Discussion: Definition and purpose of Self-Care Deficit Nursing

Discussion: Definition and purpose of Self-Care Deficit Nursing ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Definition and purpose of Self-Care Deficit Nursing Assignment 2: Middle Range Nursing Theorist Paper (25 points) Theories are patterns that guide the thinking about, being, and doing of nursing. Theories provide structure to nursing practice and research. Theories guide nursing practice, stimulate creative thinking, facilitate communication, and at the same time clarify purposes. A metaparadigm is a global concept of a disciple that identifies the primary phenomena of interest to that discipline. In nursing, the dominate phenomena within the science of nursing revolves around the concepts of man. Discussion: Definition and purpose of Self-Care Deficit Nursing Assignment Criteria: For this assignment develop a scholarly paper that includes the following criteria: Define theory and the purpose of theory. Define and discuss the nursing metaparadigm. Explain each of the four concepts that comprise the nursing metaparadigm Explain the importance of theory in nursing practice. provide and discuss two examples from current practice The scholarly paper should be 5 pages excluding the title and reference pages. Discussion: Definition and purpose of Self-Care Deficit Nursing Include level 1 and level 2 headings. The paper should begin with an introductory paragraph that includes the purpose statement. The introductory paragraph and purpose statement allow the reader to understand what the paper/assignment is going to address. The paper should include a conclusion. Write the paper in third person, not first person (meaning do not use ‘we’ or ‘I’). Include a minimum of three references from professional peer-reviewed nursing journals (review in Ulrich Periodical Directory) to support the paper. ***You may use historical references. (Definition of historical reference: reference to a well-known person, place event or literary work that adds meaning to the paper.) APA format is required (attention to spelling/grammar, a title page, a reference page, and in-text citations). Submit the assignment to Turnitin Direct. Important Note: The self-care theory by Orem begins in the Unit II – Chapter 7 Theoretical Basis for Nursing book(pdf) article_1.pdf article_2.pdf article_3.pdf theoretical_basis_for_nursing.pdf assignment_2_theoretical_class.docx The Evaluation of Supportive-Developmental Nursing Program on Self-Care Practices of Persons with Type 2 diabetes at the Health Centre in Bachok, Kelantan Rosmawati,M, B.Sc.Nursing, M.Sc. Nursing ; Rohana, A.J, B.Sc., M.Sc., PhD & Wan A. Manan, B.A., M.Ed., Ed.D Abstract: The purpose of this quasi-experimental research is to evaluate the effectiveness of a planned supportive-developmental nursing program on self-care practices of persons with Type 2 diabetes. Orem’s Self-Care Deficit Nursing Theory provides the theoretical framework for the study. The purposive sample included sixty eight adult patients with Type 2 diabetes who attended a diabetic clinic at a designated Health Centre. The subjects were divided into two groups. Group 1 (n=34) served as the control group. This group received the usual care. Group 2 (n-34) was assigned as the experimental group. This group received usual care coupled with supportive-developmental nursing program. This program focused helping methods for promoting self care capability for patients with Type 2 diabetes: 1) teaching, 2) guiding and supporting, 3) providing an environment conducive to building a relationship with participants. Data were collected by using two sets of questionnaires developed by the researcher: the Demographic and Health Information Form and Diabetes Self-Care Practice Questionnaire. The data were analyzed using inferential statistics of frequency, percentage, standard deviation, and Repeated Measured ANOVA. The study revealed that the mean scores of total and subtotal self-care practices of the experimental group, i.e., dietary control, exercise, medication taking, stress management, and personal hygiene were significantly higher than that of the control group (p<0.05). There was no significant difference (p<0.05) for HbA1c changes before and after intervention in either group. Thus, this study suggests that the supportivedevelopmental nursing program is effective in helping the Type 2 diabetic patients to improve their self-care practices. It also suggests that the application of the supportive-developmental nursing program might be applicable for extension at other health care centers and for patients with other chronic illnesses. Keywords: supportive-developmental nursing program, selfcare practices, Type 2 diabetes. Introduction Diabetes is one of the most prevalent chronic diseases among Malaysians. Its incidence has steadily increased over the past 10 years. In 1986, the prevalence was 6.3%; this increased to 8.3% by 1995 (Ministry of Health, 1998). With a population of 21 million people (1996 estimated), this accounts for approximately 1.7 million individuals. By the year 2020, the prevalence is expected to exceed 10% (Anuar, 1998). In the 16 state of Kelantan, in northeastern Malaysia, the prevalence of diabetes was 5.3 % as reported by second Malaysian National Health Morbidity Survey (NHMS, 1996). Another study conducted in 1999 revealed an increase to 10.3% (Mafauzy, Mokhtar, Wan Muhamad & Salmah, 1999).Discussion: Definition and purpose of Self-Care Deficit Nursing In addition, the number of in-patients with diabetes at the University Hospital Science Malaysia, Kelantan, is increasing every year. In 2003, the