Contributors: Katunzi Mutalemwa
Rosemary Eustace

Orem’s Self-Care Theory

History of Nursing in Tanzania

The history of nursing in Tanzania preceded from various endeavors which later brought transformation on the profession fortune. It started by domestic operations through sanitary services by few selected members who were chosen from communities to work as directors in various health undertakings back in 1925. Later then, in 1947 a first group of girls accomplished government-run nursing training at then Sewa Haji Hospital (now Muhimbili National Hospital) in Dar es Salaam.

At first it was so arduous to get men because the profession was regarded as a women’s career. The traditional challenge also curbed young women to attend childbirth or nurse male patients. Despite the challenges, some young men and women who had attained some education from mission primary schools joined the professional with strong determination and vibrant energy.

Between 1950 and 1987, a vast number of nursing schools offered professional studies to secondary school graduates, making a great visibility of nursing in Tanzania. In 1994, the first batch of Bachelor of Science in Nursing (BScN) students graduated at University of Dar es salaam now Muhimbili University of Health and Allied Sciences (MUHAS). Since then, a number of schools including Kilimanjaro Christian Medical University College (KCMUCo) have opened doors to many Tanzania students at various levels of studies. KCMUCo nursing school was started in 1999 and is among the first faith-based nursing schools in Tanzania operating under the Good Samaritan Foundation.

Education based on Orem’s Theory of Self Care

My journey at KCMUCo nursing school was full of excitement and challenges. For my graduating class, male students made up almost three quarters of the entire class. The education at KCMUCo equipped us with advanced knowledge, skills and appropriate attitudes relevant to nursing and midwifery practice in the 21st century. Most importantly, the program emphasized the value and promotion of self-care as an essential component of patient and family-centered as well as community care. As part of the Principal of Nursing course, we were introduced to Dr. Dorothea Orem a nurse pioneer in self-management principles in health care.

Orems-self-care theory defines nursing as “The act of assisting others in the provision and management of self-care to maintain or improve human functioning at home level of effectiveness.” (Orem, 1991). It focuses on the individual’s ability to perform self-care, defined as “the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being.” (Orem, 1991).

The Self-Care or Self-Care Deficit Theory of Nursing is composed of three interrelated theories: (1) the theory of self-care, (2) the self-care deficit theory, and (3) the theory of nursing systems, which is further classified into wholly compensatory, partial compensatory and supportive-educative (Orem,1991).

Initially, I rather thought the theory could be merely impactful to patients with problems and those visibly to care themselves (self-care deficit), particularly, in acute care settings. To mention, diabetic patients were the clue of consumers of this fortune. As nursing students, we were prepared to teach and direct patients on regular test and control of glucose as well as self-injection of insulin. I came to attest this when I was assigned to care for a day two post laparotomy patient on the surgical floor. After long standing days of nursing care management including bed bath, feeding, mouth wash and the like, the patient was able to get out of bed and complete some of the activities of daily living (ADLs) such as exercise without assistance.

Nursing Practice based on Orem’s Self-Care Theory

This experience indeed showcased the application of Orem’s self-care theory in action. Moreover, I learned that self-care is the ability of individuals, families and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a healthcare provider (World Health Organization, 2020). The definition aligns well with Orem’s theory of nursing systems which considers the patient’s well-being to be based on whatsoever support a nurse can offer in terms of compensatory, partial compensatory or supportive-educative support.

Supportive-educative strategies through health promotion and prevention initiatives have been instrumental in health care service delivery in Tanzania, especially in primary care clinics. To mention a few examples, regular family planning education and services offered by nurses at Reproductive and Child Health clinics have indeed reduced the rate of unplanned pregnancies, unattended babies, abortions and the list goes on. Also, the promotion of self-care awareness on non-communicable diseases such as hypertension and diabetes stand out to be an important role of nurses in the lives of patients and their families.

The provision of educative self-care to individual, families and communities affected by communicable diseases such as TB, cholera and HIV/AIDs is also a common practice among Tanzania nurses. The emerging COVID-19 pandemic has delineated new care demands on self-care requisites that Tanzania populations need to meet in order to stay healthy and free of the illness. With such as pandemic, nurses are being tasked to find new ways of assisting clients to effectively meet their self-care needs that best fit the cultural context.

Practice Exemplars

So, what are the current self-care needs of Tanzanians in the wake of the COVID-19? What kind of nursing system is in demand. Personally, I would like to highlight two exemplars that demonstrate a high demand for what I call non-pharmaceutical (NP) and Alternative pharmaceutical (AP) self-care nursing system interventions (i.e. the non-pharmaceutical primary prevention interventions) in Tanzania. My analysis on the NP and AP self-care interventions related to the current COVID-19 situation in the country assumes that Tanzanians’ self-care performances are influenced by their culture and other key societal influences on health education and behaviors. In addition, I believe that low and middle income countries are always at-risk of facing the burden of access to essential medicines (conventional) and services related to COVID-19, increasing their likelihood of turning to complimentary alternative medicine (CAM) to meet self-care needs.

First Exemplar

The first exemplar is focused on the role of nurses in promoting hand washing as a basic NP self-care strategy. We are all aware that waterborne diseases have always been catastrophic in Africa including Tanzania, mostly related to poor hygiene. Surprisingly however, recent anecdotal evidence from Tanzania nurses reveal that the number of children suffering from diarrhea has been declining following the COVID-19 pandemic due to regular hand washing practices. Why now? What made a difference this time compared to previous public health efforts on hand washing? This clinical observation warrants a critical inquiry by Tanzania and global nursologists. When I look closely at various social media outlets, I see messages supporting this change and realization of hand washing as an important public health self-care strategy.

