The chronological assessment of interdisciplinary theory has been conducted over the years by various researchers over the past decades since the publication of the concept of interdisciplinary research. The overview has been beneficial over the years as it can be utilized to measure the growth of interdisciplinary studies as a career (Koh et al., 2010). The summary is further used in managing the design and teaching of interdisciplinary courses. Therefore, this paper aims to employ Dorothea Orem Self-Care and the Self-Efficacy theories to analyze the patients suffering from type 2 diabetes mellitus who participate in self-care initiatives compared to those who are not involved in the programs.
Selected Clinical Practice Problem
The selected clinical practice problem is diabetes mellitus which has gradually become a significant concern in the medical practice. Currently, medical providers are faced with challenges linked to addressing the growing demand and need of patients with chronic illness, such as type 2 diabetes mellitus (Koh et al., 2010). Diabetes mellitus is a protracted progressive metabolic disorder that is characterized by hyperglycemia specifically due to absolute type 1 or relative type 2 absences of insulin hormone. The disease has been assumed to occur in developed economies until recently when various studies revealed that there has been a sharp rise in the number of diabetes mellitus with an earlier onset and connected difficulties in developing states.
The illness is associated with complications, such as neuropathy, cardiovascular sickness, nephropathy, and retinopathy, which can result in mortality and chronic morbidities (Koh et al., 2010). The world health organization estimates that more than 348 million individuals globally have diabetes mellitus with up to 156 million suffering from kind 2 diabetes mellitus and 192 million with type-1 diabetes (Koh et al., 2010). The growing number of persons with the disease has influenced numerous concerns amongst medical practitioners as they focus on tackling the requirements of their patients.
Consequently, self-care in diabetes has been illustrated as an evolutionary procedure of growth of awareness and knowledge through training to survive with the dynamic characteristics of diabetes in a social setting. Since the immense majority of daily treatment in diabetes is managed by the patients and their families, there is a vital necessity for valid and reliable methods for individual-handling of the disease (Roby et al., 2008).
There are seven crucial self-treatment actions for persons with diabetes, which give positive results. They comprise supervision of blood sugar level, healthy diet, regular exercise and engaging in physical activities, strictly following medical prescriptions, vibrant problem-resolving capabilities, risk-controlling activities, and healthy handling abilities (Roby et al., 2008). The proposed processes can be beneficial to medical providers and researchers treating private patients and for scholars analyzing new strategies to treatment.
Conversely, individual-record is the practical and cost-efficient approach to self-treatment evaluation and is usually perceived as undependable. The diabetes mellitus self-care undertakings are actions practiced by individuals with or at risk of the disease to successfully handle diabetes independently. All of the seven activities have been discovered to be actively associated with minimization of difficulties, enhancement in quality of livelihood, and good glycemic management (Moore, 2010).
Moreover, researchers observed that self-treatment entails not only conducting the specific procedures but further the interrelationships amongst them. The diabetes self-care necessitates the patient to alter their lifestyle and dietary adjustments complemented with the inspiring responsibility of medical staff for sustaining a significant degree of self-assurance resulting in a positive behavior transformation.
Diabetes Self-Care Activities
Diabetes awareness is vital and should be transferred to behavior or self-treatment actions to successfully profit the patient. Self-care events refer to actions, such as enhanced exercise, glucose management, adherence to a diet plan, avoiding high fat content meals and foot treatment. Reduction of an individual’s glycosylated hemoglobin degree is normally the objective of diabetes self-handling (Fineout-Overholt et al., 2011). However, the treatment cannot be conducted alone as the only goal in the care of suffering individuals. Alterations in self-treatment events should further be analyzed for prospect toward behavioral transformation.
Self-management of glycemic handling is a pillar of diabetes treatment that can certify patient involvement in realizing and sustaining particular glycemic objectives. The most critical target of monitoring is the evaluation of general glycemic handling and initiation of suitable methods in timely manner to realize optimal control. Furthermore, self-monitoring offers data on existing glycemic profile, permitting the evaluation of therapy and administrative amendments in medication, diet, and exercise to accomplish optimum glycemic management (Fineout-Overholt et al., 2011). Irrespective of weight loss, participating in consistent corporal activity has further been identified to be linked with enhanced healthcare results amongst diabetes patients. The National Institutes of Health and the American College of Sports Medicine endorse that all grown-ups comprising those with diabetes, should be involved in consistent physical exercises.
