Exploring Orem’s self-care deficit nursing theory in learning disability nursing: Philosophical parity paper: part 1
In a two-part article, Paul Horan and colleagues explore the relevance of this popular nursing model from a variety of perspectives. Can Orem’s self-care deficit nursing theory be helpful in meeting the needs of people with learning disabilities?
(Taylor 2002) and is one of the most frequently used theories in general nursing practice (Alligood and Marriner-Tomey 2002). This paper attempts to evaluate the theory as a means to address the unique needs of people with intellectual disabilities. Fawcett’s (1995) template for critically analysing conceptual models is used. Fawcett (1995) noted that the concepts and propositions of this theory could also be considered at the level of abstraction and generality of conceptual models, and referred to it as Orem’s selfcare framework. This author (Fawcett 2000) acknowledged that this framework is widely recognised as a conceptual model. In discussion and practical application it is also referred to as ‘the self-care model’ (Pearson et al 2000). This term will be used throughout this discussion. Prior to commencing this appraisal the authors held the belief that the self-care model (Orem 2001) was too complex to be 28 LEARNING DISABILITY PRACTICE vol 7 no 4 May 2004
rem’s self-care deficit nursing theory (Orem 2001) is widely used and accepted by nurses
applied successfully to the needs of those with an intellectual disability. This initial view was potentially in response to its relative under use in intellectual disability settings in the UK and Ireland, together with negative perceptions of the use of other conceptual models of nursing borrowed from the general nursing domain. This paper aims to examine the potential of Orem’s (2001) self-care model to meet the needs of people with varying degrees of intellectual disabilities and additional physical care needs, in hospital, community and residential settings. Cognisance is taken of contemporary frameworks for the analysis and critique of models of nursing, in particular those offered by Fawcett (1995) and McKenna (1999). The benefits and deficits of Orem’s self-care model are examined. The philosophical similarities between Orem’s self-care model and current concepts of care for people with intellectual disabilities will be highlighted. The terms intellectual disabilities/learning disabilities and mental handicap will be
used interchangeably in this paper to refer to the same client group. The term intellectual disabilities/mental handicap and learning disability will be used to describe a client care group who receive nursing interventions from nurses who are registered within the mental handicap division of the register with An Bord Altranais (the nursing regulatory body in the Republic of Ireland).
It is important to provide a background to the use of conceptual models of nursing within intellectual disability nursing in Ireland prior to embarking on an appraisal of Orem’s (2001) self-care model. Intellectual disability/mental handicap nursing is in its infancy compared with other nursing disciplines. Mental handicap nursing is reported to have commenced in Ireland in 1957 (Sheerin 2000). Although widely applied in other nursing disciplines, application of conceptual models of nursing within this sector represents a challenge. Contemporary
practice & research
models for care delivery for people with intellectual disabilities have their origins in nonnursing disciplines such as psychology, social work or education, which appear to more closely suit this field, rather than traditional conceptual models of nursing, which often originate from a generalist nurse perspective. Although many espouse widespread application across disciplines, use in general nursing settings predominates. The use of conceptual models of nursing in mental handicap nursing in...