number of cases was 1,176, whereas it was 628 in 2002 and 413 in 2001 (Medical Record of University Hospital Science Malaysia, 2004). The escalation in diabetes, coupled with associated chronic complications such as retinopathy, nephropathy, and angiopathy will place a growing burden on the healthcare system. Therefore, a program promoting self-care for diabetic patients might reduce this burden. Orem’s Self Care Deficit Nursing Theory provided the theoretical foundation for this program. The supportive developmental (formerly supportive educative) nursing system is applicable for patients with chronic diseases seeking to improve their selfcare. Unfortunately, there is no research examining the effectiveness of self care interventions when comparing the increasing incidence of individuals with Type 2 diabetes in Kelantan, Malaysia with that in the country at large. The hypothesis for this study is: enhancing self-care of the population will contribute to more effective control of the disease and ultimately promote a higher quality of life. This study was planned to evaluate the effect of a supportive-developmental nursing program on self-care practices of patients with Type 2 diabetes. The study results will provide knowledge and guidelines for improving self-care practices of the diabetes population in Malaysia. Conceptual Framework Orem‘s Self-Care Deficit Nursing Theory (SCDNT) provided the framework for this study (Orem, 2001). Orem’s supportive developmental nursing system forms the basis for strategies in the intervention program. According to Orem, “self-care is the practice of activities that the individual initiates • Self-Care, Dependent-Care & Nursing • Vol: 20 • No: 01 • Spring 2013 and performs on one’s own behalf in maintaining life and well being” (Orem, 2001, p.43). The actions are directed to respond to three different types of self-care requisites: universal, developmental, and health deviation requisites. Orem identifies these requisites as important for persons with illnesses, diseases, and disabilities. Effective performance in response to the requisites, known as therapeutic self-care demands, enables patients to become involved in their disease management and learn to live with their health problems. Therefore, the proposed nursing program would enable patients with Type 2 diabetes to gain knowledge and skills that lead them to care for themselves. The goal of this supportive-developmental nursing program, comprised of teaching, providing support and guidance, and managing an environment conducive to building relationships, is to help patients develop the necessary capabilities to care for themselves. The supportive-developmental nursing program in this study will focus on understanding diabetes and managing its clinical effects and complications. Understanding health problems caused by diabetes is important for the patients so that they are able to make judgments and decisions when performing self-care practices. Through the intervention, the diabetic patients will be motivated for operating self-care practices towards dietary control, exercise, medication taking, stress management, and personal hygiene (Funnel & Haas, 1995). Ethical Considerations Ethical clearance was obtained from the Ethical and Research Committee (Human) of USM. Discussion: Definition and purpose of Self-Care Deficit Nursing The written consent and approval were also obtained from the Director of Ministry of Malaysia. Informed consent was obtained from the participants at the time each agreed to take part in the study. Methodology Study Design A quasi-experimental approach consisting of two groups (comparison and intervention) was used in this study. It aimed to evaluate the effect of the supportive-developmental nursing program on self-care practices among diabetes patients. In this study, data was collected via a selfadministered questionnaire. Respondents who met the inclusion criteria were approached individually. A detailed explanation of the purposes and procedures of the study was given to all inclusive respondents. Written consent was obtained from each respondent prior to data collection in the diabetic clinic at the health center. The questionnaires were self-administered by respondents. After hearing a brief instruction on how to fill in the questionnaires, respondents were asked to complete the questionnaires within 20-30 minutes. Explanations were given to the respondents whenever required while answering the questions. The questionnaires were collected after completion by the respondents. Sample and Setting The sample in this study consisted of 68 newly diagnosed Type 2 diabetes patients. The study was carried out at an outpatient clinic, in Bachok, Kelantan. Procedure The Type 2 diabetic patients were approached on the first day of their visits at the outpatient clinic in order to seek their consent to participate in the study. The researcher explained the objectives, subject’s right, and outcomes of the study. Those who agreed to participate in this study, were given the consent form to complete. Demographic and Health Information Forms, and a Diabetes Self-Care Practices Questionnaire were administered for both comparison and interventionl groups. The questionnaires were reviewed after completion. This process was repeated every week for both groups until the number of subjects for each group reached the desired sample size. There were 34 subjects in each group. Comparison group: The participants in the comparison group received usual care from doctors and nurses at the outpatient clinic. The usual care consisted of 1) advising the patients on dietary control, exercise, medication, stress