Self-Care Deficit Nursing Theory In Adult Gerontology Nursing

Self-Care Deficit Nursing Theory

Any Adult Gerontology Nurse Practitioner (AGNP), or individual considering moving into this booming area, will probably be aware that it involves more than supporting patients through short term illnesses or meeting their needs in a hospital or nursing home.

As a rule, the older a patient gets, the more likely they are to experience chronic health complications which interfere with their day-to-day tasks. For much of history, such patients were written off, encouraged to take to their beds and be supported entirely by others, doing very little. They often didn’t live very long. But all that changed on account of one remarkable nurse, Dorothea Orem, whose legacy continues to shape the nursing profession today. This article examines her groundbreaking self-care deficit theory and looks at how AGNPs might use it for their nursing career.

Dorothea Orem

Dorothea Orem was born in Baltimore in 1914 and studied nursing in the late 1930s. This was a time when nursing schools were still a new phenomenon and there was a lot of experimental thinking in the nascent profession. Though she spent time on the wards as a staff nurse, she also worked as an administrator and consultant over the course of her career, spending her later years focusing on theory.

A naturally focused and attentive person, she soon began recording observations about the patients she worked with, leading to her self-care deficit theory of nursing, for which she strongly advocated for her entire life. It was theory which, in its early years, transformed the way nurses thought about patients and their duties. It laid the foundations for nursing today.

Universal Self-Care Requisites

Orem’s theory recognizes eight universal self-care requisites, or SCRs. Here, universal refers to things every human needs, regardless of circumstance. Air is needed for respiration. Water is needed to maintain a healthy level of hydration. Food is needed to maintain healthy energy levels and prevent starvation. Elimination or toileting, a polite way of referring to the expulsion of urine and feces from the body, is required too.

In addition to these four things, Orem posits that every patient needs a balance of physical activity and rest. Everyone needs social interaction, but also some alone time. People need to manage their lives to avoid or remove hazards, and, finally, they need to promote normality. This means that they need to achieve and maintain a way of living and relating to the world which is normal for them as individuals and does not involve psychosis.

Health Deviation Self-Care Requisites

When patients are recovering from injury or illness, or living with a chronic illness or disability, they can be described as experiencing a health deviation. This is not pejorative – it simply establishes that they differ from the norm. Health deviations are more common in older demographics, as they have additional self-care requisites.

These requisites include following doctors’ instructions (taking medicine on time), identifying problems caused by their conditions and attending to them effectively (sitting down until a dizzy spell passes), and knowing when and how to seek help from a caregiver or healthcare professional.

It is also important that these patients can understand and accept that their bodies have changed and can adjust psychologically to cope with it.

What Is A Self-Care Deficit?

A self-care deficit occurs when people are no longer able to carry out basic tasks. This can be because a disability makes them physically impossible to perform, or a number of other reasons. For example, some people get so overwhelmed by the way their bodies have changed that they stop trying to live. This doesn’t mean that they don’t deserve sympathy – it is an understandable response to an extreme situation – but it might mean that there is potential for improvement.

For some people, self-care deficits are permanent or are likely to worsen due to progressive illnesses. For others, however, they can be temporary, even in extreme old age. Self-care deficits stemming from a broken arm, for example, will normally dissipate after the arm heals, but this is less likely if the patient has learned to feel helpless in the meantime.

Assessment, Diagnosis, And Implementation

When using Orem’s theory, nurses have three steps to work through. The first is undertaken during the initial assessment of a new patient and involves identifying any self-care deficits. These are not always obvious from looking at a patient and the process may require gentle but persistent questioning. Some people may be embarrassed and hesitant to talk if they are unable to care for themselves.

The second involves full diagnosis of the deficits, including establishing causes. The third step is to draw up a treatment plan based on these diagnoses. In her work, Orem stressed the importance of recognizing that every patient is a unique individual, so there is no one-size-fits-all approach to this type of planning. In each case, AGNPs will need to work with the patient to establish the most effective way forward.

Five Ways Nurses Can Help

There are five strategies nurses can use to address self-care deficits when establishing patient care plans:

  • For the most severely incapacitated patients, it may be necessary to perform actions on their behalf, such as washing or dressing them.
  • Patients struggling mentally or who lack confidence can be guided through actions, ideally to the point of independence.
  • Patients can be taught new ways of approaching day to day tasks which make them easier to accomplish, such as taking a break to have a shower in the afternoon if it is too hard to find the energy at other times.
  • AGNPs can focus on the patient’s environment, making it easier for them to carry out self-care activities, such as suggesting kitchen gadgets to reduce the physical effort involved in preparing meals.
  • Finally, AGNPs can train a family caregiver to provide appropriate support.

