Nursing theory applied in my case

Nursing Theory is a conceptualization of some aspects of nursing communicated for the purpose
of describing, explaining, predicting or prescribing nursing care. The development of nursing
theories made advance in nursing practice till now, I applied Orem's Self Care Deficit Theory
while providing care to my patient.

Introduction
 Born 1914 in Baltimore, US
 Earned her diploma at Providence Hospital – Washington, DC
 1939 – BSN Ed., Catholic University of America
 1945 – MSN Ed., Catholic University of America
 She worked as a staff nurse, private duty nurse, nurse educator and administrator and
nurse consultant.
 Received honorary Doctor of Science degree in 1976.
 Theory was first published in Nursing: Concepts of Practice in 1971, second in 1980, in
1995, and 2001.

Application of Orem's Self-Care Deficit theory

Objectives
-To assess the patient condition by the various methods explained by the nursing theory
-To identify the needs of the patient
-To demonstrate an effective communication and interaction with the patient.
-To select a theory for the application according to the need of the patient
-To apply the theory to solve the identified problems of the patient
-To evaluate the extent to which the process was fruitful.

Orem’s general theory of nursing

Orem’s general theory of nursing in three related parts:-
a. Theory of self care
b. Theory of self care deficit
c. Theory of nursing system

A. Theory of Self Care

This theory Includes:
a. Self care – practice of activities that individual initiates and perform on their own behalf
in maintaining life, health and well being.
b. Self care agency – is a human ability which is "the ability for engaging in self care" -
conditioned by age developmental state, life experience sociocultural orientation health
and available resources
c. Therapeutic self care demand – "totality of self care actions to be performed for some
duration in order to meet self care requisites by using valid methods and related sets of
operations and actions"
d. Self care requisites - action directed towards provision of self care. 3 categories of self
care requisites are-
 Universal self care requisites
  Developmental self care requisites
 Health deviation self care requisites

B. Theory of self care deficit

 Specifies when nursing is needed
 Nursing is required when an adult (or in the case of a dependent, the parent) is incapable
or limited in the provision of continuous effective self care. Orem identifies 5 methods of
helping:
-Acting for and doing for others
-Guiding others
-Supporting another
-Providing an environment promoting personal development in relation to meet future
demands
-Teaching another

C. Theory of Nursing Systems

 Describes how the patient’s self care needs will be met by the nurse , the patient, or both
 Identifies 3 classifications of nursing system to meet the self care requisites of the
patient:-
I. Wholly compensatory system
II. Partly compensatory system
III. Supportive – educative system.

I. Wholly compensatory nursing system

This system is needed when the nurse should be compensating for a patient’s total inability for
engaging in self care activities that require ambulation & manipulation movements. This system
is for those people who are:
 Unable to engage in any form of deliberate action. E.g.: person in coma.

 Aware & who may be able to make observations, judgments & decisions about
self care but cannot perform action requiring ambulating & manipulation. E.g.:
persons with C3, C4 vertebral fracture, head injury, etc.

 Unable to attend themselves because of psychologically & mentally inability.

E.g.: mentally retarded.

II. Partially compensatory nursing system

It is used when patient improves & able to meet self care requisites but needs a nurse’s help. The
nurse & patient play major roles in performing self care. E.g.: patient who can bath but needs
assistance getting dressed.

III. Supportive educative nursing system:

It is used when a person can meet self care requisites but needs assistance with decision making
behavior control or knowledge requisition. For e.g.: a patient with controlled hypertension who
seeks additional diet information from the nurse. In this system the nurse attempts to promote the
self care agency.
For my patient Mrs. Sunita Magar:
Step I -Self Care
As my patient was unconscious, so she was not able to provide self care.

Step II- Theory of self care deficit

As my patient was unconscious, so I was not able to guide or support but I was able for acting or
doing for others.

Step III- Theory of nursing system:

In theory of nursing system, I used wholly compensatory system.

Application of Orem’s theory to nursing process

Therapeutic self care Adequacy of self care Nursing diagnosis

demand agency
Air -Maintain effective Inadequate Potential for impaired respiratory status.
respiration
 

Water Inadequate Potential to fluid imbalance.

 Hazards   Inadequate  Potential for injury

Maintenance of health Inadequate Alterations in health status and potential for

status    bedsore, DVT, respiratory and other
Management of disease Inadequate complications.
process
Awareness of potential Inadequate Actual deficit in awareness and potential for
problems infection.
Adjust life style to cope   Inadequate Actual threat to self image
with change
Actual self deficit in planning for future
needs

Nursing care was provided by considering areas and priority according to Orem’s theory of self-
care deficit, which are listed below:
 Air
 Water
 Food
 Elimination
 Activity/rest
 Solitude/interaction
 Prevention of hazards
  Promotion of normalcy
 Maintain a developmental environment
 Prevent or manage the developmental threats
 Maintenance of health status
 Awareness and management of disease process
 Adherence to medical regimen
 Awareness to potential problem
 Modify self image
 Adjust lifestyle to accommodate health status changes.

Therefore, as my patient was unconscious, so I provided care to the patient by applying self care
deficit theory and identified problems of the patient and formulated nursing diagnosis based on
theory and provided care accordingly. As she was not able to eat and she was kept in NPO so IV
fluids were given and drops/minute was maintained, position was changed every 2 hourly, back
care, oral care and sponging was done regularly, potential hazards was prevented, side rails was
kept on bed as patient was violent on the first day, medications were given on time, etc.
As a result, when I went for follow up, patient condition was improving and her GCS was also
14/15 on 2070-12-18 and there was no any signs of infection too.
Date: 2070-12-12

S. Nursing Nursing Intervention Rationale Evaluation

N Diagnosis Goals
2. Risk for Patient a. Assess signs of infection. a. Assessment provides Patient
infection will be base line data for further breathing
related to free b. Carry out proper hand intervention. pattern was
multiple from washing before and after every b. Reduces risk of cross normal with
invasive signs of procedure contamination. intact
procedure. infectio airway after
n during c. Perform sterile technique c. promotes removal of the
hospitali while suctioning. secretion and prevent intervention
zation. pulmonary infection. .
d. Provide routine urinary
catheter care and keep urinary d. Reduces risk of urinary
system closed. colonization and risk of
ascending UTI.
e. Maintain adequate hydration
and nutrition. e. Improves general
resistance to disease and
reduces risk of infection
f. Monitor vital signs. from static secretions
f. Helps in detection of
signs of infection.