Orem’s theory of self-care in the maternity department?
Introduction:Women have been endowed with the responsibility of bearing the human progeny. The word ‘mother’, is closely linked to maternity. The meaning, as defined by Chamber’s Twentieth dictionary of the word “maternity”: the fact of being in the relation of mother; motherhood; maternal nature (Chamber’s Dictionary, 1970). Women, by nature, are especially equipped to handle the contingencies of Child-bearing and pregnancy.
Research shows that maternal satisfaction after child – birth, is greatly influenced by whether the actual birth event met personal expectations, and to a lesser extent dependent also on the degree of pain endured. (Hodnett ED. 2002). The subject of short study here is, ‘The concept of Self-Care’ in nursing practice as envisaged in the maternity department of a hospital. It will be argued that the Praxis of Self-Care could greatly improve the rehabilitative role of nurses by positively influencing an individual’s self-care agency; which is the power component of self – care behavior, as according to Dorothea Orem’s Theory. (1991.)
Orem’s Self – Care Theory:
The term ‘Self-Care’, is familiar through Orem’s Self-Care Deficit Theory of nursing. Orem’s theory is composed of three related theories: the theory of Self-Care, the theory of Self-Care Deficit and, the theory of Nursing Systems (Eben et al., 1994). Orem’s theory views the individual as a self – care agent with especial needs. When ‘self-care’ is practiced it enhances health and well-being being (Lee 1999). There is a visible link between responsibility and self-care; Self-care can be stated as a self-initiated, deliberate and purposeful activity linked to health and well-being (Sullivan & Munroe, 1986; Gast, 1996). Pertinent action is performed to meet the therapeutic self-care demand arising out of known needs for care. This varies from time to time, as required by the various stages of life-cycle, of the individual person. The non-fulfillment of this demand, gives rise to a self-care deficit, which denotes the need for nursing (Orem, 1985;). The decision to provide self-care is taken jointly by the patient and the nurse. Herein the nurse plays a pivotal part in the influence of the patient. The fundamental responsibility of the nurse is four-natured: – a) to promote health, (in the maternity ward – of both the new born and the mother), b) to prevent illness (infection and unhygienic practices), c) to restore health (inducing and encouraging routine and healing), and d) to alleviate suffering(caring and dressing of wounds, pain management) (Adapted from Monet Carter, 1981). The nurse is to facilitate and increase the self-care abilities of the individual (Chang, 1980).
Swedish Adaptation Example: A case of the efforts of the Swedish government’s mid-wives’, to educate both the expectant parents on how to expect a child, well illustrates the application of Orem’s theory. The program dubbed “Su sma fron” (To sow small seeds) by Kerstin Carlson (1997), promoted and encouraged, parental education and state of parenthood, in the target group, viz. the expectant females and their spouses. The education was given on the following: hormonal changes during pregnancy, preparations of delivery, pain relief, breast feeding, sexuality, smoking, alcohol and other drugs, parental leave, social networks, civic conditions, and problem solving. Based on Dorothea Orem’s philosophy, here a human being is a unique individual who can take responsibility for his/her own life, also capable of coping with life as long as she/he has the adequate support when needed. (Adapted from Kerstin Carlson, 1997).
Relevance in the Maternity Department in Hospitals:
The importance of the role played by the nurse, in the transformation of an individual has already been elucidated. It is more so in the case of pregnant woman, since pregnancy puts the woman and the fetus into a particularly vulnerable position (James,2005). As regards Maternity, certified nurse midwives, nurse practitioners, and neo-natal nurses are uniquely qualified to undertake these assessments since, by the very nature of their everyday work, they possess an understanding of the changes in maternal physiology and anatomy during pregnancy. It is imperative for the nurses to identify and assess the background of the patient in terms of : Cultural, Economical, Educational, Sociological, Physical and Emotional preparedness. With this assessment done, then it is possible to build a relationship, and communicate support and help and then aid the healing process.
Taking into account the inherent inhibitions and fears of the patient regarding labor pain etc, whether the patient has been a victim of domestic violence, unwanted adolescent pregnancy, previous trauma/experience, loss of beloved, shall all help promote mutual bonding which is imperative for any Self-Care process(Adapted from Murphy,1983). Various techniques and medications now available for safe relief of labor pain, and hence, health care providers have the responsibility to respond to patient requests for pain management, with active information and knowledge of the patient as to what drug has been used to relieve the discomforts of labor, their advantages and disadvantages to both the mother and her newborn, and thus, may even delay the initiation of the breast feeding relationship. It falls to the members of the health care team to present an unbiased presentation of the risks and benefits of all pain management options to the patient and collaboratively support the patient in the choices that achieve a safe labor and delivery.
