However, it should be possible to situate the phenomenon of self-care within an alternative paradigm and get a new understanding of it in terms of phenomenological knowledge. The purpose of this article was to analyse the notion of self-care activity and elaborate it within a phenomenological frame of reference based on the philosophy of Merleau-Ponty. Using arguments from analytical philosophy, especially action theory, and Orem's self-care deficit theory, some self-care related concepts have first been elucidated. In order to get another understanding of self-care activity, certain parts of the writings of Merleau-Ponty were then applied to the phenomenon. It was stated that there is a dialectical relation between self-care ability as potentiality for self-care activity and self-care activity itself. Both may be regarded as structures given only to perception. Self-care ability is not in-itself a necessary means to maintain, restore or improve health and well-being but rather the potentiality for self-care activity as an integral part of the lived body. The actualization of the ability for self-care may possibly come about through a certain meaning.

Older women and the meaning of health.

Health promotion has become an essential component of comprehensive health care, especially considering the growing female population. Older women, in particular, have demonstrated an increasing need for preventive services or health care maintenance and promotion. These needs consist of services provided by health care professionals that can help women meet their own self-care demands. However, before the health care needs of women can be met, they first must be identified. Using Orem's Self-Care Theory, a three-part qualitative phenomenological study was conducted in an attempt to understand what health actually means to older women and what types of health behaviors they feel are important to maintain or promote health. Three different groups of women age 55 and older with a variety of education, socioeconomic, and racial backgrounds were interviewed. Their responses were analyzed carefully, and each participant was interviewed a second time to validate recurrent themes regarding their statements about health. Results of the interviews with the three different groups of women were surprisingly similar. Although each participant had a unique application of their definition of health, there were five recurrent themes identified by 75% to 80% of the women. The themes were interactions with a being greater than themselves, acceptance of self, humor, flexibility, and being other-centered. Numerous examples supported the five themes. In addition, several "healthy behaviors" also were identified. Based on the findings of this 3-year study, older women seem to have their own perspectives on what health actually means and how they can best monitor or maintain their health. While the list is slightly different than the traditional one prescribed by health care professionals, perhaps it is time to encourage older adults to become more of a partner in their care. These healthy behaviors could be incorporated easily into the treatment and management plans and thereby reflect both parties' definitions of what it means to be healthy. Health care professionals must continue to ask older adults about their view of health and encourage their partnership in health-related issues. All individuals, no matter what age, are being encouraged to assume more responsibility for their own personal health, and by including older adults in the decision-making process, this partnership can be strengthened.

Application of the nursing process based on Orem's theory: a case study with a pregnant adolescent

This is a descriptive study with a qualitative approach that aimed at applying the nursing process based in Orem Self-Care Theory, through a case study with a pregnant adolescent in order to identify the nursing diagnosis in the above mentioned clients, based on NANDA'S nursing diagnoses. Results obtained identified three nursing diagnoses: prejudiced adaptation, sleep disturb and familiar change process. The application of the nursing process based in Orem and the importance of the diagnosis identified for clients nursing care were evidenced.

Effects of a Nursing Intervention on Subjective Distress, Side Effects and Quality of Life of Breast Cancer Patients Receiving Curative Radiation Therapy: A Randomized Study

The purpose of this randomized study was to investigate whether a nursing intervention using Orem's self-care theory as a framework would affect subjective distress, side effects and quality of life as perceived by breast cancer patients receiving curative radiation therapy. The intervention consisted of five 30-min sessions once a week during the treatment period and two follow-up sessions after completion of treatment. The experimental group consisted of 67 patients, as did the control group. Measurements were collected five times: at baseline before commencement of treatment, at weeks 3 and 5 (completion of treatment) and follow-up periods of 2 weeks and 3 months. No measurable effect of the nursing intervention was found for side effects or quality of life but nursing intervention proved to have a positive effect in minimizing stress reactions (p=<0.05). It is suggested that a nursing intervention should be implemented for breast cancer patients receiving curative radiation therapy.