Compliance to Self-Care Activities
Treatment devotion in diabetes is a field of attention and apprehension of healthcare providers and clinical scholars despite previous extensive studies conducted on the area. In diabetes, individuals are anticipated to monitor an intricate set of actions to care for their illness every day. These behavioral activities entail participating in positive livelihood activities, taking medical prescriptions indicated by the physician, supervising glucose ranges, reacting to and self-treating diabetes symptoms, and pursuing private suitable care for the illness and medical concerns (Fineout-Overholt et al., 2011). The recommended regimen is also complicated by the requirement to incorporate and sequence all of the behavioral responsibilities in an individual’s regular routine.
Improvement of self-care actions plays a significant role in assisting patients in minimizing the chances of developing long-standing difficulties. However, compliance to the activities has been realized to be low, especially when considering long-lasting transformations. In the event of delivering sufficient backing to health practitioners should not criticize the persons despite their adherence being poor (Kleinpell, 2009). In a research conducted between patients with diabetes, it was concluded that 30 percent of the individuals were obedient to drug contingents and the non-compliance was substantial amongst the lower social class.
Similarly, one of the realisms about the kind-2 diabetes affirms that sole practice of self-compliance will not present the desired results. Global research further asserts that metabolic management is an integration of numerous variables and not sole patient compliance. For instance, in the United States analysis, it was identified that contributors were more inclined to make alterations when every change was executed individually (Kleinpell, 2009). Therefore, accomplishment varies considering how the transformations are adopted, concurrently or independently. Some of the scholars have also recommended that healthcare experts should design their patient self-treatment support centered on the level of private duties the person is prepared to undertake towards their diabetes self-therapy handling.
The selected clinical practice problem is the self-care in diabetes, which is an evolutionary change procedure of consciousness through learning to survive with the intricate nature of the diabetes in a social setting. Since there are numerous daily care activities in diabetes, the illness is managed by the patient and their families. Consequently, there has been a growing demand in the need for reliable and valid measures for self-handling of diabetes.
Diabetes mellitus is a chronic disease that influenced by progressive metabolic disorders which is linked to the deficiency of insulin. Over the past years, the healthcare system has faced various challenges in administering treatment to the patients. For instance, lack of awareness within the patients’ communities has impacted the reduced rate of patient recovery and increased mortality rate. The introduction of self-care procedures has, therefore, been effective in the management of the illness despite its conception amongst the world populace.
Theories Employed in the Model
Dorothea Orem’s Self-Care Model
The Dorothea Orem’s self-care concept is an action model that has explicit stipulations for medical providers and patients responsibilities. The building steps of the model consist of vital and peripheral ideas. Dorothea Orem created the self-care deficit theory early in her profession and advanced it through her career and retirement. While Orem campaigned for the separation of institutional amenities and hospitals, as she identified the necessity for progressing the nursing quality in the national general hospitals (Sobczak, 2009).
Such resulted to Orem developing her meaning of treatment practice and she believed that patients have a natural skill for self-treatment and that care should concentrate on impacting the ability. Orem developed the self-care deficit model entails the synthesis of understanding concerning the theoretical entities self-treatment, agency, therapeutic self-care demand, and the relational unit of self-care deficit and nursing agency.
The theory of self-care deficit comprises various presuppositions that link the central idea of the concept to treatment of diabetes. For instance, the arrangement of self-care requires the capability to handle self within a stable or shifting environment. The care towards management of diabetes is significantly influenced by the changing nursing guidelines as various states have their distinct healthcare guidelines. However, the theory assumes that the involvement of a patient in self-care requires that the individual and the nurse should be flexible to the changes in healthcare structures and guidelines (Sobczak, 2009).
Furthermore, the concept proclaims that a diabetes patient’s engagement in individual-treatment is influenced by the person’s evaluation management measure with regards to livelihood, growth, healthcare, and life. The practitioners should therefore understand the clients’ behavior, preferences, and lifestyle before concluding on the care procedure that should be prescribed to them.
Considering the complexity of diabetes, the theory regards that the completeness and quality of self-care is dependent in families and communities since they influence culture, including the scientific knowledge of the social unit and educability of its members. Diabetes patients require an inclusive treatment procedure that involves the overall society, thus, creating awareness amongst individuals in the community and training them will assist in boosting the outcome of treatment (Musker, 2011).
