The self-care deficit nursing theory is a grand nursing theory that was developed in 1959 by Dorothea Orem.¹ The theory is also referred to as Orem’s model of nursing. This theory originates from the totality paradigm based on human beings being able to adapt to one environment. In 1971 she published nursing concept and practice.²

Orem’s generates theory of nursing consist s of 3 related parts: (I) Theory of self-care, (II) Theory of self-care deficit, (III) Theory of nursing systems. The theory of Self-care in human regulatory functions that individuals must with deliberation, perform for them to maintain life, health, development and well-being. Self-care is an action system.³ The elaboration of the concepts of self-care, self-care demand and self-care agency provide the foundation for understanding the action requirements and action limitations of persons who may benefits from nursing.⁴

The central idea of the theory of self-care deficit is that requirements of persons for nursing are associated with the subjectivity of mature and maturing persons to health related or health care related action limitation that rather than completely or partially unable to know existent and emerging requisites.⁵ The theory of nursing system proposes that nursing is human action, nursing system are action systems formed by nurses through the exercise of their nursing agency for persons with health derived or health associated limitations in self-care or dependent care.

The theories of self-care requisites are directed towards the self-care it consists of 6 universal self-care requisites such as:

1. Maintenance of sufficient intake of respiration, water and food.
2. Provision of care associated with elimination process and excrements.
3. Maintenance of balance between activity and rest.
4. Maintenance of balance between solitude and social interactions.
5. Prevention of hazards of human life.
6. Promotion of human functioning.

The postpartum care that which means the care given immediately after the delivery of the placenta up to the 6 weeks of postnatal period. Schedule of postnatal visit: First – within 24 hours, second visit- within 2-3 days, third- 4-7 days, fourth- within 45 days. ⁷

The postpartum period is from the end of labour until the genital tract has returned to normal. It usually lasts for 42 days. Support mother and family, prevention, early diagnosis and treatment of complications, counseling, support of breast feeding, educate on nutrition and supplementation, counseling contraception and the resumption of sexual activity, immunization of infant.⁸

The needs of women and newborn are: Information and counseling on: her self-health, self-care, sexual life, nutrition, contraception, support on physical and psychological from, health care providers, partner and family, employer, health care for suspected or occurring complications. eg: fever, PPH. Time to care for the baby. Help with domestic tasks. Social reintegration into her family and community. Protection from abuse/ violence women. Counseling regarding breast feeding techniques.⁹

In every visit assess for health and well being, symptoms of abnormal lochia, chest pain, difficulty in breathing, redness and inflammation of lower limbs, calf swelling and tenderness and examination of vital signs, breast, abdomen, perineum. Observe the feeding pattern and help the mother to improve the technique of breast feeding. Plan simple and healthy meals that include choices from all of the recommended groups like vitamins, proteins, minerals.¹⁰

Postnatal mothers needs to be explained to assess their own breast and do the self breast examination it helps finds any lumps, nodules. To assess the nipple for any eversion, flat, inverted, crackled nipple or having any pain and blistles. Should educate the mother regarding the breast feeding and the advantages of giving breast feed to the baby. While giving breast feed to the baby nipple should be washed with sterile water before and after each feeding. Keep the nipple clean and kept dry after the feeding.¹¹

The maternal infant bonding starts from first few movements after the birth. This is manifested by bonding, kissing, cuddling and gazing at the infant. The baby should be kept in her bed or in a cot bedside her bed. This is not only establishes the mother and child relationship but the mother is conversant with the art of baby care so that she can take full care of the baby while at home. ¹²

Aseptic techniques must be maintained specially during the first week of puerperium. Liberal use of local antiseptics, aseptic measures during perineal wound dressing, use of clean bed linen and clothing are positive steps. Clean surroundings and limited number of visitors could be help in reducing nosocomial infections. Administration of anti D – gamma globulin to unimmunized Rh – negative mother bearing Rh – positive baby. Women who are susceptible to rubella can be vaccinated safety with live attenuated rubella virus. The booster dose of tetanus toxoid should be given at the time of discharge; it is not given during pregnancy.¹³