Bone Up on Osteoporosis

To describe the development of an instrument to measure women's knowledge of osteoporosis based on Orem's self-care theory and the latest clinical research on osteoporosis. One hundred and four women from four groups including graduate and undergraduate nursing students, sociology students, and a community sample, completed the instrument. Items for the instrument were developed from three objectives related to osteoporosis risk factors, known facts and preventive behaviors. There were 34 items on the original instrument. It was content validated by experts and subjected to item analysis. The report contains a copy of the instrument with the theoretical classification and item analysis. The Facts on Osteoporosis Quiz had a content validity index of .92, a reliability of .83 and a reading level of sixth grade. Item difficulty and item discrimination were used to delete items. The final instrument contains 25 items. The quiz is a simple, inexpensive measure that can be used in various settings by nurses to assess women's knowledge of self-care in osteoporosis.

Reducing teenage and unintended pregnancies through client-centered and family-focused school-based family planning programs

Achievement of the national health goal to reduce teenage and unintended pregnancies through family planning requires a holistic approach to primary prevention. Building upon Rogers' Science of Unitary Human Being, Orem's Self-Care Theory, and Rosenstack's Health Belief Model, a client-centered and family-focused school-based family planning program is proposed as a means to achieve the health goal. FNPs play a pivotal role in development and successful implementation of such a program.

The relationship of self-concept and self-care in children with cancer

The purposes of this descriptive study were to examine the relationships between self-concept and (a) self-care, (b) dependent-care, and (c) basic conditioning factors for children with cancer, and to compare the self-concept of children on- and off-therapy. The theoretical framework was Orem's self-care deficit theory of nursing. The sample consisted of 74 children with cancer and their mothers. Results showed small but significant correlations between variables, providing some evidence that if children had higher self-concept scores they performed more self-care activities and received more dependent-care from their mothers. The self-concept scores of the on- and off-therapy groups were not significantly different. This study supports Orem's theory and reinforces the need to promote positive self-concept.

Quality of life in pacemaker patients from a nursing perspective

Summary The aim of this study was to describe quality of life (QoL) in pacemaker patients based on a nursing perspective. The questions at issue were how these individuals assessed their QoL in general and also with respect to sex, age, civil status and occupation. A cross-sectional study was conducted in a health care area in southern Sweden with 310000 inhabitants. A sample of pacemaker patients (n=182) entered into the study through a random selection of every fourth person. The results show that the total QoL for these pacemaker patients was acceptable. A poorer QoL was found with regard to physical health, the possibility of influencing one's own situation, lifestyle, health care resources and sociocultural orientation. Men, those who were cohabiting, white-collar workers, managers and those 64 years of age or younger assessed their QoL as higher. By using Orem's self-care theory, information, support and education can be carried out in such a way that nursing care affects the entire QoL in pacemaker patients. Measures should be taken on behalf of women, those living alone, those who are oldest and those who are blue-collar workers, all of whom have a lower QoL.

NURSING MANAGEMENT OF ANXIETY IN HIV INFECTION

Anxiety is a universal problem for individuals with AIDS because the disease creates uncertainty and disruptions in every aspect of their lives. Nurses have a wide variety of holistic interventions to help persons living with AIDS (PLWAs) manage anxiety. Orem's self-care theory of nursing provides a framework for assessing, diagnosing, planning, implementing, and evaluating nursing care for an HIV-infected person experiencing anxiety. This article presents an overview of anxiety, the nature of anxiety in HIV-infected individuals, and psychological, pharmacological, and holistic interventions to assist the client in self-care of anxiety.

Caring for the community: development of the advanced practice nurse role.

In a collaborative effort with a large metropolitan hospital in Boston, a community assessment was conducted to determine ways in which an advanced practice nurse (APN) could enhance delivery to a nearby small urban community. The authors attended healthcare delivery meetings, interviewed community leaders, visited various community sites, and became familiar with the community and its residents. The assessment included evaluation with proposed intervention strategies, development of a model for enhancing delivery of care based on Orem's Self-Care Theory, and a role description for an APN that incorporated collaboration between the APN and the community health nurse. A community assessment enabled the APN to become a vital healthcare leader.

