Mary J. Denyes

Health and illness self-care in adolescents with IDDM: a test of Orem's theory.

Orems theory suggests that different self-care actions are necessary to meet requisites related to health (universal self-care) and illness (health-deviation self-care). The authors differentiate these types of self-care, propose hypotheses relating these concepts to other concepts in Orems theory, and test them in a sample of adolescents with diabetes mellitus. As predicted, universal self-care is significantly related to a measure of the global health state, and health-deviation self-care is related to control of pathology. The findings provide direction for additional research and theory development.

Orem's model used for health promotion: directions from research.

Orems theories of self-care and self-care deficit contain several propositions important to health promotion. This article presents results of tests of these relationships, which indicated partial support for the model. In an aggregate sample of 369 adolescents, self-care and self-care agency were significant predictors of health. This relationship held when health was defined as a general positive state of integrity and soundness, but not when it was considered as merely the absence of disease.

Self-care agency: conceptualizations and operationalizations.

This article traces the interactive process between theory and research as it has been used to clarify the concept of self-care agency, a key concept in Orems model of nursing. Theoretical constructions of self-care agency that have emerged in the work of Orem and the Nursing Development Conference Group are reviewed. Operational measures of self-care agency are described, particularly with regard to their underlying theoretical formulations. Factorial structures for some self-care agency instruments are related to the components of self-care agency in Orems most recent conceptualization. Dimensions of self-care agency that are consistently supported by research studies of this phenomenon are identified.

Pain assessment in children: theoretical and empirical validity.

Valid assessment of pain in children is foundational for both the nursing practice and research domains, yet few validated methods of pain measurement are currently available for young children. This article describes an innovative research approach used in the development of photographic instruments to measure pain intensity in young African-American and Hispanic children. The instruments were designed to enable children to participate actively in their own care and to do so in ways that are congruent with their developmental and cultural heritage. Conceptualization of the instruments, methodological development, and validation processes grounded in Orems Self-Care Deficit Theory of Nursing are described. The authors discuss the ways in which the gaps between nursing theory, research, and practice are narrowed when development of instruments to measure clinical nursing phenomena are grounded in nursing theory, validated through research and utilized in practice settings.

Predictors of Self-Care in Adolescents With Cystic Fibrosis: A Test of Orem's Theories of Self-Care and Self-Care Deficit

Pediatric nurses often struggle to find ways to encourage adolescents with cystic fibrosis (CF) to engage in self-care that is essential to their health and life. A study of predictors of self-care was conducted to provide a stronger evidence base for nursing practice with these youth. Orems theories of self-care and self-care deficit were tested to explain and predict the universal and health deviation self-care of 123 adolescents with CF. Four dimensions of self-care agency emerged as predictors of universal self-care, two of which were also predictive of health deviation self-care. Seventy percent of the variance or change in universal self-care scores and 40% of health deviation self-care variance were explained. Clarification and extension of Orems theories were also an important outcome. Development of nursing interventions designed to strengthen predictors of universal and health deviation-specific self-care identified in this research holds the potential to improve length and quality of life for adolescents with CF.

Nursing Actions to Prevent and Alleviate Pain in Hospitalized Children

Nurses are confronted daily with the responsibility to care for hospitalized children in pain, yet the substantive knowledge base about that care and how effective it is remains extremely limited. Although there is initial evidence of effectiveness of several pharmacologic and nonpharmacologic pain relief approaches, little evidence of use or effectiveness in clinical nursing practice exists. To begin to address this knowledge deficit, two studies conceptualized within Orems (1991) general theory of nursing were undertaken: one involving ethnographic interviews to determine what pain relief actions are taken by nurses with recognized expertise in caring for children in pain and another, follow-up survey to examine the frequency with which these actions are used by general nursing staff. Data about perceived effectiveness of the actions were also obtained. The results of these two studies of nursing actions to prevent and alleviate pain in hospitalized children document that nurses use a wide variety of creative methods to relieve pain. From interviews with the nurse experts both specific actions and action patterns and themes were identified. Furthermore, these patterns were congruent with methods of helping used by nurses as described by Orem. Results of this research currently serve as the basis for development and testing of nursing action protocols for alleviation of pain in hospitalized children.

Expanded nursing care for contraceptive use

Nursing actions to promote contraceptive self-care are described. Orems self-care theory was used to develop assessment tools and to plan nursing actions.

Nursing Research Related to Schoolage Children and Adolescents

The review of nursing research in this chapter includes studies published between 1952 and early 1982. Investigations pertaining to children and adolescents between the ages of 6 and 18 years that were reported in major nursing research journals or maternal child nursing journals are included. Additionally, the review includes nursing studies reported in other nursing journals or journals of other disciplines and retrieved by computer searches, search of nursing indexes, review of reference lists of related studies, or informal contacts of the author. While these search techniques yielded a large number of studies for review, the limitations in formal indexing of nursing publications may have left relevant research unidentified.