Abstract
The concept of self-care is analyzed from the field of nursing. Avant and Walker’s theoretical model of analysis provided information for the study. Self-care was defined through different field and correlated with relevant terms. Terms like, antecedents, empirical referents, consequences of self-care concept, and references were examined. Model cases, borderline, related cases, invented cases, contrary cases, and illegitimate cases were correlated with an ESRD patient. The concept of self-care, the factors of occurrence of self-care, and empirical referents were explored in the study.
Aim of Analysis: The aim of the concept is to develop an operational definition of theoretical concept of self-care.
Introduction
Self-care is important to humanity and nursing. Self-care influences the lives of patients and the nursing profession. Self-care is a treatment procedure introduced to a patient, thus increasing the knowledge and independence of the patient. Self-care educational program improves the life of ESRD patients because it provides the patient with knowledge of his or her diseases and the ability to carry on with his or her daily activities. Self-care education will reduce the dependence on nurses and will reduce the number of avoidable pain, discomfort and even death suffered by patients. Self-care is a scheme or mechanism that empowers a CKD or ESRD patients during the early stages of dialysis (Backmann & Hentinen, 1999). An ESRD patient loses control of his or her mental state thus, requiring assistance and support. This procedure helps nurses formulate a training program to provide learning methods for CKD or ESRD patients. Patients who can sit and see how things are done could assist themselves as their situation improves. This will be achieved through educational procedure. Self-care program will have a positive influence on humanity, the nursing profession and the ESRD or CKD patient.
Purpose of Analysis
The purpose of the study is to determine the influence of self-care on the quality of life of an ESRD patient. This analysis will correlate the importance of self-care to humanity, and its importance in the nursing profession. Self-care program will empower the patients to adequately control his or her environment and self, thus, providing solution s to the limitations of healthcare management, nursing shortages. Patients with End Stage renal disease usually have poor adherence to fluid restrictions. Improving adherence by use of an education program on self-care will aid in improving the quality of life for these patients. Orem (2003) said nursing care revolves around three major things: giving care to a patient; giving instructions to a patient on how to care for them and helping the patient achieve self-care. Giving care to a patient may seem easy to achieve without self-care of the patient; this is not the case. Every nursing procedure requires consent (Clark, 1995). This consent may be hard to achieve if the patient does not have self-care. It is an aspect of self-care which makes an individual recognize symptoms of a disease and seek professional help (Katz & Kelvin, 1980). There are two major goals of nursing: Ensuring a patient meets their daily health care requirements and ensuring patient participation in his or her health care as directed by the health service provider (Gaffney & Moore, 1996). For nurses to achieve their goals they should understand the concept of self-care.
Miller (1992) says that the importance of self-care in a patient with chronic illness cannot be overemphasized. To achieve quality of life in the management of chronic illness, the patient should have self-care skills (Bandura, 1986). End Stage Renal Disease is a chronic disease. Its management involves among other things, fluid restrictions; protein restrictions and sodium and potassium restrictions (Jenerette & Murdaugh, 2008). This is due to the function of the kidney in regulating fluid, ionic composition and protein. In the pathophysiology of End Stage Renal Disease, the functions of the kidney are severely compromised. The patient is required to limit intake of these substances to improve health (Barofsky, 1987).
Definition of self-care
There are various definitions of the word self-care by many authors and organizations. The definition of self-care is important in coming up of the various attributes of self-care which is the major part of concept analysis. The attributes will develop conclusions which later be applied in cases. The table below provides a list of some definitions needed to study the concept analysis of self-care.
Defining attributes of self-care
According to Avant & Walker (2005), the following self-care attributes can be identified: 1. Self-care is an action done for the individual, by the individuals to enhance their health by either improve, restore, treat, or prevent illness. 2. Self-care includes all health decisions (individual, family, or community) make for themselves and their families holistically. 3. Self-care addresses all universal needs to gain independence, adaptability, and integration of self in daily life. 4. Self-care is a gradual transition of competence derived from knowledge from professionals or lay experiences which occur throughout a lifespan. Listed below are some examples of cases with the various attributes.