These five strategies involve numerous actions, skills, and tools that nurses can use. Patients may need particular assistance with the following tasks.

Helping With Eating

Patients should always be encouraged to do as much for themselves as is reasonably possible. When it comes to eating, nurses should start with encouragement. Many older people lose their appetite and don’t feel motivated to eat, especially when it requires effort. So, an AGNP can point out that they have more energy when they manage to eat regular meals.

If the patient can get food to their mouth by themselves, nurses should resist the temptation to assist, even if they sometimes drop the food. Instead, nurses can reassure them that this is not uncommon and all they need to do is take a little more time. Nurses should also be alert to the possibility of choking issues and arrange X-rays if concerned. If some food proves difficult to eat, they can discuss the possibility of dietary adjustments.

Helping With Toileting

Nurses should reassure patients that, awkward as they may feel, there is nothing to be embarrassed about. The nurse must ensure they can transfer on and off the toilet safely and consider options like raising the height of the seat or installing grab. If there is a risk of falling, AGNPs may suggest bedpans for use when no caregiver is present. If adult diapers are needed, nurses should ensure that patients know how and when to change them (even if they are not soiled) and how to protect their skin against rashes or bruises caused by wearing them. Finally, nurses can also discuss medical options for softening stools or speeding up or slowing down digestive transit.

Helping With Dressing And Grooming

A balance must be struck between helping patients be more independent in dressing and grooming themselves and enabling them to maintain a style or standard of appearance that is natural for them. Some older men prefer to be clean shaven but end up growing beards because it is easier to trim a beard than it is to shave safely and neatly, for example. Some clothing options can be easier to get into than others, depending on a patient’s particular mobility difficulties. Simple devices such as a stick with a hook on the end can make adjusting the back of a garment or doing up a zip much easier. Nurses should pay particular attention to footwear to make sure patients can stand or walk safely.

Reducing Hazards

Whether a nurse is helping a patient to move around and complete self-care tasks in a hospital ward, a care home, or their own home, they must always pay attention to hazard prevention. Hazards can include mess, a layout created without regard for disability, or other people or pets moving around. Nurses can start by ensuring that the patient is aware of the risks and can recognize dangerous situations.

They should discuss simple measures like installing handrails or changing routines to make it easier to keep the area tidy. Nurses can also ensure that the patient can summon help if something goes wrong, by persuading them to install an alarm system or carry a charged mobile phone at all times, for example.

Care With Communication

Often, older patients who have self-care deficits also have difficulty with communication, whether due to physical or cognitive disability. Depending on their lifestyle in recent years, they may also be unfamiliar with modern technologies, but shy about admitting this. It is important for nurses to make sure that when they are addressing issues around essential needs, the patient understand them properly and vice versa.

It can be helpful to use pictures in communication, which are often available in support materials. When meeting a patient in the place they are going to be living, the nurse and patient can explore it together (in stages, if necessary) so both parties can directly identify issues.

Seeing Each Patient As An Individual

An essential tenet of Orem’s theory is that patients must be treated as individuals. This increases the chance that they will stick to treatment plans, as well as directly improving their psychological wellbeing.

Any nurse that’s interested in Orem’s theory and is considering joining this field will be looking into gerontology nurse practitioner programs online. The best courses place a lot of emphasis on adaptability and on learning how to manage different types of patients in different environments. The program at the University of Indianapolis, for example, encourages students to develop the patience and listening skills essential to getting to know patients and making them a part of the process. This communication and relationship building is essential to developing plans which will really benefit patients over the long term. The course at the University of Indianapolis is an eight-semester program designed for working nurses, involving part-time study and an intensive clinical placement.

The Nursing Profession Continues To Benefit

Thanks to Orem and her self-care deficit theory, patients are no longer left to waste away as they begin to struggle with old age. Generations of nurses who have practiced this theory have observed that, even in later life, patients can often improve and regain their self- care abilities with the right support. Advances in assistive technologies continue to make this even easier.

The right support, focused on facilitating and encouraging independence, enables seniors to go on living satisfying lives on their own terms for much longer. Even when they need extensive practical support, giving them more control helps to maintain their morale and ability to navigate the final chapter of their lives. In the process of providing this support, AGNPs also get what they really want; to see their patients thrive, no matter what they must overcome to achieve it.


