Orem's Theory

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Predictors of Self-Care in Adolescents With Cystic Fibrosis: A Test of Orem's Theories of Self-Care and Self-Care Deficit Lois K. Baker, PhD, RN, CPNP Mary J. Denyes, PhD, RN, FAAN

Pediatric nurses often struggle to find ways to encourage adolescents with cystic fibrosis (CF) to engage in self-care that is essential to their health and life. A study of predictors of self-care was conducted to provide a stronger evidence base for nursing practice with these youth. Orem's theories of self-care and self-care deficit were tested to explain and predict the universal and health deviation self-care of 123 adolescents with CF. Four dimensions of self-care agency emerged as predictors of universal self-care, two of which were also predictive of health deviation self-care. Seventy percent of the variance or change in universal self-care scores and 40% of health deviation self-care variance were explained. Clarification and extension of Orem's theories were also an important outcome. Development of nursing interventions designed to strengthen predictors of universal and health deviation-specific self-care identified in this research holds the potential to improve length and quality of life for adolescents with CF. © 2008 Elsevier Inc. All rights reserved.

EDIATRIC NURSES OFTEN observe an inconsistency in the performance of self-care in adolescents with cystic fibrosis (CF) and struggle to find ways to encourage them to engage in selfcare that is essential to their health and life. Owing to medical advances, children and youth with CF are now surviving many years longer as compared with the past. The current median life expectancy is 36.5 years (Cystic Fibrosis Foundation, 2005). In spite of impressive medical advances and increased survival rates, self-care remains to be a critical element for persons with CF. To survive and thrive, adolescents with CF not only require self-care supportive of general health and development but also self-care specific to the management of their disease. A growing body of research about self-care of children and youth with chronic illnesses is emerging (Dashiff, McCaleb, & Cull, 2006; Frey, Ellis, Naar-King, & Gregor, 2004; Moore & Beckwitt, 2006; Patton, Graham, Holsclaw, & Varlotta, 2005; Patton, Graham, Varlotta, & Holsclaw, 2003; Schilling, Knafl, & Grey, 2006; Velsor-Friedrich, Pigott, & Srof, 2005; Velsor-Friedrich, Vlasses, Moberley, & Coover, 2004). However, these research studies have provided only limited insight for nurses about what may contribute to adolescents' consistency or inconsistency in performing essential self-care. It was this relatively limited


knowledge in combination with frustration in the practice arena that led the authors to undertake a study of predictors of self-care in adolescents with CF. The authors believed that if we had better understanding of these predictors, we would have a clearer foundation for designing nursing care to promote more consistent self-care and foster improved health in youth with CF. The work of Orem (2001) provided a theoretical basis for addressing the questions of what contributes to adolescents' engagement or nonengagement in critical self-care and what interventions might be most effective in promoting self-care behaviors. However, Orem's theories, like theories in all fields of knowledge, need to be tested empirically if they are to provide essential direction for practice and research. In spite of nearly three decades in which the critical need for theory testing research in nursing has been identified (e.g., Chinn,

From the Cedarville University, Cedarville, OH; Wayne State University College of Nursing, Detroit, MI. Address correspondence and reprint requests to Lois K. Baker, PhD, RN, CPNP, Cedarville University, 251 North Main St., Cedarville, OH 45314. E-mail: bakerl@cedarville.edu. 0882-5963/$ - see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.pedn.2007.07.008

Journal of Pediatric Nursing,...
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