An examination of the self-care needs of clients with rheumatoid arthritis.

Investigators used Orem's self-care deficit theory to guide their examination of the needs of clients with rheumatoid arthritis. Several research questions, which were guided by the proposition that universal self-care requisites are influenced by a person's age, gender, and health state, were addressed. Interviews with 59 clients with rheumatoid arthritis were tape recorded, and transcripts of the interviews were analyzed by two experts using assigned codes of universal self-care requisites (USCRs). The most frequently reported USCRs for these clients with rheumatoid arthritis were the maintenance of a balance between activity and rest (83%), the promotion of normalcy (66%), and prevention of hazards (58%). Clients' health state and age, but not their gender, affected USCRs. The clinical and theoretical implications of the findings are described in light of clients' rehabilitation.

Telephone follow-up program evaluation: application of Orem's self-care model.

The traditional model of nursing, in which patients are discharged with a follow-up medical appointment, is no longer sufficient in the current healthcare environment. Primary nurses working in a 58-bed rehabilitation unit located in a 1,700-bed tertiary care medical center implemented a follow-up telephone call program to support the patient's transition from acute rehabilitation nursing care to community living. Patients discharged to home within a five-state area were called 2 weeks and 6 weeks after discharge. Notes on the telephone conversations were entered on a data collection form and later analyzed using Orem's self-care deficit theory (Orem, 1991). A total of 144 follow-up calls were made. During the first call (n = 105), 157 problems (1.5 per call) were noted, whereas 79 (2.0 per call) were identified during the second call (n = 39). Medication, safety, and bladder problems were most often cited as concerns by patients and caregivers after discharge. The most frequently used helping interventions during both the first and the second telephone calls were guiding and supporting.

Nursing and self-care theory applied to utilization review: concepts and cases.

The following article demonstrates how Dorothea Orem's Self-Care Theory of Nursing serves as a theoretical framework for the hospital-based utilization review process. Orem's theory is a popular and practical one which dovetails beautifully with the goals of any department of utilization management.

Research testing theory: a selective review of Orem's self-care theory, 1986-1991.

The purpose of this study was to determine the extent to which theory testing may have increased in the 5 years since Silva's initial investigation. Using the criteria established by Silva, a review of five major research journals in nursing was used to investigate the degree to which Orem's self-care theory of nursing was being empirically tested. Hand and computer searches yielded 31 studies purporting to use Orem's theory as the basis for research. Of these studies, however, only four (13%) met the criteria for appropriately testing the theory. The findings indicate that little change has occurred in using research to test Orem's theory appropriately. Implications for research and practice are discussed.

Self-care agency in persons with rheumatoid arthritis.

Using a framework based on Orem's self-care deficit theory, five hypotheses related to conditioning factors in self-care agency were tested. The study sample consisted of 60 outpatients with a diagnosis of rheumatoid arthritis in a large research hospital. Patients completed the Exercise of Self-Care Agency instrument and the Health Assessment Questionnaire; a physician rated their arthritis severity. Twenty percent of subjects had high scores on self-care agency, 63% had average scores, and 16% had low scores. The conditioning factor of age was not related to self-care agency. However, education and the duration of illness were related to self-care agency in this group of persons with rheumatoid arthritis.

Using self-care theory to guide nursing management of the older adult after hospitalization.

This article describes Orem's Self-Care Theory (Orem, 1985) and applies it to the home setting. The purpose of the study was to identify how older adults manage self-care activities at home following discharge from a hospital. Results of the survey indicated that 66% of the clients reported self-care deficits after discharge. In addition, 15% reported inability to care for themselves totally after discharge. Analysis of the information indicated the lack of a supportive-educative system to promote self-care at home. The solution to the management of self-care is the rehabilitation nurse clinical specialist, who can provide nursing strategies that promote partnership with the older adult in planning self-care activities after hospitalization.