" (Health Care System, Canada, 2007)
V. THEORETICAL BASIS of OREM'S SELF-CARE MODEL
Social Learning Theory was developed by Bandura (1987, 1986) who held that behavior results from the individual's personal and environmental factors. It was stated in findings of a study reported by Hyndman et al. (1993) that there is a need to change the individual's environment in order to encourage positive health behavior and that there is a need to correct misperceptions about health. Training and development of skills is necessary in creation of new behaviors and in approaching solutions as well as are role models and self-efficacy. In Orem's conceptualization of health "the concept of wholeness, soundness and well-being are closely integrated." (Health Care Canada, 2007) Orem's definition of health includes "...psychological, interpersonal and social aspects of living as well as the commonly emphasized physical aspects." (Health Care Canada, 2007) Well-being has been associated with health in Orem's theory that provides a definition of well-being as: "...a state characterized by experiences of contentment, pleasure and kinds of happiness, by spiritual experiences, by movement towards fulfillment of one's self-ideals and by continuing personalization." (Orem, 1995: 101) Orem distinguishes humans from other living beings by their ability for reflection upon themselves and the environment and in being able to symbolize their experiences as well as having the capacity to symbolically create through thought, communication, and in bringing about necessary and beneficial change. (Orem, 2001: 182) Within the application of Orem's theory interaction takes place between the nurse and the individual, family or groups and an assessment is conducted in order to make a determination of deficit between the needs of self-care and the abilities of the individual to accomplish self-care.
Offerings of nursing are based on (1) the request of the patient; (2) an assessment of the nurse as to how the patient might be assisted through nursing; or (3) how coordination of services and the integration of nursing into the patients daily living activities might be accomplished. (Orem, 1995: 125) Within the framework of Orem's model "nursing is a specific type of human service..." with helping others and self-help as the basis. Orem (2001) held that a requirement of nursing exists when self-care maintenance makes a requirement of special techniques or applying knowledge of a scientific nature in provision of or design of that care. Furthermore, patient's needs are determined and the role arrangements between the patient, caregivers and family are made "in the context of the interpersonal dimensions of practice." (Health Care Canada, 2007)
Within Orem's model are three self-care requisites: (1) universal; (2) developmental and (3) health deviation. (Health Care Canada, 2007) Universal self-care requisites are those linked with life processes: (1) sufficient intake or air, food, and water maintained; (2) the elimination process; (3) the balance between activity and rest maintained; (4) the balance between solitude and social interaction maintained; (5) prevention of hazards to human life, functioning and well-being (6) the promotion of human functioning and development within social groups in accord with human potential limitations; and (7) the desire to be normal (Orem, 1995:191) Developmental self-care requisites "are either specialized expressions of universal self-care requisites that have been particularized for development processes, or they are new requisites derived from a conditions." (Health Care Canada, 2007) One example of this given is "during pregnancy the expectant mother will adjust her food intake and balance between rest and activity in accordance with her condition." (Zuyderduin, 2004) Health deviation self-care requisites are existing "in conditions of illness, injury or disease but may also result from medical measures required to diagnose and correct a certain condition." (Zuyderduin, 2004) This area of self-care requisites is one in which "the individual will have to seek and secure appropriate medical assistance, and be aware of and attend to the effects and results of pathological conditions and states." (Zuyderduin, 2004)
Orem notes that care for the individual is "interpersonal, based on the objective needs of the recipient of care and respecting and accepting the freedom of this recipient to decide upon a course of actions. Care requires that care agents have sufficient knowledge, both theoretical and experiential to provide care." (Orem, 2001: 27) it is important to note that Orem has cautioned that factors of care situations may either help or harm human beings. Orem states four critical aspects for self-care and helping others which are: (1) care; (2) responsibility;...
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