Furthermore, the concept is vital in the understanding of the effectiveness of a diabetes treatment procedure. For instance, the participation in self-management and dependent care is normally influenced by a patients’ limitation in knowing the actions to undertake in current conditions and circumstances (Musker, 2011). Different patients have distinct reaction to conception of diabetes, therefore it is vital for nurses to understand the person’s circumstances and adjust the treatment program to accommodate such patients.
Societies offer human state of social dependence by establishing conducts and means for assisting diabetes patients according to the characteristics, nature, and reasons for their treatment. When the methods are institutionalized, directing aiding processes for diabetic individuals becomes a means for helping patients who are currently in the state of community dependency (Musker, 2011).
Likewise, Orem’s theory presents that medical practitioners should direct aiding procedures of diabetes individuals of various social groups through categorizing them in groups comprising state of age-related dependency and those actively connected to the treatments. The approach will enable the nurses to understand the type of self-care management to prescribe for different groups of patients. Finally, the physicians should further be encouraged to be involved in direct aiding service constituted in various social groups to offer assistance to patients irrespective of age and social status (Musker, 2011). It will ensure that the diabetes treatment is conducted comprehensively to promote positive outcomes for the patients and the general medical system. Consequently, Dorothea Orem’s Self-care concept plays a substantial part in the establishment of treatment methods for the diabetes individuals.
Self-efficacy was established by the psychologist, Albert Bandura. According to Bandura, self-efficacy is the perception of persons in their capabilities to conduct successful practice. Despite self-efficacy being an independent theory, the concept is a structure of social cognitive theory. It concludes that patients will undertake an action when they perceive they are capable to handle it and will evade an activity if it is viewed to fail. Self-efficacy is a requirement of a conduct and should be regarded as an autonomous division of basic healthcare skills (Grove et al., 2017). Furthermore, Bandura argues that the concept is the pillar in forecasting people behavior shift and normally the ones that indicate a high degree of behavioral transformations have high efficacy.
Self-efficacy plays a prominent part in diabetes self-care and projects its results. In recent studies, researchers have recorded that self-efficacy illustrated 11.4 percent of variance concerning diabetes self-management and 31.3 percent change of diabetes self-care social objective (Grove et al., 2017). Similarly, the diabetes management self-efficacy which was created by various scholars evaluates the diabetic patients’ confidence concerning exercise, diet plans, and medical care.
The general self-care efficacy also has outstanding connections with particular self-efficacy comprising, self-directive, optimism, and self-esteem. Therefore, self-efficacy has a dynamic link to the quality of life in diabetic patients. For instance, the eating patterns of diabetic individuals are associated with their self-efficacy, thus determining their glucose level. The outcomes from the theory indicate the influence of diabetes mellitus on self-efficacy in glycemic management. However, studies have not distinguished the role of general self-efficacy (GSE) and diabetes management self-efficacy (DMSE) and their connection to glycosylated hemoglobin.
Selected Theory for Practice
The selected theory for the practice is Dorothea Orem’s Self-Care model. The Orem’s elf care concept clearly illustrates all the aspects of a patient’s engagement during their recovery period comprising nursing, environment, health, and person. According to the theory, the person is the receiver of thee treatment required for diabetes mellitus and has the prospect for growth and knowledge, and also displays the capabilities to achieve how to satisfy their desires (Grove et al., 2017).
The diabetes patients usually have distinct treatment preferences that should be understood by the nurses. Furthermore, the individuals have the capability for learning, thus employing the Dorothea Orem’s Self-care model will enable the medical providers to effectively tackle all the areas that play a vital role in the treatment and recovery of diabetes patients. The research question for the study would therefore be; how utilization of Dorothea Orem’s Self-care theory would influence a successful self-care for diabetes patients. The question addressees the Orem’s concept in management of diabetes mellitus by analyzing four paradigms comprising environment, person, nursing, and health.
Recommendations for Self-Care Activities
Since diabetes self-care actions can have intense influences in reducing glycosylated hemoglobin, medical practitioners and experts should measure perceived patients barriers to self-management activities and make commendations aligned to such factors. However, though diabetic individuals usually seek guidance from physicians, numerous healthcare practitioners are not including self-care activities with patients during discussion or treatment sessions (Thorne, 2009). Nurses should begin their treatments by creating time to analyze their patients’ discernments and conclude realistic and particular references for self-care undertakings.