I see individuals, families and communities adopting hand washing self-care practices. I must acknowledge that the Tanzania government and public health officials have played a key role in promoting hand washing by mandating businesses and communities to place hand washing stations in public buildings, schools and markets. This mandate has prompted public health innovations and creativity among young Tanzanians [e.g. social medial YouTube videos innovative hand washing station 1 and hand washing station 2].

Second Exemplar

The second exemplar relates to nurses’ roles in promoting complimentary alternative medicines (CAM) as an Alternative pharmaceutical (AP) self-care strategy. Herbal steam therapy (commonly known as kujifukiza in Kiswahili) demonstrated in this social media YouTube video herbal steam therapy has been a common self-care practice in many households in Tanzania following the COVID-19 pandemic. There is a public perception that the steam therapy in addition to fruits consumption promotes health and prevents one from contracting COVID-19. Locally, it is believed to be a reason why many Tanzanians are free from the virus…. Who knows! The method has received support from influential politicians and top government officials through the media. I also learned from the media that local village chiefs have been consulted to assist with finding safe herbal immune therapies for COVID-19.

Implications

What self-care implications can Tanzania nurses and global nurses draw from the two exemplars in this COVID19 era? As once mentioned by Dr Jacqueline Fawcett in her blog The value of primary prevention, that “As always, nursology has an answer to how to emphasize primary prevention”, I recommend that we “nurses” advocate for effective non-pharmaceutical (NP) and Alternative pharmaceutical (AP) self-care policies through the lens of unique nursing perspectives.

Likewise, it is important for nurses to understand the power of the media as a health promotion tool. The two exemplars clearly tell the story that upon planning of any successful health-related project, it is important to consider the role of government and media in health and health policy implementation.

We need to be proactive in assessing, intervening and evaluating NP and AP self-care practices to promote population health. The evidence in Sub-Saharan shows that, although nurses are receptive of alternative modalities, they still lack appropriate knowledge about complementary health therapies (Gyasi, 2018).

I am one of those nurses who lack appropriate knowledge about CAM. I was not fortunate to have this kind of education in my nursing program beside a one-day CAM observational opportunity during a palliative care rotation. We need to find better ways of integrating NP, conventional and alternative pharmaceutical modalities in nursing education and practice. We need to advocate for holistic approaches that include NP and AP strategies within the realm of the public’s needs and beliefs.

The “Kujifukiza” (i.e. herbal steam therapy) phenomenon was eye opening. Nursologists should collaborate with government officials and other health officials to study and put in place evidence-based protocols or guidelines that promote “safe” herbal alternative modalities as well as quality hand washing stations. Thus, to continue the dialogue on NP and AP self-care strategies, I would like to invite my fellow nurses and nursing students around the world to join me in the discussion by reflecting on the COVID- 19 pandemic as it relates to these important issues.

References

Dorothea Orem: Self-Care Deficit Theory https://nurseslabs.com/dorothea-orems-self-care-theory/ web accessed on 29/05/2020

Gyasi, R. M. (2018). Unmasking the practices of nurses and intercultural health in sub-Saharan Africa: a useful way to improve health care?. Journal of evidence-based integrative medicine, 23 2515690X18791124Gustav, M.&

Gregory, M., (2011).The History of Nursing in Tanzania. Nursing history review, 19:161-164.

Katunzi, A.M. (2020). Nurses The Cornerstone of Health care system. Available at URL: https://www.amazon.in/Nurses-Cornerstone-Health-care-system-ebook/dp/B082J2279R

Myint, P. K,; Bachmann, M. O,; Loke, Y. K,; Musgrave, S. D,; Price, G. M,; Hale, R., et al. (2017). Important factors in predicting mortality outcome from stroke. Age Ageing, 46(1):83-90. Available from: DOI: 10.1093/ageing/afw175

Orem, D. (1991). Nursing: Concepts of practice. (4th ed.). In George, J. (Ed.). Nursing theories: the base for professional nursing practice. Norwalk, Connecticut: Appleton & Lange https://www.who.int/reproductivehealth/self-care-interventions/definitions/en/ web accessed on 08/06/2020

About the Contributors

Katunzi Mutalemwa, BScN is an evolving young Tanzanian nurse leader who just completed his baccalaureate nursing education in the Fall 2019. He is currently working on a Non-Communicable Diseases (NCDs) project in Tanzania and waiting to start his one year nursing internship at Kilimanjaro Christian Medical Center in November 2020. Mr. Katunzi was honored to write his BScN thesis on ‘Nurses Experiences of Caring LGBTQ Patients with HIV Infections guided by Travelbee’s Human-to-Human Relationship Model’ at Swedish Red Cross University in Sweden. He recently published a book titled “Nurses the Cornerstone of Health Care System” to inspire his fellow nurses in Tanzania. He is the former Chairperson of the University Nursing Students Association of Tanzania (UNSATA). He would like to thank Dr Rosemary Eustace for her mentorship in preparing this information for Nursology.net.

Rosemary W. Eustace, PhD. , RN., PHNA-BC.  Associate Professor & Carnegie Fellow at Wright State University College of Nursing and Health. She serves in the Nursology.net Management Team  and is also a Nursology.net author