Borderline case
Adam is a nurse and has practiced for 4 years. Adam was reassigned to Martha Smith who had chronic kidney disease. Due to shortage of resource personnel Adam had to work on his new assignment. She was becoming unstable and had to be restrained to her bed. Fortunately, Martha Smith is the mother of his childhood friend. Smith recognized Adam as he entered her room to take her medication. She asked him about his family life and Adam feeling sorry for her, began the treatment. Martha Smith later asked Adam to remove the restraints for a few minutes. She told Adam she felt belittled with the chains and she was scared. Adam reluctantly removed her restraints and continued his duty. Adam returned fifteen minutes after to discover Martha Smith lying on the floor. The antecedents in the case where complete including, maturity, age, job experience, routine activities and specialization. In this study, the outcome affected Martha Smith.
Contrary case
Ben has been registered as a nurse for 2 years. He worked in the CKD unit and had rough days with chronic patients. Ben believed he could not cope with critical patients and it affected his confidence. Ben reported a medication breached twice last week, signaling his fear for critical ESRD patients.
Related case
Mr. Muigai is a 50year old African man. He was admitted due to renal failure. He was scheduled for dialysis and was given nutritional information. Mr. Muigai could not control his salt and water intake. He could not control his protein intake. Three nurses missed work on the day of Muigai’s admission. The staff strength was reduced to two. While the nurse attended to her patients, Muigai’s son called out for help. The nurse rushed into Muigai’s room, went to the medication drawer and picked a bottle without looking at the contents, handed it to Muigai’s son. The nurse informed the boy to give the medication to his father, and she hurriedly left the room to attend to her patient. Muigai missed the scheduled dialysis session. He also developed edema due to fluid accumulation.
Invented case
An invented case is unlikely to occur in real life situation. It is important in determining the importance of the concept being analyzed.
Mr. Red is a 30year old man. Red is on dialysis and has symptoms of mental instability. He does not have medical insurance neither does he have funds to seek medical attention. He remembered a friend with similar condition. Mr. Red examined his friend’s empty bottles of medicine to check for the name of the medication. He planned and robbed a drug store at night to get the medication. He took the medication and recovered from his illness.
Mr. Red met the self-care attributes but did not have the resources to cater for his illness; he resorts to stealing to ensure he meets his self-care needs.
Illegitimate case
Mr. Caleb is a Stage five CKD patient who had been admitted for three days following excessive nose bleeding. He was informed about the need for self-care. When asked about the most important health care practice would ensure he remains healthy all the time, he mentioned complete bed rest to avoid complications, he should avoid all activities in the house. The major reason why he was discharged to home care was to ensure he continues his daily activities; as much as rest is important in avoiding severe hypertension, it is not an important factor. This may meet some requirements of self-care but it does not fulfill all the requirements (Zambrowski, 2008).
Model case
Mrs. Veronica, a 50year old woman was diagnosed with End Stage Renal Disease. Since the diagnosis, she has attended training on the management of chronic illness. She has adhered strictly to her dialysis appointments. She has maintained a strict diet which has decreased protein, decreased fluid intake and decreased electrolyte intake. She has an appointment monthly with the urologist. Her responsiveness to signs may indicate fluid overload such as edema and increased blood pressure. She managed to control her condition as evidenced by urea and electrolyte findings, consistently within the required limits for a patient with end stage renal disease. She maintained a stable blood pressure and never had an incident of toxemia related to End stage renal disease.
Mrs. Veronica has all the characteristics of self-care. She practices health maintaining activities such as diet restriction. Her ability to recognize symptoms may indicate changes in condition; she takes appropriate action when symptoms occur and she complies with the health care prescription.
Referenced research and studies
Orem (1971, 1980, 1985, 1991, and 2001) has done a lot of research on self-care. She has attempted to analyze the concept of self-care and even developed a theory on the same. Orem observed the importance of self-care program to ESRD patients. Other researchers have also studied the relationship between self-care and its antecedents (Ailinger & Dear, 1993; Hart & Foster, 1998; Lukkarinen & Hentinen, 1997; Mapanga & Andrews, 1995). The chances of occurrence were attributed to the antecedents of self-care. The study provided support with different case analysis to authenticate their findings. Studies have been done on factors that predict occurrence of self-care (Ailinger & Dear, 1993; Aish & Isenberg, 1996; Baker, 1997; Folden, 1993; Schott-Baer, Fisher, & Gregory, 1995). Age, physical ability, need for care, prevention, control and independence influenced the occurrence of self-care. Shortage of nurses, resources, and improved quality of life, had major influence in the occurrence of self-care (Ralph & Taylor, 2013).