management, and personal hygiene, and 2) encouraging the patients to follow treatment regimen by making routine appointments. Intervention group: This group received the usual care. In addition they participated in a 7 week supportive-developmental nursing program conducted by the researcher. This program followed 7 modules developed by the Epidemiology Unit of Health Department Kelantan, Ministry of Health (2004). The supportivedevelopmental nursing program consists of: 1) teaching: 2) guidance and support, and 3) providing environment for self-care development. (Please see Table 1). Both groups continued to receive usual care at the out-patient clinic. Instruments 1. Demographic and health information form The instrument was designed by the researcher to assess the basic conditioning factors of the participant. It also included questions about current prescribed medications and HbA1c. (See Table 2) 2. Diabetes self-care practice questionnaire The questionnaire developed for this study was based on Doungchan’s (2004) self-care Vol: 20 • No: 01 • Spring 2013 • Self-Care, Dependent-Care & Nursing • 17 Table 1: Supportive/Developmental Program Week Teaching Modules Guiding and Supporting Environment Week 1 General Knowledge of Type 2 Diabetes: Discussion with participants : Comfortable room provided. Participants encouraged to express individual feelings, concerns and worries. Risk factors, symptoms, monitoring, complications Identifying individual self care needs and health problems, soliciting questions. Group exploration of alternative ways to provide self care. Appointment for next session scheduled. Discussion: Definition and purpose of Self-Care Deficit Nursing Written guidelines of material covered provided for practice Week 2 Diabetic Diet: Emphasis on 3 categories of diet: foods to avoid, food allowed, food portion Diet guidelines demonstrated by researcher. After review of guidelines, participants were asked to perform these guidelines with a return demonstration of calorie calculations Printed material reinforcing information form second module provided. Week 3 Medical Management Discussion on concerns and problems with taking medications. Printed material from third module given to participants. Week 4 Exercise: Types of light exercise identified. Participants asked to choose a group exercise. Walking was selected. Each week group members and the researcher will walk for 30 minutes together. Week 5 Management of Diabetes in Special Circumstances: Areas identified: Fasting, traveling, social events, pregnancy, preoperatively Week 6 Monitoring Glucose Level Teaching focused on monitoring glucose levels before and after meals and at bedtime 18 Discussion centered around participants’ needs related to self care practices. Questions about self care practices were asked and answered by researcher. Group sharing of information from previous week including problems encountered and opinions on performing self care at home. Group sharing of experiences and problem solving Appointment for next session scheduled. Calm, private room continued to serve as a conducive environment for sharing and expressing concerns. Appointment for next session scheduled. Meetings continued to be held in the same manner and environment. Appointment for next session scheduled. Printed material from fourth module given to participants. Discussion about self care practices during special circumstances. Alternative choices were suggested and shared among group members and facilitator. Written guidelines were given and questions encouraged. Meetings again focused on problems and concerns encountered by participants and clarification of self care practices as needed. Appointment for next session scheduled. Discussion about the use of glucometer at home including any problems encountered by participants. Each participant was asked to demonstrate the use of the glucometer. The researcher continued to provide an open, nonjudgmental environment in order to encourage participation and disclosure of self care practices. Printed information about the material covered was given to each participant. Appointment for next session scheduled. • Self-Care, Dependent-Care & Nursing • Vol: 20 • No: 01 • Spring 2013 Week 7 Complications, Symptoms, Risks: Teaching focused on hypo and hyperglycemia, and ketoacidosis Discussion centered around the content of the session, problems encountered in self care management and concerns of individual participants. Questions, concerns, and accomplishments shared and participants continued to be encouraged to provide self care Printed information to reinforce the session was handed out. practice questionnaire which was used to measure nurses’ capabilities in promoting self-care practice of diabetes patients. The original version was translated from Thai to English by a bilingual ThaiEnglish expert. Subsequently, the English version of questionnaire was translated to Bahasa Malaysia by a bilingual Malay-English expert. The questionnaire was a rating scale ranging from 1 to 6. The higher the score, the higher the level of self-care practice promoted. The total scores, ranged from 44 to 264. Validity. The content validity of the Diabetes Self-Care Practice Questionnaire was evaluated by five experts. Discussion: Definition and purpose of Self-Care Deficit Nursing One expert in the area of diabetes was from Medical Faculty of University Science Malaysia. Two theory experts were lecturers from Nursing, Prince of Songkla University, Thailand. The other was experienced in provision of care for diabetes patients from University Hospital Science Malaysia. These experts were asked to evaluate each item. Then, the researcher modified the items based on the experts’ recommendations. Reliability. The Diabetes Self-Care Practice Questionnaire was administered to ten patients with Type 2 diabetes for testing its reliability. The internal consistency was evaluated by using Cronbach’s alpha coefficients. The coefficient alpha of self-care practice was .97. The alphas of each dimension in self-care practice questionnaire were as follows: 1) dietary control was .97, 2) exercise was .98, 3) medication taking was .97, 4) stress management was .97, and 5) personal hygiene was .96. 