Evaluating Practice Through Theories And Assessment Answer

The 'Person' refers  to the recipient of nursing care. The 'Environment' is the internal and external surroundings that affects the patient. 'Health' is described to be the well-being of the patient and lastly, 'Nursing' is the practice of the art and science focusing on rendering safe, efficient and effective care to the client through knowledge and clinical skills alongside the associated multi-disciplinary team (Alfaro-LeFevre, 2011).

The different nursing theories have different emphasis on the different metaparadigms however, all of which share the same goal of achieving optimal health.

Theory 1: Orem’s Contemporary theory in Nursing

In Dorothea Orem’s theory, the researcher focusses on the self-care deficit model in the theory. This is one of the main nursing theories of the modern generations. The theory is one of the most complex with the broadest scope that are presented in nursing theories (Dickson, Deatrick, & Riegel, 2014).  The theory is about ensuring a healthy lifestyle which is the central focus for any individual. In this regard, governments will spend many funds in the health sector to ensure everyone in the community is fit health wise. Thus, all activities that the individual engages in will be looked upon so as to ensure they are physically and mentally fit. The initiative will look at taking care of small things in life that people will normally overlook.

 For example, physically care of the food they eat, water they drink and the air they breathe. They also need to take care of their mental health at all times (Jaber, et al., 2010).  Orem continues to stress in his theory that in the event an individual fails to take care of their wellbeing, it is imperative to seek medical assistance. This is also referred to as the self-care deficit. Through nursing, an individual is in the ability to overcome their limitations and make certain that they are provided with the assistance to cover a deficit that causes illness and other mental problems (Riegel & Dickson, 2010).

Orem argues that self-care nursing theory will look at the direction that nurses will take in their practice. If the main aim of a nurse is to assist patients, then they will be called upon to the direction of helping them meet their self-care need (Jurgens, 2014). For this reason, a nurse should understand the proper systems of nursing and ensure that they are applied in practice. 

Decades ago, the practice of nursing was usually put on a low profile as being a vocational occupation. However, Orem’s theory puts nursing practice in the lime light and ensures that proper systems in the practice are recognized and put in place. This makes nursing occupations more professional.  When one looks at Florence nightingale for example, she was the first person to bring to the profession the need to have a nursing system. From this time, the nursing profession has grown through various phases. However, in the contemporary era, Orem was able to come up with a comprehensive approach on how the nursing profession needs to be managed in order to achieve required results. To the present, the professions is studied just like any other medical discipline (Register & Herman, 2009). 

In turn, nursing has evolved positively over time. According to Orem’s theory of self-care, people need to be self-reliant and responsible when it comes to taking care of their health as well as the health of their families. The theory enabled people to interact and learn more about their health (Brown, 2011). Thus, people are able to meet and understand developmental and universal self-care as an important factor in primary care. In addition, if a person has the knowledge of their potential health problems, then they can be able to implement some self-care behaviors.

In order to discuss this well, Orem divided her theories in to three parts that included, the theory of self-care deficit, theory of self-care and the theory of nursing system.

Theory of Self Care

Here Orem discusses the practice of activities which a person initiates and performs in his or her own behaviour. These behaviours are meant to take care of their health, life and wellbeing. The self-care agency is the human ability to practice self-care activities. These practices will be conditioned by developmental stages, age, experiences in life, health, social cultural orientation and other available resources. They will also look at therapeutic self-care demand that are the total self-care actions which are to be performed by the individual in a given duration so as to meet different care requisites (Wangberg, 2008). At this the nurse will use related sets of operations, valid methods and other forms of action. Self-care requisites will look at different categories that emphasizes developmental, universal and health deviation self-care requisites.

Also Orem stated that the universal self-care requisites are essentials required throughout any individual’s life.  It ensured the integrity of human structure is maintained and functioning. The requisite were named by Orem as being Activities of daily living. They included areas such as, provision of care that is associated with the process of elimination, maintenance of food, air and water intake, prevention of things that are harmful in the human life, having a balance in activities and break times. There was also time to be alone and to socially interact. Lastly, the function of promoting human functioning (Endsley, 2010).

In saying this, the developmental self-care requisites will look at all the developmental processes of human life for instance, from young to old. They will be derived from particular conditions or be linked to a particular event.  In times of illness, there is usually health deviation, whereby an ill individual will seek and secure the much needed medical assistance. They will tend to be aware of the effects and results of their medical conditions. Due to the illness, they will need to carry out medical measures as prescribed by the doctor or nurse. Individuals will learn how to manage their illness and modify their own concepts to include their newly found medical conditions (Dickson, Deatrick, & Riegel, 2014).