Need for THE study

Many studies conducted on post partum period have extensively discussed healing of reproductional organs, but have slightly mentioned issues such as the transition process to parenthood, increasing fatigue, changes in the relationships with the spouse, starting to the pre-pregnancy social and professional activities and adaptation to the postpartum period. In other words, diagnosis of the healing process in the postpartum period has conventionally focused on the recovery of the reproductive organs and the physiological adaptation.¹⁴  

The world health organization (WHO) estimates that, of 536,000 maternal deaths occurring globally each year, 136,000 and 800 women die from pregnancy or child birth – related complications daily and approximately 287,000 women lost their lives during pregnancy and child birth related causes there are 43,64,885 new mothers reporting the disease.

The world health organization estimates that the incidence rate of neonatal complications is 40-49 per 1000 live births and 70% of the total infant deaths and more than half of under five deaths fall in the neonatal period. The world health organization estimates that child birth related complications is around nearly 2-3% per 1000 live births. According to 2015 – 2018 18.5 maternal deaths. ¹⁵

The world health organization estimates that 56% of postpartum hemorrhage during labour and the 5-10% of women during puerperium period. The world health organization estimates that puerperial sepsis accounts for 15% and sixth leading cause of the maternal deaths during this period. The world health organization estimates that 60% of maternal deaths due to PPH and 1000 deaths per 100,000 live births.

A retrospective cohort study was performed for patients attending a breastfeeding education class at an Army Medical Center. Controls were matched for sponsor rank, marital status, and smoking status. 194 mothers who expressed intent to breast feed received breast feeding education as follows: (a) a class that used video demonstration and group teaching by a lactation consultant, (b) a new mothers' support group with one to -one teaching prenatally and weekly meetings on postpartum, taught by a lactation consultant and a pediatrician, and (c) a control group educated at prenatal visits only. Results revealed that women who attended prenatal breast feeding classes had significantly increased breastfeeding at 6 months when compared to controls (P = .01). There was no significant difference in rates between types of classes offered (P = .45). The investigator recommended that prenatal breast feeding education can influence the amount of time women breast feed. All providers of prenatal care should consider offering such classes in order to improve breast feeding rates.¹⁶

STATEMENT OF THE PROBLEM:

A study to assess the effect of Orem’s self-care model on postpartum care among postnatal mothers at Narayana  Medical College Hospital, Nellore.

OBJECTIVES:

• To identify the self caring ability of postnatal mothers.
• To estimate the effectiveness of Orem’s self-care model on postpartum care.
• To determine the association between the effect of Orem’s self-care model on postpartum care with selected socio demographic variables.

RESEARCH HYPOTHESES:

H₁: There will be a statistically significant difference in the post test that the pre test after applying Orem’s self care model on postpartum care.

H₂: There will be a statistically significant association between the effect of care given using Orem’s self-care model on postpartum care with their selected socio-demographic variables.

DELIMITATIONS:

• Women who are in postpartum period and admitted in Narayana Medical College Hospital, Nellore.
• Mothers with normal vaginal delivery.
• The sample size is 60 postnatal mothers.

METHODOLOGY:

RESEARCH DESIGN: Quasi experimental design was used.

O₁=Pre-test (To assess the level of health outcome)

X=Intervention (application of Orem’s self-care model)

O₂=Post-test (To determine the effect of care given using Orem’s self-care model on postpartum care)

SETTING OF THE STUDY:

The study was conducted on postpartum mothers who are admitted in postnatal ward in Narayana Medical College Hospital, located at located in Chinthareddypalem, Nellore.

TARGET POPULATION:

The target population in the present study was all postnatal mothers.

ACCESSIBLE POPULATION:

The postpartum mothers admitted in NMCH, Nellore.

SAMPLE:

The sample of the present study was 60 postnatal mothers admitted in Narayana Medical College Hospital, Nellore and who fulfilled the inclusion criteria.

SAMPLING TECHNIQUE:                                                                                          

Non-probability convenience sampling technique was used to select the participants.

SAMPLE SIZE:

The sample size of the study was 60, among them, 30 participants were assigned to interventional group and 30 participants were assigned to control group.