Barsha Bhattacharya is a senior content writing executive. As a marketing enthusiast and professional for the past 4 years, writing is new to Barsha. And she is loving every bit of it. Her niches are marketing, lifestyle, wellness, travel and entertainment. Apart from writing, Barsha loves to travel, binge-watch, research conspiracy theories, Instagram and overthink.

View all posts

Leave a Reply

Your email address will not be published. Required fields are marked *



Are You Wondering About The Risk Factors For Depression?

Many people tend to think of depression as a temporary phase where someone is sad, and this makes many think that you need to get out of that emotional state. However, the illness is much more than that, as it is the result of changes in the chemistry of the brain.Like all other conditions that can develop in your body, there are risk factors that raise the chances of you getting the illness, although it is possible you can develop it without the risk factors being present. However, it should be kept in mind that your risk of developing the illness is higher when there are more risk factors, so you need to ask your doctor about reducing these factors.The risk can be related to a combination of various circumstances such as environmental, psychological, and genetic ones.  The NIMH (National Institute of Mental Health) estimates that almost 16 million Americans have experienced a major episode of depression. Different Reasons Of Sleep Dis-orders & Depression Are As Follows:-  In this article, you will get the complete information of the depression and sleep disorder reasons that can bother you later on. Risk factors: Biochemical risks: The beginning of depression occurs when certain neurotransmitters in the brain are off balance. Neurotransmitters are certain chemicals that the brain produces, and they assist the brain to communicate with other organs in your body. They also assist the brain to carry out certain physiological functions such as breathing.When these neurotransmitters are at low levels, the person is more vulnerable to depression, particularly certain neurotransmitters – dopamine, serotonin, and norepinephrine. Genetic factors:When you have someone in your family who is suffering from the illness, there is a higher chance you will develop it as well. However, it can also develop when there is no family history of the illness, and this is why it is termed as a combination of life events and genetic reasons. Sleep disorders: There is a reason why your body needs sleep, as it is able to reduce the buildup of cortisol in the body, a stress hormone that is good for short periods but causes stress to the body when it stays for long periods.Because of this, it is not surprising to find that people who struggle with sleep disorders will also tend to develop depression, especially those who suffer from insomnia – leading to bouts of low moods. Suffering from chronic illnesses: Because these conditions will cause you stress and pain, they can also take a heavy toll on your mental health. These include chronic pain, diabetes, cancer, arthritis, heart diseases, stroke, thyroid disease, Alzheimer’s disease, and multiple sclerosis. Social risks: Abuse:When a person goes through any form of abuse, whether as a child, teen or adult, they have a major risk of developing the condition, and also developing other mental illnesses as well. This abuse can range from emotional, physical, verbal or sexual abuse. Gender factors: Men are generally less at risk of developing depression compared to women, but this might be because there are more women who are open to seeking treatment for their symptoms compared to men. Some people also believe that the illness is due to changes in hormone levels throughout the person’s life.In fact, women are vulnerable to developing the illness when they are pregnant and also after childbirth (postpartum depression), in addition to developing it during menopause. The lack of a strong support system: When a person spends a lot of time in isolation, and they have very few support systems or friends, it can be a common source of depression. It is important to note that this is not the same as introversion, and is more described as a feeling of loneliness or extreme changes in a person relating to their moods and emotions. The occurrence of major events:This is among the most common reasons for developing depression, mainly relating to stressful or sad events. These include losing a job, divorce or breaking off a relationship, retirement from a job, moving to a new place, and death of a close loved one. If a major event has occurred in your life and you have experienced sadness for more than two months without getting better, then it is best to see your doctor so that you can go through tests for depression. Substance abuse risk factors: Abuse of drugs and alcohol: For many people who are struggling with substance abuse, it is mainly tied to mental health disorders, including depression. This is also known as dual diagnosis, and there are various rehab facilities that can help a person struggling with it, such as Colorado substance abuse treatment centers.It is also important to note that drug abuse leads to significant changes in the brain, which in turn increase your risk of developing depression. Many people who have developed depression symptoms also tend to self-medicate as well, which increases their symptoms and overall risk. The use of certain medication: There are some medicines that raise the risk of developing depressive symptoms as a side effect, and they include blood pressure medication, steroids, prescription painkillers, sleeping pills, and sedatives. Other factors: Psychological reasons:There are some psychological factors that will increase the risk of developing depressive symptoms. For instance, if you have low self-esteem, this makes you view your world through a pessimistic outlook, and raises your risk of depression. It will also leave you with an overwhelming feeling of stress and sadness.There is also the case of perfectionism increasing your risk, as you do not see things going the way you want them. It also makes you very sensitive to errors, rejection, and losses, which increases your risk of developing the condition. In addition, if you are suffering from another mental illness, such as chronic anxiety disorder, as well as avoidant and borderline personality disorders, your risk of getting depression is significantly higher. Low socioeconomic status: You may not think much about it, but it is a major risk factor for the development of the disease. It may be due to cultural reasons, social status, stressful environments, and so on. Final thoughts: If you know someone struggling with the illness or you are struggling with it, it is very important to seek medical help. The illness is not well understood, as it is a complex medical condition. The good news is that is easy to treat and manage.Read Also:Five Benefits Of Meditation That Will Change Your Life 5 Things You Should Do To Reduce Stress

