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Advantages and disadvantages of orem s self care

Department of Nursing Faculty of Medical Science Tarbiat Modares University Tehran Accepted on April 11, 2016 Visit for more related articles at Biomedical Research Abstract The purpose of this research was to defining the limitations of self-care behaviours in heart failure patients.

The participants of the study were 24 patients with heart failure and 3 members of their family using purposive sampling.

Advantages and disadvantages of orem s self care deficit theory

Using content analysis, 99 basic codes, 13 categories and 4 themes were obtained including economical-sociocultural limitations, medical regimes and disease limitations, individual and family limitations and environmental limitations. In the first steps of heart failure, knowledge limitation, judgment and decision cause the most self-care limitations, and in the advance steps of the disease, physical and psychological limitations lead to the self-care limitations of the patients.

In the current study, self-care limitations in the patients with heart failure were economical sociocultural limitations, disease and medical regimes limitations, individual and family limitations and environmental limitations. The limitations of self-care behaviour provide a framework to test the patients for learning and changing the self-care behaviour. There are evidences of self-care behaviour that help the nurses to determine the required range and type of nursing care for patients.

Introduction Heart failure is a chronic progressive [ 1 ] and debilitating disorder [ 2 ] characterized by impaired cardiac pump function in metabolic needs of the body [ 3 ]. Thus, the heart failure is one of the challenges of the health care team [ 7 ].

Heart failure effects on physical, psychological, social functions and daily living activities [ 8 ]. The treatment of heart failure mainly focuses on self-care activities [ 9 ].

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Accordingly, the limitations of self-care behaviour should be determined in order to improve the self-care ability of the patients and increase the efficiency of those who care the patients [ 15 ]. The limitation of self-care behaviour defined as effective factors that limited people to take the necessary measures to achieve health.

Self-care barriers are known as limited knowledge, lack of social supports, complexity of regimes, and lack of access to treatment or high costs. There are other limits including features of heart failure, environmental factors, individual characteristics, and the factors relevant to self-care systems [ 16 ]. She also mentions that as the self-care agent people are able to identify and explain their self-care needs, judge and make decision about what to do and practice the purposeful activities.

Self-care deficit occurs when people are unable to meet the mentioned capabilities. Thus, as the result of the current limitations limited knowledge, limited judgment and decision making and limited result full practicepeople are unable to meet self-care requisites.

  1. To validate the data, sampling was conducted with a maximum variance the samples were selected in Shahid Rajaei Heart Research Medical Centre of Tehran where there are many patients across the country with different ages, sexes, education, residential places, heart failure classes, jobs, disease histories , also the researcher involved continuously in the subject of the study and samples for 6 months. Thus, the patients do not manifest their disease when they are at the party that leads to the violation of their medical regimes.
  2. Self-care in patients with heart failure Stockholm. J Am CollCardiol, 2012; 60.
  3. Factors associated with beliefs about adherence to non-pharmacological treatment of patients with heart failure.
  4. Some of the participants involved in taking care of family members, so they did not have enough time to take care of themselves.
  5. What are some nursing theory disadvantages s to organising nursing care for the patient what are some advantages disadvantages of community health nurse.

Regarding the effects of socio-cultural factors on self-care or the limits of self-care, also limited attention to this issue in the heart failure patients in Iran, the researcher aimed at explaining the limitations of self-care behaviour in heart failure patients on the basis of socio-cultural factor. Materials and Methods The current investigation is a qualitative research using Conventional content analysis approved by Research Ethics Committee of Tarbiat Modarres University.

They were interviewed and they were clarified with the purpose of the study, the right of individuals to participate in the study and confidentiality of data, then informed consent were obtained.

The individual deep interviews were conducted for two-way conversation about 50 minutes for patients and 20 minutes for their family. Furthermore, comparing the categories and analysing the data, the major themes were extracted.

Interviews continued until data saturation was achieved; in that, the data was sutured after interview of 24 participants and no new data were obtained in 3 last interviews. To validate the data, sampling was conducted with a maximum variance the samples were selected in Shahid Rajaei Heart Research Medical Centre of Tehran where there are many patients across the country with different ages, sexes, education, residential places, heart failure classes, jobs, disease historiesalso the researcher involved continuously in the subject of the study and samples for 6 months.

Member check methods were also used in order to check the authenticity of the work; that, after the first analysis the codes of each interview were given to the participants to verify the accuracy.