SAMPLING CRITERIA

INCLUSION CRITERIA

• The women who are in postpartum period.
• Women admitted in NMCH, Nellore.
• Mothers who had normal vaginal delivery.
• The women who are willing to participate in the study.

EXCLUSION CRITERIA

• Mothers delivered by LSCS.
• Postnatal mothers who are not willing to participate.
• Postnatal mothers with other complications.

VARIABLES

INDEPENDENT VARIABLE:

Application of Orem’s self-care model 

DEPENDENT VARIABLE

Level of postpartum care

DEMOGRAPHIC VARIABLES

Age, parity, mode of delivery, number of children, education, occupational status and family income

DEVELOPMENT OF THE TOOL:

• The investigator developed a tool based on the objectives of the study.
• Construction of demographic proforma.

DESCRIPTION OF THE TOOL

SECTION-I

It deals with socio demographic variables. This includes age, education, occupation, family income, parity and mode of delivery.

SECTION-II

It consists of checklist to assess the self care ability of postnatal mothers. This includes 10 items.

SECTION - III

Rating scale to assess the effect of Orem’s self care model on postnatal care. It was categorized like universal self care, developmental self care and health deviational self care.  

SCORE INTERPRETATION:

INTERVENTION PROTOCOL:

Orem’s self-care requisites include

• Maintenance of sufficient intake of air, water and food
• Provision of care associated with elimination process and excrements
• Maintenance of balance between activity and rest
• Maintenance of balance between solitude and social interactions
• Prevention of hazards of human life and promotion of human functioning.

CONTENT VALIDITY

Content validity of the tool was obtained from 5 experts in obstetrics and gynaecological department and modified based on their suggestions. The suggestion of the experts was included and the tool was modified before conducting the main study.

RELIABILITY

The reliability of the tool was established by using split half method and spearman browns prophesy formula (split half method) r=2r/1+r and ‘’r’’ value was obtained. The ‘’r’’ value is 0.8.

PILOT STUDY

After obtaining the formal permission from the Medical Superintendent and Nursing Superintendent in Narayana Medical college hospital.  Pilot study was conducted on 6 postnatal women for a period of 1 week.

DATA COLLECTION PROCEDURE

After obtaining the formal written permission from the medical superintendent and nursing superintendent. The study was conducted in Narayana Medical College Hospital, Nellore. Data collection procedure was carried out for 6 weeks. To assess the effect of Orem’s self-care model on postpartum care. These self-care requisites was used for the data collection procedure that are: maintenance of sufficient intake of air, water and food, provision of care associated with elimination process and excrements, maintenance of balance between activity and rest, maintenance of balance between solitude and social interactions, prevention of hazards of human life and promotion of human functioning and these will be compared by using descriptive and inferential statistics. Data was analyzed and tabulated according to the objective and hypothesis.

Table-1: Frequency and percentage distribution of health outcome based on Orem’s model among postnatal mothers.                                                                                                                                 (N=60)                                                                                

Figure-1: Frequency and percentage distribution of health outcome based on Orem’s model among postnatal mothers.

Table-2: Frequency and percentage distribution of self care ability among postnatal mothers in experimental group.                                                                                                                    (N=30)  

ntetions on cyclic pelvic pain 13.3%) had self care agency.Table-3: Frequency and percentage distribution of self care ability among postnatal mothers in control group.                                                                                                                               (N=30)

Table-4: Effectiveness of self-care model on postpartum mothers in experimental group and control group.                                                                                                                                                           (N=60)

Table-5: Comparison between Orem’s self-care model on postnatal mothers in experimental group and control group.                                                                                                     (N=60)

MAJOR FINDINGS OF THE STUDY:

I: Frequency and percentage distribution of health outcome based on Orem’s model among postnatal mothers.             

The health outcome in experimental group, 28 (93.33%) were had average health outcome and 2 (6.67%) had good health outcome. Whereas in control group, 24(80%) were had average health outcome and 6(20%) had good health outcome.

