Nursing Theory Application

NURS 306

Old Dominion University

I choose the Self-Care Deficit Theory (SCDT) by Dorothea E. Orem for my theory application paper. I enjoyed learning about Dorothea Orem and the creation of her SCD Theory. It made good common sense to me and it can be applied in a variety of patient populations.

Summary

I would summarize the SCDT as the patient, being self-reliant and responsible for their own wellbeing experiences different levels of healthcare needs during their lifetimes, the nurse, as part of that equation, fulfills that need for assistance for the individual to regain their health. The SCDT identifies every individual as unique, not everyone fits into the same mold or nursing care plan. The personal knowledge of an individual regarding their health directly impacts their own well-being and the nurse is an important part of that education. The SCDT is a combination of related pieces. Self-care is based on the activities of daily living which every individual performs for themselves to maintain their own lives and their own health. Self-care agency is the individual’s ability to perform that care for ones-self which is affected by differing factors such as age, physical development, financial situation, family and other available community resources. Therapeutic self-care demand, is the accumulation of self-care actions performed over a set amount of time to meet certain necessities of health and well-being. Self-care requisites are the “musts” to maintaining and promoting a healthy life. There are eight universal self-care requisites in Orem’s theory are air, water, food, elimination, activity balanced by rest, socializing balanced by solitude, safety, and a sense of normalcy. Self-care deficit is where nursing comes in to assist the individual either in a supportive role, assistive role or complete care role.

The benefits of this theory are numerous, it can be applied to a variety of patient populations in multiple settings. One of the limitations is that at first glance it can look complicated because of the different related theories and layers.

Journal Article

The article I chose is “Developing a Supportive-Educative Program for Patients With Advance Heart Failure Within Orem’s General Theory of Nursing” by T. Jaarsma, R. Halfens, M. Senten, H.H.A. Saad, and K. Dracup published in the Nursing Science Quarterly in the summer of 1998. The main focus of the article was on the development of a supportive-education program based on the SCDT for individuals and their families experiencing the effects of heart failure. The article discusses how the use of SCDT provided a clear framework for the complex symptoms and treatments involved with treating heart failure and the implications for everyone personally involved. The article points out how it’s not a one size fits all process dealing with, or recovering from, hearth failure. The article reviews how the SCDT addresses all sides of the process through their physical symptoms, the personal impact, and social aspects effecting individuals with this specific diagnose. It draws clear connections with the SCDT and the application to heart failure patients, the methods used in the application, the therapeutic self-care demands of the patient population, self-care agency involved, assessment tools used, the supportive education of heart failure patients, and the testing of that program. They also discuss how a combination of information from nursing care plans, journal articles, and text books in combination with the SCDT were applied to the process in creation of the supportive educational program for this specific patient population. The authors also concluded that more work still needed to be done in the area of developing supportive educational programs for specific patient groups. This article seems to encompass all aspects of the patient need with the application of SCDT to this population. It also appears to meet the complexities of individuals with heart failure and their families. The testing of each self-care requisites or deviation as it applies to individual’s suffering from the effects of heart failure are easy to follow and connect with the impacts in this article.

Clinical Practice

This theory relates to my own clinical practice area in numerous different aspects. Each new admission to detox has their own personal self-care deficit and this theory can be applied at any stage. Through assessment of an individual I am able to assist the patient either wholly, partially, or supportively. A detox client’s Universal Self-Care Requisites are out of balance. Many of them are daily smokers, are dehydrated, are malnourished, have diarrhea or constipation, have insomnia or are sleeping all day and all night, aren’t able to interact with others in an appropriate manner (lying, cheating, stealing), engaging in hazards behaviors regularly with the over use drugs and/or alcohol, and have a distorted sense of normalcy. At any given time with each admission to detox numerous Therapeutic Self-Care Demands (TS-CD) can be identified within this patient population.

The most prevalent issue of TS-CD I encounter with detox patients is dehydration. The nursing diagnoses of fluid volume deficit. The main outcome is to increase the amount of fluids consumed and the goal to achieve is improved hydration. The objective is for the patient to verbalize understanding of the importance of hydration by voluntarily increasing their consumption of fluids. The design for nursing is supportive educational. The method of help is by education, guidance, support and providing an optimal environment. The objectives implemented in cooperation from patient to increase fluid intake with an understanding for required change is to have their requisites fulfilled. The patient would acknowledge the importance of proper fluid intake for their own wellbeing, and the Self-Care Deficit would be addresses with their increase of adequate fluid intake and adequate hydration.

Personal Philosophy

My own personal nursing philosophy is based on the golden rule, personal integrity, freedom through autonomy, and justice. I like to believe these principles direct my nurse-patient relationships while I administer care and create an environment of recovery and wellbeing. Caring for others as myself, has always been a deep moral conviction of mine. My personal nursing philosophy is simple, remember to treat others as I want to be treated. Dorothea Orem’s SCDT is much more advanced in its complexities, but I believe the bases of her theory is the wellbeing of others which starts with herself. She values independence and the promotion of helping an individual be their personal best which could be considered treating others as you want to be treated. I want to be my best, to be encouraged and independent that’s what the SCDT is focused on. The SCDT seems to meet the individual where they are and not where we want them to be as nurses.

Learning

Learning about Orem’s SCDT really opened my mind to new perspectives regarding the roles the nurse plays in the wellbeing of her patients. This lesson gave me an opportunity to develop a more well-rounded view of how, as a nurse, I fit into the personal care of others as needed. As a nurse I have wholly supported, partially supported and been the supportive educator when providing care to patients. I had never thought about the theory behind the relationships before in my nursing career. This assignment also gave me the opportunity to learn about the research application of this theory through the journal article. This exercise force me to come up with my own summary which caused some critical thinking, then how the SCDT is directly applied to my own clinical environment helped me to really put it into action.

References

Berbiglia, V.A. and Banfield, B. (2014). Self-Care Deficit Theory of Nursing. In A. Editor, Alligood, M. R. (Eds. 8), Nursing Theorists and Their Work (pp. 240-557). Missouri: Elsevier.