The Orem theory defines nursing as the act of assisting other people, for instance, those with disabilities, to attain self-care capacity and maintain it and improve its effectiveness (Orem, 1990). The major themes in her theory include self-care, the nursing system, and self-care deficit. Self-care refers to the personal initiatives by an individual to enhance life, his health, and general well-being. Self-care deficit concept refers to the inability to perform self-care due to various reasons which include age, disabilities, health, and sociocultural issues among others things. The nursing system refers to the team of nurses who facilitate self-care to a patient who are unable to care for themselves (Taylor, S.G. (2006).
Peter is a 62 years old retired high school teacher, who came to the hospital accompanied by his son and was admitted. He is 97kg and has a height of 177cm, with a body mass index of 30.7 showing that he is overweight. Peter was admitted, and he complained shortness of breath for past three weeks which had worsened on that day. The symptom was accompanied by fatigue, legs swelling up from the thighs, orthopnea, and nocturnal dyspnea. Three and five years ago he had been diagnosed with heart failure and hypertension respectively. For the two conditions before the admission, Peter was using simvastatin and frusemide both 40mg, Metoprolol 50mg, asprin150mg, and amlodipine 10mg. Peters father as show from the family history succumbed to ischemic heart disease, and his elder brother suffers from hypertension. For the previous 31 years, Peter has been smoking 3-4 cigarettes each day and take alcohol regularly. His blood pressure was at 97/83, while the heart rate was at 111 per minute. His son reported that he did not take his medication as required which worsened the condition. From Orem's theory of self-care, the three major concepts can be used to facilitate positive outcomes for Peters situation. Self-care practices that Peter can apply include avoiding smoking, taking regular exercises to control his weight, and taking a balanced diet. He can also learn to take medication as prescribed to manage his condition. He is old, and this hinders his ability to engage in physical exercise a condition under Orems theory known as self-care deficit. He can be assisted by family members and nurses to start small exercises and adjust with time to prevent self-injury. He can also be provided with nursing systems services such as education to help him identify the cause and factors that worsen his condition. For instance, he should understand that his weight, smoking and alcohol taking worsen his condition. He can be provided with rehabilitative services and addiction counseling and treatment to help quit smoking and taking alcohol. The expected outcome, will be reduced weight and drop body mass index, improvement of his hypertension and hence heart failure case.
Form the theory the advanced practice nurse play three roles, as stipulated by the theme of the nursing system, depending on the needs of the patient. The first one is a wholly compensatory system, where the nurse compensate care for the patients who exhibit total inability for self-care (Taylor, Geden, Isaramalai and Wongvatunyu, 2000). For instance, those patients whose self-care activities that requires manipulation and ambulation movements require. The second one is supporting through channels of education, where the patient can perform self-care but still need support. The third one is partly compensatory nursing where the patient and the nurse perform self-care activities, for instance, those that require manipulation and ambulatory movements.
Jean Watson mid-range theory of human caring provides for three major concepts which are related; the first one is the environment, health, and people (Pajnkihar, Stiglic, and Vrbnjak, 2017). For Peter, a heart failure patient to realize the outcomes as stated by the theory various activities have to be performed by an advanced nurse practitioner. The nurse has to establish a caring relationship with the Peter. The nurse will then apply a holistic system of treatment that focuses on the body, spirit, mind, and the soul (Cara and O'Reilly, 2008). The nurse has to display unconditional acceptance to the Peter to facilitate recovery. There should be a caring moment where the nurse and the patient bond without interruption through a talk (Watson, 2008). The advanced nurse to use professional knowledge and other interventions to facilitate treatment.
Cara, C., & O'Reilly, L. (2008). Embracing Jean Watson's Theory of Human Caring through a reflective practice within a clinical situation. Recherche en soins infirmiers, (95), 37-45.
Orem, D. (1990). A nursing practice theory in three parts, 1956-1989. In M. E. Parker (Ed.), Nursing theories in practice (p. 47-60). New York: National League for Nursing.
Pajnkihar, M., Stiglic, G., & Vrbnjak, D. (2017). The concept of Watson's curative factors innursing and their (dis) harmony with patient satisfaction. PeerJ, 5, e2940.
Taylor, S. G., Geden, E., Isaramalai, S. A., & Wongvatunyu, S. (2000). Orem's self-care deficitnursing theory: its philosophic foundation and the state of the science. Nursing Science Quarterly, 13(2), 104-110.
Taylor, S.G. (2006). Dorothea E. Orem: Self-care deficit theory of nursing.
Watson, J. (2008). Nursing: The Philosophy and Science of Caring (rev. ed.), Boulder: University Press of Colorado.
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