Additionally, some patients may undergo difficulty in appreciating and adhering to the fundamentals of diabetes self-care actions. When following the self-care techniques patients are occasionally anticipated to make medical decisions which are normally complex amongst most individuals (Thorne, 2009).
These necessities or modifications should be distinct for every diabetic person and should be modified according to the patient’s reaction. It is vital that medical doctors actively engage their clients in enhancing self-care regimens for each private patient. Such regimen should be designed to be suitable for each patient and realistic for them to follow. Concurrently, healthcare practitioners should comprehensively record the particular diabetes self-care regimen in the diabetes individuals’ medical report since it will further enable physician-patient interaction and aid in evaluation of agreement (McEwen & Wills, 2017). Similarly, the requirement for routine monitoring should be encouraged in chronic diseases, such as diabetes and should be perceived as a vital part of its long-standing management.
Implications of Practice
A medical practitioner should identify patients who are viable for non-adherence and offer exceptional care to them. At the local community level, states need dynamic diabetes self-care education initiatives at the principal care level with importance being placed on encouraging suitable self-management conducts especially lifestyle alteration (McEwen & Wills, 2017). Moreover, these initiatives should be regular and periodic reinforcement is essential to realize shift in behavior and maintain similar results for a significant period. While establishing such training programs, sufficient community care channels, such as support groups should be organized.
Implications for Future Study
Considering that numerous researches are originating from developed economies, there is a demand for an extensive study in rural regions of such countries. Simultaneously, field research should be encouraged in developing nations concerning opinions of patients on the usefulness of their self-treatment management so that the reserves for diabetes mellitus can be utilized successfully.
From the research conducted in this paper, to regulate diabetes linked mortality and morbidity, there is a necessity for dedicated self-care conducts in various domains comprising physical undertakings, diet plan, appropriate medication, and blood sugar tracking from the patients.
Despite several demographic, social, and socio-economic aspects can be regarded as constructive contributors in facilitating self-care actions in diabetic individuals, responsibilities of physicians in inspiring self-treatment is essential and should be affirmed. Understanding the complex nature of the concern, a methodical, multi-divided, and an incorporated strategy is needed for enhancing self-care practices amongst diabetic patients to prevent log-lasting complications. Self-efficacy is, therefore, regarded as a predisposing factor that should be declined in lasting illnesses, such as diabetes. Enhancing self-confidence in patients can set the platform for glycemic management.
Fineout-Overholt, E., Williamson, K. M., Gallagher-Ford, L., Melnyk, B. M., & Stillwell, S. B. (2011). Evidence-based practice, step by step: Following the evidence: planning for sustainable change. AJN The American Journal of Nursing, 111(1), 54–60. Web.
Grove, S. K., Burns, N., & Gray, J. (2017). The practice of nursing research: Appraisal, synthesis, and generation of evidence. Elsevier Health Sciences.
Kleinpell, R. (2009). Evidence-based review and discussion points. American Journal of Critical Care, 18(6), 533–534. Web.
Koh, H. K., Sondik, E. J., Huang, D. T., Klein, R. J., Satcher, D., Ford, E. S., Ajani, U. A., Croft, J. B., Fielding, J., & Kumanyika, S. (2010). A 2020 vision for healthy people. New England Journal of Medicine, 362(18), 1653. Web.
McEwen, M., & Wills, E. M. (2017). Theoretical basis for nursing. Lippincott Williams & Wilkins.
Moore, Z. (2010). Bridging the theory–practice gap in pressure ulcer prevention. British Journal of Nursing, 19(15), S15–S18. Web.
Musker, K. (2011). Nursing theory-based independent nursing practice: A personal experience of closing the theory-practice gap. Advances in Nursing Science, 34(1), 67–77. Web.
Roby, D. H., Kominski, G. F., & Pourat, N. (2008). Assessing the barriers to engaging challenging populations in disease management programs. Disease Management & Health Outcomes, 16(6), 421–428.
Sobczak, J. A. (2009). Managing high-acuity-depressed adults in primary care. Journal of the American Academy of Nurse Practitioners, 21(7), 362–370. Web.
Thorne, S. (2009). The role of qualitative research within an evidence-based context: Can metasynthesis be the answer? International Journal of Nursing Studies, 46(4), 569–575. Web.