There are many ways to define family. The traditional definition is a group of related people living together in the same household. Families of today may have only one parent may have a step mother or step father may have adoptive parents, and in some cases may have parents of the same gender (Friedmann, Bowden, & Jones, 2003). Family is a term that can be interpreted differently by different individuals. No matter how a family is described or defined, there is a need for family support, particularly when it pertains to health care.
This paper will focus on the importance of family in the health of our society and the application of Dorothea Orem’s Self-Care Deficit Theory. A basic function of the family is health promotion and illness prevention. An illness can affect the whole family (Friedmann, Bowden, & Jones, 2003). The family works together to ease stressors that may affect the health of the family unit. Healthy family systems adapt to these stressors to help alleviate the effects of the stressor on the system. An example may be receiving vaccinations to prevent disease, or healthy lifestyle choices to encourage wellbeing. There are differing concepts of family with reference to family nursing.
Friedmann, Bowden, and Jones (2003) identify five concepts of family nursing. These concepts are Family as Context, Family as Sum of its Parts, Family Subsystem as Client, Family as Client, and Family as a Component of Society. The Family as Context focuses on the individual as primary concern and the family is the secondary focus. The nurse may assess the family as part of the patient’s support system but may not include the family in the plan of care. Family as Sum of its Parts is associated with community health nursing where the individual family members (not one individual, but all members individually) are the focus.
The Family Subsystem as Client focuses on the interpersonal relationship of the family. These relationships include the parent-child relationship and marital relationships. The Family as Client centers the focus on family dynamics and relationships. The family is the primary focus and the individual family members are secondary. Finally, the Family as a Component of Society is where the family is seen as a part of a larger system.
The family here is on the large scale or institutional size. The family is considered an institution, or component of society, just as religious or educational institutions are. The concept of family most used in the intensive care unit (ICU) is Family as Context. Working in the ICU, the patient must be the focus of the care provided and this concept of family is the most helpful. This does not mean that the families are overlooked but are incorporated into the care as the patient recovers. The family is updated regarding the condition of the patient and is taught about the importance of what may seem simple (oral care) and what is more complex (dressing changes).
As the patient recovers, the involvement of the family and the incorporation of the family into the plan of care become greater. Dorothea Orem developed the Self-Care Deficit Nursing Theory. Orem’s initial work focused on the person as an individual (George, 2011), although her theory later developed into the person ranging from families up to the whole community. Orem’s theory stated that the person could initiate, perform, and maintain care of oneself, and this is learned through relationships (“Nursing Theories: A Companion to Nursing Theories and Models”, 2012).
Her theory goes on to explain the self-care requirements, or requisites, are found in every human being, and across all stages of life (Romeo & Devereaux, 2006). Orem’s theory, or philosophy, is essentially to get the person back to his or her level of self-care. This point of self-care can be extremely different in various parts of the world. The self-care of a person in Africa, Mexico, or the United States may be vastly different, or as with the patient who has heart failure as compared to a young healthy person with no deficits. Orem’s theory is the most conducive in the ICU setting as these patients or families can no longer care for themselves.
Assisting these patients, or at times giving total care, allows the family to recognize the amount of care the patient currently needs and what he or she may need in the future. Compassion and caring for the family is shown by addressing their need for rest and nourishment. The need for the family members to take care of themselves is highly encouraged so that they in turn can take care of their loved one during what may be a long recovery period.
Nurses provide complex care to people during all stages of wellbeing and illness. This care is often defined by different concepts of family and different nursing theories. This paper has focused on the family as context and the application of Dorothea Orem’s Self-Care Deficit Theory in the ICU setting.
Friedman, M. M., Bowden, V. R., & Jones, E. G. (2003). Family nursing: Research, theory, &practice (5th ed.). Upper Saddle River, NJ: Prentice Hall.George, J. B. (2011). Nursing theories. The base for professional nursing practice (6th ed.).Boston, MA: Pearson/Prentice HallNursing Theories: a companion to nursing theories and models. (2012). Retrieved fromhttp://currentnursing.com/nursing_theory/self_care_deficit_theory.htmlRomeo, E. V., & Devereaux, M. J. (2006). Orem’s self-care deficit nursing theory (2nd ed.).New York, NY: Springer Publishing Company.