The other part of this theory thus will look at when nursing practice  becomes important in the person’s life. According to Orem, the practice of nursing usually affects an adult who is limited in the provision of self-care or may not perform self-care activities.  So as to assist this individual, the nurse practitioner will act for and do these things for the individual, guide them, support and provide and environment which will promote their development. At this a nurse helps the individual meet their future demands.

Theory of Nursing

In the theory of nursing systems, Orem looked at ways that patient’s self-care needs were met by the individual themselves. She identified three classifications of nursing systems that will be needed by the patients for self-care requisite. These included the wholly compensatory system, the partially compensatory system and the supportive-education system. Orem recognized that with use of contemporary technology, members of the nursing industry are able to perform their duties well. These technologies include the interpersonal and social were communication is modified to the health status of the patient in relation to their age. The nurse in this case was responsible in maintaining the patient’s intra-group, interpersonal and inter-group relations to enable them coordinate (Hofmann, 2011).  During this time, the nurse needs to maintain a therapeutic relationship in view of the psychosocial modes of health functions and disease.

The nurse will conduct assessment of the individual actions, abilities, needs and limitations.  The other technology of regulation looked as factors that promote life processes. In this category, the nurse focusses on psychological and physiological needs of the health and disease diagnosis. At this the nurse’s job was to promote human development and growth and regulate movement and positions in space (Patel, Shafazand, Schaufelberger, & Ekman, 2007).  These approaches to nursing practice provides a way of judging deficits in self-care and also identify roles of the patient and that of the nurse to attending to the self-care demands. The steps in the approach are also the main components of nursing practice. In this regard, Orem insisted that they need to be well coordinated with social pressures and interpersonal issues surrounding the nursing practice.

Nursing process theory:

In this model, Orem discusses three parts, the first one is the assessment of the nursing practice. Data is collected to determine concerns which could be addressed by improving the nurse and patient relationship. The following step would be the definition and creation of the nursing care plan. Last but not least, is the discussion and evaluation of the nursing implementation of the care plan. Goals set by the patients should also be taken into consideration (Carlson, Moser, Sebern, Hicks, & Roland, 2009).

Theory 2: Florence Nightangale Traditional Theory

Florence nightingale is famous for an adherence to what is known as the traditional or the virtue theory of nursing care. The traditional concepts are found in the virtue model theory which looks at nursing as a profession that carries within particular moral obligations. The virtue theory holds the moral influence of nursing care on patients and other health care workers. The application of this theory in the practice is characterized by her contribution to the nursing profession (Alfaro-LeFevre, 2011). The theory is best remembered in the Crimean’s war’s ‘Lady of the Lamp’. Her influence in nursing is far reaching in the same regard.

Florence Nightingale was very instrumental during the establishment of different procedures and policies that addressed four main aspects of the virtue theory of nursing; promotion of patient welfare to the physical treatment, nursing duty of care, environmental health  and nurses acting in the capacity of the role models.  The theorist was very active in the innovation of the nursing practice applications in reference to hospital, surgical, clinical and home based care.

Virtue Theory

The virtue theory of nursing is inspired by services that nurses should be providing in relation to the internal and motivational values for the patient and the nurse practitioner. The theory discusses these aspects by indicating that nurses need to uphold traditional and social morality when providing healthcare. In this regard, they should also look at the practice of nursing in relation to pre-conceived imaginative standards that were originally defined by Florence Nightingale.  For example, in 1893 nurses in the United States had nightingale pledge written by Lystra E. Getter, superintendent of the Harper Hospital in Detroit. The pledge provide ethical orientation like other similar pledges which are not celebrated highly in Hippocratic Oath.  The virtue theory has for decades impacted on the duty of care among nurses in a very powerful manner as the responsibility rests on the nurse to be responsible and act in ethical manner with carrying on their duties (Cameron & Leventhal, 2013). 

They needed to do this with little or no supervision from their managers. Her vision in the field of nursing was to ensure they have professional responsibility which is linked to the life and challenges of the nursing profession. In doing this they have to ensure that they uphold their moral duty as well.

To embrace this type of responsibility, it called for a sense of moral agency that is linked to those who practice the nursing profession. It is the highest and the most original aim of a nurse according to Nightingale, because nurse have to be responsible persons and ensure little or no suffering of their patients. In addition, the traditional model with regard to the virtue theory emphasizes on specification and maintenance of quality when it comes to the nursing profession (Grant, 2013). The theorists advocated for recommended scientific methods of sanitation during the early days of her career, despite the fact that the setting was of the Crimean war, which was not ideal prototype to practice various environmental measures.