Active teaching of the recommendations of Association for Women’s Health, Obstetric, and Neonatal Nurses shall definitely improve efficient tackling of emergencies and minimize stress. The recommendations are that pregnant women always carry with them, a copy of the prenatal record, all the emergency phone numbers, an emergency birth kit, essential additional prescription medicines, ready-to-feed formula, and a basic disaster supply kit (Association website, 2003). It is an important role for each and every neo-natal nurse to play; an important need because of their expertise in working with pregnancies, newborns, emergent situations, and situations where an immediate response is needed to save lives in the dynamic environment of the Maternity Ward.
Conclusion: Positive Advantages gained from Orem’s Theory: One can argue that, on the basis of Research (Allison & Renpenning, 1997), the self-care deficit theory of nursing (SCDNT) as the basis for practices of Nursing, proves to be definitive structure for humanistic approach to attain the goals of Nursing. The SCDNT becomes the foundation for not only the design and development, but also the production and management of nursing for patients across cultures and boundaries, through which the functions of nursing administration can be fulfilled.
List of References.
Chang B. (1980) Evaluation of health care professional in facilitating self-care: Review of the literature and a conceptual model. Advances in Nursing Science 3(1) 43-58.
Eben J.D., Gashti N.N., Hays S.E., Marriner-Tomey A., Nation M.J.& Nordmeyer S.B. (1994) Self-Care Deficit Theory of Nursing. In Nursing Theorists and their work 3rd ed. (Marriner-Tomey A., ed.), Mosby, St Louis, pp. 181-198.
Gast H.L. (1996) Orem’s self-care model. In Conceptual Models of Nursing: Analysis and Application 3rd ed. (Fitzpatrick J.J. & Whall A.L., eds.), Appleton & Lange, Stamford, pp. 111-152.
Hodnett ED. Pain and Women’s satisfaction with the experience of childbirth: a systemic review. Am J Obstet Gynecol . 2002;186(5):S160–S172.
James DC. Preparing staff and inactive registered nurses to manage casualties. In: Langan J.C, James DC, eds. Preparing Nurses for Disaster Management. Upper Saddle River, NJ: Prentice Hall; 2005:95–124.
Kerstin Carlson (1997). International Orem Society for Nursing Science and Scholarship Self-Care Deficit Nursing Theory, Newsletter November. Volume 5: Edition 3
ISSN 1081 – 7700 Editors : Susan Taylor and Kathie Renpenning.
Lee M.B. (1999) Power, self-care and health in women living in urban squatter settlements In Karachi: a test of Orem’s theory. Journal of Advanced Nursing 30, 248-259.
Monet Carter, Frances (1981). Psychosocial Nursing. Theory &Practice in Hospitals & community Mental Health. Macmillan Publishing Co. Inc. New York.
Murphy E.C. (1983) Module 3. Nurse/physician relationship: part 1–some basic insights. NursingManagement 14(8), 22-24.
Orem D.E. & Taylor S.G. (1986) Orem’s general theory of nursing. In Case studies in nursing theory (Winstead-Fry P., ed.), National League of Nursing, New York,
Orem D.E. (1971 ) Nursing: Concepts of Practice. McGraw-Hill, New York.
Orem D.E. (1985) Nursing: Concepts of Practice 3rd ed. McGraw-Hill, New York.
Orem D.E. (1991) Nursing: Concepts of Practice 4th ed. Mosby, St Louis.
Orem D.E. (1995) Nursing: Concepts of Practice 5th ed. Mosby, St Louis.
Orem D.E.(1997) Views of human beings specific tonsuring.
Nursing Science Quarterly 10.
Sullivan T.J. & Munroe D.J. (1986) A self-care practice theory of nursing the elderly. Educational Gerontology 12, 13-26.
Sarah .E. Allison & Kathie Renpenning(1997). A Model for Nursing Administration. Published by: Sinclair School of Nursing, International Orem Society for Nursing Science and Scholarship Self-Care Deficit Nursing Theory, Newsletter November. Volume 5: Edition 3. ISSN 1081 – 7700.
Web site and Internet references:
Association of Women’s Health, Obstetric, and Neonatal Nurses. How can nurses advise pregnant women to prepare for bio-terrorism events? Available at: http://www.awhonn.org/awhonn?pg873-8010-3350-6890. Accessed December 3, 2002