Furthermore, the interview transcript, the codes and classification of the codes were reviewed by other observers in order to enhance the accuracy of the codes. Results A total of 27 interviews, using content analysis, 99 basic codes, 13 categories and 4 themes were obtained including economical-sociocultural limitations, disease and food regimes limitations, individual and family limitations and environmental ones.

Economical-sociocultural limitations This theme is composed of three sub-categories no affordability, sociocultural habits and limited work activities.

  1. Dorothea e orem the self-care deficit nursing theory orem developed the self-care deficit theory of nursing. Unresponsive family is another limitation of self-care behaviour.
  2. Gender-specific barriers and facilitators to heart failure self-care. Self-care deficit occurs when people are unable to meet the mentioned capabilities.
  3. Nursing paradigms and theories.
  4. However, the patients who had supports of family faced little self-care limitations. Gender-specific barriers and facilitators to heart failure self-care.

In this study, sociocultural habits including conservatism in social relations are the limitations of self-care behaviour. Some patients embarrass, so they hide their disease or they do not report some of their problems to the doctor.

Avoid taking help from others is another cultural habit that 3 women and 6 advantages and disadvantages of orem s self care mentioned it 63-yearold man: Disease and medical regimes limitations Disease and medical regimes limitations: Physical limitation and complexity of medical regimes are the sub-categories of this theme. Complexity of food and medicine regimes is one of another factor that limits self-care behaviour. I take 14 pills daily that is really suffering. I would like my doctor discontinue the drug.

Individual and family limitations The sub-categories of this theme are limited knowledge about the disease and treatment, lack of self-care responsibility, depression and unresponsive family. In this study, lack of self-care responsibility is one of the most important limitations of self-care behaviour. Lack of self-care responsibility causes ignorance of medical regimes due to holidays, parties, trips or partial recovery.

Depression is another limitation of self-care behaviour that patients confront with this limitation in advanced stage of the disease. Unresponsive family is another limitation of self-care behaviour. Environmental limitations Lack of access to self-care essentials, inefficient health care system, adverse environment and social stressful environment are defined as the sub-categories of environmental limitations theme.

Adverse environment is another limitation of self-care behaviour. Discussion In the current research, the limitations of the self-care behaviour were determined on the basis of the experiences of participants including economical-sociocultural limitations, disease and medical regimes limitations, environmental limitations and individual and family limitations.

The results indicated that lack of affordability for self-care costs causes limited result full practices. In USA, decreasing salary as the result of after illness disability and high treatment costs lead to the lack of affordability of the patients for their health care costs [ 15 ].

In Iran, also the participants expressed severe economic difficulties and lack of supportive resources [ 18 ]. In this study, after illness disability that leads to low salary was one of the reasons of lack of affordability of the patients, so they were not able to afford health care costs.

Moreover, some participants had to work to afford the costs that lead to ignoring the self-care behaviour and illness exacerbation. Sociocultural habits were another limitation of self-care behaviour in this study that impairs judgment and decision making led to unrecognizing the appropriate self-care behaviours.

  • There are other limits including features of heart failure, environmental factors, individual characteristics, and the factors relevant to self-care systems [ 16 ];
  • They were interviewed and they were clarified with the purpose of the study, the right of individuals to participate in the study and confidentiality of data, then informed consent were obtained;
  • In this study, the majority of participants had limited knowledge about the disease and medical regimes that caused exacerbation of the illness, for example drinking water while dyspnoea appears.

Orem believes that, cultural norms effect on selfcare responsibilities and individual, family and society behaviour. In this research, conservatism in social relations is one of the self-care behaviour limitations that stems from Iranian cultural norms.

Advantages and disadvantages of orem s self care

Iranians are the people of compliments and they try to speak indirectly in their inter-personal relationships and behave so pleasant to others. Thus, the patients do not manifest their disease when they are at the party that leads to the violation of their medical regimes. Avoid taking help, also stems from Iranian culture.

In general, Iran is an individualism society with little interest to group works. Accordingly, some patients did not ask for help-even in critical situations. Orem; moreover, says that sometimes people reject the self-care requisites due to sociocultural point of view. In respect of cultural view, most Iranians have negative feeling to normal toilet and they think it is not hygienic and it is difficult for them to clean themselves.

Thus, in spite of the care team recommendations, they prefer to use Iranian toilet.