Antecedents
According to Avant and Walker (2005), antecedents are pathways to different occurrence. The need for self-care may be the cause of the need to prevent, restore, regain, control, or understand a disease. These factors are the antecedents prior to the occurrence of self-care. They are factors or conditions which influence a patient to achieve self-care (Walker & Avant, 2011). Self-care is performed by individual, family or a community to improve the health status. To achieve self-care, there are requirements that have to be achieved. These factors may influence whether an individual can have self-care or not. 1. The need of care, illness, disease, prevention, of the individual. 2. The mental capacity to know or understand the need of self-care dealing with knowledge deficit. 3. The factors that prevent self-care. 4. Physical ability to perform self-care (Doran). Some psychological factors that influence self-care include: ability to recall; ability to learn; knowledge of the disease and the disease process; and ability to find solutions to problems (Jaarsma, Halfens, Senten, Abu Saad & Dracup, 1998).
Consequences of self-care
Consequences refer to the end product of self-care. Self-care has a positive impact on both the patient and the health service system. The consequence of the outcome occurs after administering self-care. When an individual believes he or she is incapable of hurting another, or being hurt, it reduces the chances of occurrence. However, when the individual feels incapable of hurt, such actions may hurt others. To the patient especially when managing chronic illness, there is better prognosis and reduced risk of complications (Badzek et al 1998, Kimberly 1997, Leveille et al, 1998). In addition to this the patient will also feel as helpful and in control as he is responsible for his health. Patients whose health care needs are attended to usually feel helpless. It ensures that the nursing fraternity can provide holistic care to the patient even when the patient is not under their care (Challiner, 1998).
It also has a positive impact on the health care system. Most patients are admitted into hospitals because of inability to take care of themselves (Kutner, Zhang, & McClellan, 2002). If most patients can achieve self-care, then the incidences of admission will be reduced and spending on health care, services will also be reduced. This theory is supported by various authors who have the same view. Self-care results in decreased admission in hospitals (Dundar, Jacobson & Deatson, 1998) & Slusher (1999) say self-care reduces the costs of health service.
Empirical referents
Avant and Walker (2011) described empirical referents as types and classes of a process which demonstrates a concept. The variable in this concept invulnerability and it influences the occurrence of the concept. The variable will provide a measurement in the nursing profession and the concept of analysis can be determined by the measurement. Empirical referents related to self-care include: patient demonstrates knowledge of the disease process; patient performs activities to improve his or her health; adherence to medication; keeping appointments with the health professionals; seeking medical attention when the patient has symptoms; regular medical checkups and taking a health insurance to cover for his or her medical bills when he or she is ill (Dashiff et al, 1998).
Theoretical definition of self-care
Self-care is practicing health maintenance activities; recognizing symptoms or changes in health status; responding to the symptoms using the most appropriate option; and complying with professional guidance regarding the management of illness. Variables include exercising, eating healthy food, regular medical checkup and adherence to medication. Indicators for self-care include: Weight; Laboratory findings; Number of checkups in the last 12 months, and number of missed doses of medication. In the case of a patient with End Stage Renal Disease Laboratory findings of Urea and Electrolytes may be used to determine nutritional self-care. Weight may be used to determine adherence to the fluid requirements (Dunbar et al, 2006).
According to Carter (1998) self-care is not something observable and there is no tool that can be used to measure it specifically. There is need to use other means of observation that measures factors related to self-care. A case in point is the Diabetes Quality of Life Measure (Lewin, 1977). It has 46 elements that measure three factors which are: level of satisfaction of the patient, worry and the impact of the disease on a patient’s life (Vingerhoets, 2001).
The concept of operations
The aim of the study is to construct an operational definition of self-care. The theoretical model provides the basis for judgment. From the analysis, improve quality of life, adherence, decision, family, health status, control, and prevention influence the concept of self-care. Thus, the variables can be used to ascertain its occurrence.
Concept analysis of self-care in a diagrammatic representation
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