Protein Shake Recipes

10 Best Protein Shake Recipes for Weight Loss

Market economy foresees an abundance of products for various human needs. In other words, you can go online or to a retail store and buy what you need. However, such an option is not always relevant. The trend of recent years is to paddle own canoe in miscellaneous tasks including the creation of nutritional supplements.DIY protein shakes are rather popular among people who want to both gain musculature and reduced fat in the body. Unlike most marketed solutions, homemade drinks provide a guarantee that no artificial components are inside. Besides, users can control the so-called specification of the product namely the nutritional value. Also, read the shakeology review.If you share that approach, the following selection of the best protein shake recipes is right for you. Coffee Whey protein source - (one serving of the chosen powder); Fat-free milk or freshwater (one or one and a half cup); Raw almonds/cashews (quarter/half cup); Instant decaffeinated coffee (one/two tsp); Ice (handful). Apple Cinnamon Whey protein source (preferably vanilla) - (one serving of the chosen powder); Fat-free milk or freshwater (one or one and a half cup); Chopped apple (half/one cup); Cinnamon (one tsp); Ice (handful). Chocolate Cherry Chocolate whey protein source - (one serving of the chosen powder); Almond milk (one and a half cup); Fresh/frozen black cherries (half cup); Ice cubes (up to five pcs). Pina Colada Whey protein source (preferably vanilla) - (one serving of the chosen powder); Fat-free milk or freshwater (one or one and a half cup); Fresh/frozen pineapple pieces (half/one cup); Coconut extract (half tsp); Ice cubes (handful). Creamy Peach Smoothie Whey protein source (preferably vanilla) - (one serving of the chosen powder); Fat-free milk or freshwater (one or one and a half cup); Fresh/frozen peaches (quarter/half cup); Fresh/frozen banana (quarter/half). Tropical Dream Chocolate whey protein source - (one serving of the chosen powder); Fresh/frozen pineapple (half/one cup); Ice cubes (handful). Almond Peach Delight Whey protein source (preferably vanilla) - (one serving of the chosen powder); Fat-free milk or freshwater (one or one and a half cup); Fresh/frozen peaches (half/one cup); Almond extract (half tsp); Cinnamon (half tsp); Ice cubes (handful). Blueberry Vanilla Pear Whey protein source (preferably vanilla) - (one serving of the chosen powder); Fat-free milk or freshwater (one or one and a half cup); Fresh/frozen blueberries (quarter/half cup); Chopped pear (quarter/half cup); Ice cubes (handful). Breezy Freezy Shake Whey protein source (preferably vanilla) - (one serving of the chosen powder); Fat-free milk or freshwater (one cup); Reduced-fat mango yogurt (one cup); Fresh/frozen pineapple (quarter); One banana Melon Madness Whey protein source (preferably vanilla) - (one serving of the chosen powder); Fat-free milk or freshwater (one or one and a half cup); Fresh/frozen watermelon (quarter/half); All of the above are only ingredients. And a recipe stipulates a certain procedure of turning raw materials into a ready-to-drink product. One of the principal benefits of nutritional shakes and their variations like smoothies, rich-in-protein drinks, and others is the simplicity to prepare. You won’t need special kitchen equipment except for the blender. Naturally, one can blend ingredient manually and shed a couple of pounds while doing it but it is better to assign the task to automation. So, take that device, which is usually accompanied by a container. Put all the ingredients for your future DIY protein shake and push the Start button. The blending time is not limited. You are free to play with the blender as long as you wish. However, watch the thickness of your shake. Adjust the liquid level according to your preferences. It is not necessary that any of the mentioned recipes will be to your taste. Sometimes, a pinch of a certain spice can turn the flavor upside down and add the missing smack. That is why homemade drinks are so popular. You can create own taste and forget about the necessity to put up with the marketed flavor solutions. Read More:Anti Aging Creams – What To Consider Before You Purchase? How To Remove Acne Scars Naturally

Addiction Effective

Is Outpatient Treatment for Drug and Alcohol Addiction Effective?