3. Manual handbook The education guidelines for diabetes patient were developed by Epidemiology Unit of Health Department Kelantan in year 2004. This handbook is divided into learning modules. The content consists of the definition of diabetes, its clinical effects, and severity of its complications, and self-care management for dietary control, exercise, medication taking, stress management, and personal hygiene. 4. Supportive-developmental nursing care plan The nursing care plan was developed by the researcher (see Table 1). Four experts confirmed the content validity of this instrument. The plan consists of teaching, guiding, support and providing an environment conducive to promoting self-care practice for diabetic patients. Supportive-Developmental Nursing Program Orem (2001) describes helping methods as: (1) acting for or doing for another, (2) guiding another, (3) supporting another, (4) providing a developmental environment, and (5) teaching another (56-59). This study used 3 categories: teaching, support and guidance, and providing an environment conducive to building relationships. The teaching sessions were held for seven weeks, taught in groups of 7-10 participants, as suggested by Rickheim, Weaver, Jill, and Kendel (2002). The sessions lasted approximately 60 minutes. The first 30 minutes of each session focused on information needed to understand diabetes and manage self-care. The sessions were divided into modules each with a specific focus. The seven modules were: general knowledge of Type 2 diabetes, diet, medical management, exercise, blood glucose monitoring, and managing diabetes in special circumstances. The teaching portion lasted about 30 minutes for each module. The final 30 minutes of the session was devoted to support and guidance. The participants were encouraged to discuss problems they encountered and methods that helped them in managing their self-care. Choices and alternative strategies were offered by the nurse. Nursing assistance was always offered in a calm, polite, respectful manner. All the sessions were held in a private, comfortable environment. Appointments for the next session were always given at the end of the previous session. Results Sample. A total of sixty eight of Type 2 diabetic patients who met the inclusion criteria were recruited for this study. Data of the control group revealed that the majority were female (58.8%), married (85.3%), and Muslim, (97.1%). The average years of age of the subjects were 53.56 (±11.15) with an educational background of Lower Secondary School (38.2%). Most of them had an income of about or less than 500 ringgit per month (76.5%), and controlled their diabetes by oral medication (100.0%). Similar to Vol: 20 • No: 01 • Spring 2013 • Self-Care, Dependent-Care & Nursing • 19 the comparison group, there were more female (73.5%) subjects in the intervention group. Average years of age of the subjects in the intervention group were 50.00 (±8.77). Discussion: Definition and purpose of Self-Care Deficit Nursing All of the subjects were Muslim (100.0%) and married (100.0%). The majority of them had attained Junior High School (58.8%). Most were housewives (82.4%), had a monthly income of equal or less than 500 ringgit (79.4%), and controlled their blood sugar level by oral medication (88.2%). (Please see Table 2). Self-care practices of persons with Type 2 diabetes. Self-care practices were measured in five dimensions: dietary control, exercise, medication taking, stress management, and personal hygiene. The total and subtotal scores of self-care practices of the control and experimental groups are presented in Table 3. In addition, the total self-care practice scores of the control and experimental groups ranging from 44 to 220 were compared both at the pre-test and post-test periods. The results showed there were differences between the mean scores of both groups at both points of measurement. (Please see Table 3). Repeated Measured ANOVA A repeated measure ANOVA was performed to determine the mean differences between the total scores of self-care practices in the control and the experimental groups. The differences between the pre and post test for the comparison group and for the intervention group were measured. Then the difference between the pre test scores between the comparison group and the experimental group were calculated. Finally, the difference between the post test scores of the two groups was determined. The post intervention scores between the groups revealed a statistical difference between the groups. (Please see Table 4). In conclusion, the study results suggest that the implementation of this supportive-developmental nursing program has the potential to enable nurses to promote self-care capabilities for disease management in people with Type 2 diabetes. Discussion The findings of this study suggest that the supportive-developmental nursing program led to a significant improvement in self-care practic … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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