Among process to seek solution to identify

Among the nursing theories in all categories, Orem’s Self-care deficit theory and Roy’s adaptation theory are applied commonly for chronic illnesses such as Diabetes Mellitus. Roy’s adaptation theory highlighted an adaptive system of a person. Major concepts of adaptation model are: (a) Adaptation (goal of Nursing); (b) Person (adaptive system); (c) Environment (stimuli); (d) Health (outcome adaptation); (e) Nursing (promoting adaptation and health. The adaptive system has inputs of stimuli, output as behavioral responses’ and control process known as coping mechanism (George, 1995). Orem’s self-care deficit theory focus on self-care deficit and the concept of nursing to assist people to meet their self-care needs. The Orem theory is mostly relevant to explaining the self-care sharing process in a transitional period/ adolescence period which is described in the proposed study.

It is widely recognized theoretical model for the patients with chronic conditions. Orem is a needs/ problem oriented theorist. Need/ problem oriented theorists primarily identify needs and problems of the patients. They use the nursing process to seek solution to identify needs and problems. Dorethea Orem’s self-care deficit theory is the theoretical underpinning for this research study.

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(Figure 1 & Figure 4)Orem (2001) described the general theory of nursing as following: “Orem’s general theory of nursing focused on the concrete world of men, women, and children and on the concrete conditions and circumstances of human living in families and societies” (p.131) Orem’s general theory called “Self-Care Deficit Theory” comprises of three interrelated theories. (a) The Theory of Self-Care, (b) The Self-care Deficit Theory, (c) The Theory of Nursing System. Six central concepts and one peripheral concept are included in these theories. The six concepts are: (a) self-care, (b) self-care agency, (c) therapeutic self-care demand, (d) self-care deficit, (e) nursing agency and (f) nursing systems.

The peripheral concept is “basic conditioning factors” (Figure 1) 2.4.1 The Theory of Self-CareThe theory of self-care focuses on the care one gives oneself to maintain or improve life and health. Orem explained the means of self-care and various factors that affect it in this theory. Self- care, self-care agency, therapeutic self-care demand and self-care requisites are the main concepts which describe self-care theory. Understanding of the main concept is important to utilize self-care theory.

(George, 1995) Self- careSelf- care is the practice of activities that individual intakes and performs within time frame on their own behalf to maintain life, healthful human functioning, continuing human development and well- being. It is human regulatory function that individual must, with deliberation, perform for themselves to supply and maintain a supply materials and conditions to maintain life (Orem, 2001). Self-care agency Self-care agency means the individuals’ ability or power to engage in self-care. This ability associates with the basic conditioning factors. These basic conditioning factors are: (a) age, (b) gender, (c) development state, (d) health state, (e) life experience, (f) socio cultural orientation, (g) patterns of living (activities regularly engage in), (i) health care system factors (diagnostic and treatment modalities), (j) environmental factors, and (k) resources.

Normal adults have the ability to care for themselves, but children, aged people, disable person require assistance (Orem, 2001). 2.4.

1.3 Therapeutic health care demand Therapeutic health care demand is the totality of self-care actions to be performed over certain duration to meet all of individual’s known self- care requisites using valid, appropriate methods (Orem, 2001). 2.4.

1.4 Self- care requisites Group of actions or needs for self- care described as self-care requisites. Orem (1991) presented three types of self-care requisites. (a) Universal self-care requisites, (b) Development self- care requisites, (c) health deviation self-care requisites.2.4.1.

5 Universal self-care requisitesUniversal self-care requisites are associated with life process. Activities of daily living and functioning common to everyone to all human-being during all stages of the life are included in this category. Orem’s (2001) universal self-care described in eight components: (a) the maintenance of sufficient intake of air; (b) the maintenance of sufficient intake of water; (c) the maintenance of sufficient intake of food; (d) the provision of care associated with elimination process and excrements; (e) the maintenance of behavior between activity and rest; (f) the maintenance of behavior between solitude and social interaction; (g) the prevention of hazards to human life, human functioning and human well-being; (h) the provision of human life functioning and development with social group (p225) Development self-care requisites Development self-care requisites are related to the development process in different stages of life or new requisites derived from a condition or associated with an event.

Eg; promoting human development/ maturation and preventing or treating illness and disease which affects human development or maturation, adjusting to a new job, adjusting to body changes. The commonly recognized life cycle changes with developmental events and occurrences are: (a) the intrauterine stages of life and the process of birth; (b) the neonatal stage of life when an individual is born at term or prematurely and born with normal or low birth weight; (c) infancy; (d) the development stages of childhood, including adolescents and entry into adulthood; (e) the development stages of adulthood; (f) pregnancy in either childhood or adulthood (Orem, 2001) Health deviation requisitesHealth deviation requisites are needs arising from an injury or disease. Eg: effective adherence to medical treatment. The health care deviation self-care requisites are: (a) Seeking and securing appropriate medical assistance; (b) being aware of and attending to the effects and results of pathologic conditions and states; (c) effectively carrying out medically prescribed diagnostic therapeutic and rehabilitative measures; (d) being aware of and attending to or regulating the discomforting or deleterious effects of prescribed medical care measures; (e) modifying the self- concept (and self-image) in accepting oneself as being in a particular state of health and need of specific forms of health care; (f) learning to live with the effects of pathologic conditions and states and the effects of medical diagnostic and treatment measures in a life-style that promotes continued personal development.

(Orem, 2001, p.235) 2.4.2 Theory of Self- Care DeficitThe theory of nursing system establishes the structure and the content of nursing practice.

. This theory specifies when nursing is needed to assist a person in the provision of self-care. This is the core of Orem’s general nursing theory (Figure 1 & 4). The theory describes the relationship between the action capabilities of individuals and their demands for self-care. Self-care deficit occurs when the self- care agency is unable to meet self-care requisites. The deficit stands for the relationship between the action that individuals should take (the action demanded) and the action capabilities of individuals for self-care (Orem, 2001). The nursing care requires to fulfillment of the deficit.

The nursing actions are used to enhance self-care abilities needed for maintaining life, well-being and Quality of Life. Orem (2001) identified the following five methods to help patients resolve their self- care deficits. (a) acting for and doing for others, (b) guiding and directing, (c) providing physical or psychosocial support, (d) providing and maintaining an environment that supports personal development, (e) Teaching (p. 56) (Masters, 2011). Orem (1991) has identified five areas of activity for nursing practice. Those are: (a) Entering into and maintaining nurse- patient relationships with individual, family or group until patient can legitimately be discharged from nursing; (b) determining if and how patients can be helped through nursing; (c) Responding to patients’ requests, desires and needs for nurse contacts and assistance; (d) prescribing, providing and regulating direct help to patients (and their significant others) in the form of nursing; (e) coordinating and integrating nursing with the patient’s daily living, other health care, social and educational services needed or being received. (George, 1995)