In the year 2000 a theory was developed by Dr. Leenerts and Dr. Magilvy concerning the patient’s ability for providing self care. Leenerts and Magilvy describe how the theory developed… “A study was conducted to explore the self-care practices of low income, White women diagnosed with HIV/AIDS. The research question was; Is there a basic social process (BSP) that captures self-care attitudes and behaviors in low-income, White women?
The purposes of the study were threefold: (1) identify and describe interactions that characterize self-care, (2) identify and describe interactions that promote and constrain self-care practices, and (3) develop an initial midrange theory of ways low-income women practice self-care while living with HIV/AIDS.” (Leenerts 2000). Even though this theory was developed and researched using a very specific population, the overall definition of the theory is: Investing in Self-Care. Patients today are beginning to understand that the most important key to their health is becoming active in the processes of their treatment or a preventative care method. Meaning the patient is taking responsibility for their own health. The BMA has defined self care as… “Self care is the practices undertaken by individuals towards maintaining health and managing illness. Long term conditions identified as those which could benefit from patient self care include: • arthritis
• chronic bronchitis / asthma
• chronic glaucoma
• chronic heart failure
• deafness
• endometriosis
• epilepsy
• incontinence
• manic-depression and chronic depression
• psoriasis
• schizophrenia
• ulcerative colitis.
Self care uses a range of methods and aids to enable people to manage their own health which include: self monitoring, self help and support groups, self management education programmes, patient access to personal
medical information, easy access to high quality information on conditions and services and patient-centered tele-care. The diagram below shows some of the options for self care.
Self care is about ‘helping people feel empowered’ rather than ‘making them empowered’. In this respect, the NHS cannot do self care to people but it can create an environment where people feel supported to self care.”(BMA). The significance in developing/helping patient’s to provide self-care would include several factors. To list a few would include overall rising health costs, health care professional shortages, and the simple fact that a patient can provide the best care for them if provided the proper education/information and tools needed. Understanding the application of patients investing in self-care is easily divided into categories as provided below from Leenerts and Magilvy: [pic]
Fig 1. Core category—investing in self-care: Categories, processes, and strategies. Categories in uppercase; processes in italics; and strategies in boxes. (Leenerts, 2000) These four categories as described above are listed and defined as follows: 1) Focusing Self – this describes the social process of investing in self-care. 2) Fitting Resources – this describes the process of finding available resources in self-care. 3) Feeling Emotions – this describes investing emotions into one self-care plan. 4) Finding Meaning – this describing find meaning in living and work with fears of death. Practice Setting
Since this theory was developed in an area that considered mainly lower income white women, a modification or adjustment would be definitely required when using for different patients. With a self-care theory teaching, education, and information would need to be provided to the patient by a health care worker. This could either take place in the hospital setting before discharge, in the Dr’s office for a routine appointment, or during a home health visit.
When a patient becomes involved with their own care they begin to understand the level of work/service the health care worker provides to them. And when
the patient develops an understanding of self-care the education becomes very valuable to them, meaning the less money for health care expenses, better quality of life, and a more effectively managed and healthier lifestyle.
Self-care and Dependant-care has been on the rise since most hospital stay has been reduced due to lack of insurance funding or increased patient turnover. Another recent study found by Moore and Beckwitt deals with the self-care measures related to children cancer patient and their families. Moore and Beckwitt start off by using three different theories of care…”Orem’s theory of care, self-care deficit, and theory of nursing system (2001), three articulating theories in the self-care nursing deficit theory, were used as theoretical frameworks for this study. The theory of self-care postulates that individuals are responsible for performing care for themselves or others. The theory of self-care deficit describes the grounds for patients’ requirements for nursing care. The theory of nursing system proposes approaches to nursing practice.”(Moore, 2006). These 3 theories combined to help form a case study from a problem area. This case study helps form interventions for nurses to teach the families and children how to provide daily self-care/dependant care. Allowing the families of these patient to save money and become closer to there children or loved one.
In developing this case study Moore and Beckwitt have helped patients and nurses overcome tremendous obstacles of financial burden, emotional strain, and feeling of helplessness. Application of Theory into Practice Setting
In developing the case study for children with cancer, Moore and Beckwitt borrowed the Orem’s self care theory plan. The theory was divided into three different steps the first one being are Estimative which are operations that involve gathering and analyzing the information/knowledge. The second being Transitional operations which is where decision making and determining the courses of any actions are made.
Finally, there is productive operations which were the action takes place and any adjustments based on outcomes of the action are adjusted. With in case study the individuals will perform self-care operations of any health promotional interventions in order to follow there self-care requisites. In the Figure below that I have provided from Moore and Beckwitt’s case study they described these three areas of self-care requisites as being: universal, developmental, and health deviation. The universal self-care requisites are very much similar to the basic needs of life. Developmental self-care requisites however are those needed to grow and mature. And, health deviation self-care requisites are needs that arise from obtaining an illness or injury. These self-care requisites are described in the provided Fig. 1 shown below (Moore, 2006).
Moore and Beckwitt’s case study at a glance…”The purpose of this study was twofold: (a) to determine what self-care and dependent-care operations children and their parents performed to address children’s self-care requisites, and (b) to identify participants’ perceptions about nursing interventions that promoted these operations. The objective of this investigation was to encourage nurses to design a systematic method to determine appropriate nursing interventions. The research questions were: What are the links between (a) specific self-care requisites and operations, and (b) operations and nursing interventions?
The goal of this examination was to identify nursing interventions that better assisted (a) children in caring for themselves, and (b) parents who provided dependent-care at home. There is little published research in this area… A purposive sample of 27 participants (9 children with cancer and 18 parents) was recruited for this study. Not all children and parents were matched. Some parents were divorced or unavailable. Child participants’ ages ranged from 7 to 21 at the time of diagnosis, while parents’ ages varied from their 30s to their 50s at the time of interview…
This study was conducted to explore children and their parents’ self-care and dependent-care operations that address children’s self-care requisites. A further purpose was to identify the nursing interventions that promoted these operations. The findings indicated that both children and parents performed operations that addressed children’s self-care requisites. Findings revealed specific nursing interventions that promoted operations and identified areas where additional nursing interventions were needed. The goal of this study was to use Orem’s (2001) theory to develop a basis for a systematic approach to design interventions that encourage self-care. In this study the links were explored between (a) self-care requisites and participants’ operations, and (b) participants’ operations and nursing interventions that promoted them” (Moore, 2006).
Conclusion
Based on the results and background research of both case studies provided data has shown that with the proper educational interventions for self-care, both patients and their dependents can greatly improve their lives by becoming more involving in their own care. Even though one case study was based on white women with HIV, and another was children with cancer, interventions can be swapped and converted for the correct age, race, and religion group if needed. Nurses however must provide the education at the correct level in order, and must be very understanding to the repetitive teaching that follows in order for the patient involved to grasp the technique or skill required in some cases. .