The results showed that the disease factors and medical regimes cause limitations of self-care behaviour. Physical limitations due to the illness are one of self-care limitations. The second factor of such limitations fatigue from the illness or disability caused by aging [ 15 ].

  • These patients neglected the regime immediately after resolution of symptoms;
  • One of the individual limiting factors was limited knowledge about the disease and treatment of the disease that the results were in consistence with the study of Desai, 2013 [ 20 ];
  • However, the patient who had supportive and motivational resources felt less depression and actively participated in self-care practices;
  • Advantages and disadvantages of self patient self-administration of medication:

Limitations of heart failure patients effect on their ability and limit daily living activities and self-care behaviour [ 16 ]. Orem also explains that low energy, disability or limited ability of physical movements limit the self-care behaviour. Simultaneous chronic diseases were another limitation of selfcare behaviour.

Simultaneous chronic disease misleads the heart failure patients due to recognize the symptoms [ 16 ]. The researcher believes that simultaneous chronic disease causes the complexity of treatment and conflicts of self-care needs. A patient, for example, had to drink water while taking medicines to prevent stomach ache; however, it caused water retention in the body and disease exacerbation.

Simultaneous chronic disease did not effect on the self-care of male patients with heart failure because of their mastery in symptoms diagnosis [ 19 ].

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In this study, also the participants who planed how to take their daily medicines faced with little problems. The results of the study revealed that individual and family factors caused the limitations of self-care behaviour in HF patients.

One of the individual limiting factors was limited knowledge about the disease and treatment of the disease that the results were in consistence with the study of Desai, 2013 [ 20 ].

  • Economical-sociocultural limitations This theme is composed of three sub-categories no affordability, sociocultural habits and limited work activities;
  • What matters to patients with heart failure?
  • Conclusion In this study, the limitations of self-care behaviour in heart failure patients were as follows:

Saibai says that limited knowledge about medical regimes and misconceptions about the nature of disease lead to misunderstanding the relationship between the symptoms [ 16 ]. In this study, the majority of participants had limited knowledge about the disease and medical regimes that caused exacerbation of the illness, for example drinking water while dyspnoea advantages and disadvantages of orem s self care.

In the current research, lack of self-care responsibility, non-compliance with medical regimes, and self-care carelessness are the limitations due to recovery of the patients. In USA the reason the patients do not comply with medical regimes are as follows: Holden; moreover, reports that forgetfulness and miscomprehension of the self-care benefits are the signs of lack of accountability to treatment. Orem believes that self-care behaviour needs both knowledge and motivation, and instability of the patients is due to lack of purposefulness and respect for self-care.

In this study, lack of accountability in patients newly diagnosed with the disease was due to limited knowledge about the disease and misperception of the conditions. These patients neglected the regime immediately after resolution of symptoms. However, lack of self-care responsibility in the patients with advanced degree of disease was due to lack of motivation; that, although they complied with their regime, the disease exacerbated.

In this respect, the participants with higher knowledge, motivation, and supportive sources adhered to their medical regime. Another sign of lack of self-care responsibility was due to postpone going to clinics or hospitals. The patients usually go to clinics after three-day delay [ 21 ].

Unresponsive family including unsupportive family and illness of family members was another self-care limitation. Riegel Family supports effect on self-care behaviour and social isolation due to loneliness has negative effects on self-care behaviour [ 19 ].

Moreover, the patients frustrated due to loosing emotional supports that effect on self-care behaviour. However, the patients who had supports of family faced little self-care limitations. The illness of other members of family was another critical situation that caused the limitations of self-care behaviour. The patients have to care other family members due to their illness, so they do not have enough time for self-care behaviour [ 15 ].

In the current research, limitations of self-care behaviour due to illness of family members had multiple reasons. Some of the participants involved in taking care of family members, so they did not have enough time to take care of themselves. Sometimes emotional feelings and stress due to advantages and disadvantages of orem s self care of family members caused disease exacerbation and impair judgment and decision making.

Furthermore, sometimes the illness of spouse led to loose physical and emotional supports that affected on self-care behaviour. According to the results, depression caused the limitations of self-care behaviour. In women, the grief due to disease caused that they do not pay attention to disease symptoms and waiting for spontaneous resolution of symptoms [ 19 ].

Depression and hopelessness due to disease treatment led to non-compliance with self-care behaviour [ 18 ].