When a person is seeking help to overcome addiction, it is important that they choose a treatment program that best meets their specific needs. For some, this means entering a residential program so that they’re away from bad influences, whereas others aren’t in a position to spend months away from home or work responsibilities.Elevate Addiction Services offers an outpatient program that is designed to serve local residents struggling with heroin and other drug use in San Francisco who require the flexibility of attending drug and alcohol treatment sessions when they are able to. Outpatient Care vs. Inpatient Treatment: Inpatient treatment available at the best heroin rehab centers offers the advantage of immersing people into a healing environment, away from the enabling people and places in their daily lives. Elevate’s inpatient program has a duration of 90 days which provides adequate time for people to start the healing process ahead of life in recovery. This program is only suitable for those people who do not have to disrupt their lives in order to attend or for whom addiction has become so severe they require intensive treatment for heroin in San Francisco.On the other hand, outpatient care at the best heroin rehab centers allows patients to remain at home so that they can continue in their daily routine. For some people, this is important as they may have a caregiving role at home or a position of responsibility for others at work. Outpatient services are the same as those offered in our residential program although sessions are arranged for evenings so that it is easy for people to attend. Elevate’s outpatient program has a recommended duration of 8 weeks although this can be extended should individuals require continued support. About the Elevate Addiction Services Outpatient Program: Elevate’s drug and alcohol outpatient care program contains the most effective components of our inpatient care including:Evidence-based treatments such as cognitive behavioral therapy (CBT) One-to-one, group and family counseling sessions Nutritional education and awareness Planning a recovery strategy Relapse-prevention using holistic coping mechanisms Management of stressors and cravingsAbout the Holistic, Non-12-Step Approach to Outpatient Addiction Recovery: The term holistic refers to healing a person as a whole in terms of mind, body, and spirit. The Elevate approach encompasses the best components of holistic practices and therapies, using them to address the physical, mental and emotional needs of the patient. One of the main elements of Elevate outpatient treatment for heroin in San Francisco is mindfulness, an ancient practice that focuses on deep and slow breathing.Mindfulness is a mental state that is achieved using holistic techniques like meditation that focuses on the individual’s awareness of being in the moment. Very often, people with substance abuse issues have lost the ability to relax without taking drugs or using alcohol. Mindfulness opens a doorway to self-exploration that enables participants to gain a fresh perspective. Becoming more self-aware is important in the fight to overcome addiction and mindfulness practices promote this kind of positive introspection. How Is Evidence-Based Behavioral Therapy Beneficial in Outpatient Addiction Treatment? CBT and other evidence-based therapies are invaluable in addiction treatment as they allow patients to identify the negative thoughts and feelings driving substance abuse. When individuals discover the root of their substance use, they are able to work with the therapist to make necessary behavioral changes for a more positive outlook.The evidence-based aspects of an Elevate outpatient treatment for heroin in San Francisco curriculum include the following:Conscious acceptance of how emotions and feelings drive behaviors and tools for coping Eradicating irrational thoughts and feelings by practicing logical thinking Discovering the connection between thoughts, emotions, and actions relative to health and overall wellbeing Identifying and understanding the root causes of an individual’s addiction issues Rebuilding relationships and improving communication skills Maintaining sobriety in recovery and preventing relapseFinding the Right Route to Recovery from Alcohol and Drug Abuse: Everyone has their own unique journey into addiction and so it makes sense that they will find their own path to recovery. This is why the decision to attend outpatient or inpatient rehab should be made with the interests of the individual in mind. Some people flourish in residential rehab and make leaps and bounds progressing towards recovery because they’re away from everything they associate with substance use. However, other people find it difficult to be away from loved ones, dependents, co-workers and employers, without either drawing too much attention to their issues or letting people down by walking away temporarily from responsibilities.Research shows that outpatient treatment is as effective as inpatient care, particularly for people with less severe addiction illness. For people who have developed more serious substance abuse issues, an intensive outpatient program or IOP can provide them with flexible treatment that fits around their daily schedule. Essentially, the best rehab centers devise personalized treatment plans for each patient entering their care, with the decision of whether to opt for an inpatient or outpatient program taken into account.Read Also:Addiction Treatment: 11 Tips To Find The Best Rehabilitation Center How 12-Step Works As Addiction Recovery Support