1. Frequency and percentage distribution of self care ability among postnatal mothers in experimental group & control group:

• In experimental group, pre-test, 24 (80%) had supportive education and 6 (20%) had self care agency. Whereas in post-test, 26 (86.6%) supportive education, 4 (13.3%) had self care agency. And none of them came under fully compensatory or partially compensatory category either in pre test or post test.
• In control group, in pre test, 22(73.3%) are in supportive education, 8(26.6%) are in self care agency and in post test, 17(56.6%) are in supportive education and 13(43.3%) are in self care agency.

III: Mean and standard deviation of self care ability among postnatal mothers in experimental group and control group:               

• In experimental group, the pre-test mean is 24.2 with standard deviation of 1.51 and in post test mean is 25.3 with the standard deviation of 1.85.
• In control group, the pre test mean is 19.2 with standard deviation of 1.90 and in post test mean is 16.2 with the standard deviation of 1.64.

The findings show that, the calculated value is higher than the table value, and the research hypothesis is rejected and the null hypothesis is accepted.

IV: Effectiveness of Orem’s model on self care among postnatal mothers in experimental group and control group                 

• The paired ‘’t’’ test shows that in experimental group, mean is 24.2 with standard deviation of 1.85. Whereas in control group, mean is 19.2 with standard deviation of 1.64. The calculated value t test is 2.53 and the table value is 2.04. It discerns that the calculated value is greater than the table value at P< 0.05 level of significance. It can be concluded that there is effectiveness of Orem’s model on self care among postnatal mothers. Hence the research hypothesis is rejected and the null hypothesis is accepted.
• The independent ‘’t’’ test, shows that in experimental group, mean is 24.2 with standard deviation of 1.85 where as in control group mean is 19.2 with standard deviation of 1.64. The calculated value t test is 2.53 and the table value is 2.04. It discerns that the calculated value is greater than the table value at P< 0.05 level of significance. It can be concluded that there is effectiveness of Orem’s model on self care among postnatal mothers. Hence the research hypothesis is rejected and the null hypothesis is accepted.

V: Association between the self care ability with selected socio demographic variables among postnatal mothers in experimental group in post test.                                                  

• There was a significant association found between post-test on self care ability with demographic variables such as age, parity, number of children, education, occupation status of postnatal mothers at the level of P<0.05.
• There was a significant association between health outcomes with selected socio demographic variables among postnatal mothers such as age, parity, education, occupational status and income of family at the level of P<0.05.

The study concluded that there was a significant improvement on self care ability among postnatal mothers in experimental group as compared to the control group. The study shown providing the effective care will improve the good health status among postnatal mothers.

1. R & Tomey.AM. “Text Book of Nursing Theory Utilization and Application of Mosby’s” published by Elsevier; pg no 135- 139.
2. “Text Book of Midwifes”. 4^th edition. Published by Churchilivingstone; pg

 no 343-346.

3. DE “Text Book of Nursing Concepts And Theories Of Practice” page no 182-185.
4. v Raman “Text Book of Maternity Nursing” published by Wolters Kluwer , page no 423-426.
5. pubmed.com
6. http:// dx.doi.org/10.1590/0034 June 2016.
7. http://medlineplus
8. ncbi.nlm.nih.gov
9. scibd com/study document
10. World health organisation, 2012maternal mortality rates estimation
11. sciencedirect.com/ science articles
12. Lutsiv O, Mah J, Beyene. conducted an experimental study to assess the effect of self-care based on the teach back method on the postpartum quality care among postpartum mothers. Rev. 2015, pg no :531–536.
13. Rahman MM, 2015, conducted a prospective longitudinal study was conducted on postpartum mothers using self care model . page no 356-358.
14. john, conducted a study to assess the effect of socio demographic and psychosocial characteristics on breastfeeding duration of mothers attending breastfeeding support groups.
15. Alligood M.R & Tomey.N, conducted a study on early postpartum dietary practices among a group of Saudi women, volume-5, page no 542-543
16. Atici I, & Gozum S. (2001). Health education on postpartum anxiety and postpartum problems and its impact on the maternity, volume-4, page no 423-424.