Nursing Model

With regards to the nursing profession, the traditional model came up with the following processes and actions. Nightingale stated that the roles of the nurse is to maintain pain reduction through administration of medication. They also needed to assist patients and other significant individuals in coping with the medical condition. In doing so, the nurse should also work with the patient and reduce tension that is related to the medical condition. The nurse should also serve as a liaison person between the patient, the doctor and other members of the family or relations. The nurse needs to make sure that the rights and wishes of the patient are respected and adhered to (McElmurry & Zabrocki, 2009). This will happen when the nurse creates an environment that a patient will accept his or her condition with privacy and dignity. They will also help the patient in carrying out care with compassion, empathy, skills and professionalism.

One of the reasons Nightingale laid down these processes, was to ensure that they are related to her own personal philosophy of practice of nursing and ensuring proper standards of care for the patient. This is because a nurse is within the boundaries of the practice and values are embraced upon. In the same regard, Nightingale also believed that when nurses are able to provide patients with a suitable environment there will be a positive recovery, which underlies in her theory (Alfaro-LeFevre, 2011). This means that she insisted on actions which bring innovative results to the care and treatment of patients.  In some of her literature also, she addressed the factors around provision and maintenance of an atmosphere that will be favorable in facilitating the healthy living and healing of the patient process.

Some of the factors that ensured a proper nursing and patient care environment were also highlighted by Nightingale as follows; cleaning, proper ventilation, health, proper lighting, feeding and odors.  If these factors were well considered patient recovery process will be possible and with the aid of nature. In the nursing profession however, the concern about environment has been paramount from the day professional nursing began in the nineteenth century. The nature of the profession is also witnessed in the present days of nursing care with regard to the environmental control around the patient. This is the kind of relationship that nightingale envisaged between the patient and the nurse environment. (Cameron & Leventhal, 2013) It is also important to note that the relationship is only among the devices needed for the development of the nursing professions. However, this can be added in other devices such as collegiate management, risk rating, training programs in the health profession, reference teams and the matrix support, companion rights and other open visits in the collective nursing care profession.

Lastly, relating to Nightingales traditional concept of nursing theory, the main goal of the nursing profession is to provide assistance for the patient. This means that the nurse should be able to maintain the patient’s vital capacity and meet their needs in all possible ways. In this regard, nightingale showed that nursing professions is not a healing practice as the patient condition and care will depend on the environment and not the kind of treatment received.  Here, the focus of nursing profession will be on matters to do with hygiene and other basic characteristics and concepts of their work.

Case Study and theory Application:

Madam Lee, aged 80 years is widowed and lives alone in a 1-room HDB rental flat in Toa Payoh. She is unemployed and is on public assistance. She has mild dementia, diabetes mellitus, chronic kidney disease, impaired vision and is at risk for fall. She is currently on more than 10 types of medications including, Risperidone. Madam Lee is non-compliant to medication and was admitted to the hospital a few times for hypoglycaemia. She has poor personal hygiene and her apartment is dirty and cluttered. She keeps leftover food in her refrigerator that has turned mouldy and rancid Madam Lee attends the Dementia Day Centre just a block away at irregular intervals. She is aggressive and does not get along with others at the centre. The day centre has committed staffs who have been trying to coax her to attend the sessions more regularly but to no avail.She is referred to the community case manager for further management. The case manager feels is it safer for Madam Lee to be admitted to a nursing home but she adamantly refuses.

Application of Orem’s Theory

In view of patient’s condition, there will be no chances or guarantees that patient can take care of herself independently which could be applied to Orem’s theory. Requires home nursing services or a nursing home where her ADLs will be taken care of. A better and cleaner environment will be available that would not make her more ill.

May improve patient’s violence issues when the patient is cared for properly. Moods and behaviours can be improved as well.

The case study clearly indicates a patient with a variety of chronic illnesses and is unable to care of herself. This is because all the elements of self-care have been manifested by the patient and can be used across the patient’s conditions during the processes of maintaining her health.  In fact, the theory of self-care was emanated from taking care of adults with dementia and other chronic illnesses. The clinical experience of the above case study shows that challenge that the patient has in caring for herself with her decision needs to be in line with the needs that have been dictated in her current condition. (Carlson, Moser, Sebern, Hicks, & Roland, 2009)  The clinician should ensure that there is self-care maintenance by the patient. This will look at ensuring the patient adheres to Dementia classes as they will be important to ensure her wellbeing and preserve her health. The clinical visits will also ensure that there is proper monitoring of her clinical conditions both emotionally and physically.  In her case, self-care will not only look at self-improvement but will also look at different behaviors that  could put her life at risk like smoking, eating healthy and coping with old age, given that she is 80 years old with a couple of chronic illnesses (Dickson, Deatrick, & Riegel, 2014).  At this, the patient needs to be assigned a clinical nurse that will ensure she is able to take her medication as needed. The activities will be imposed mostly by the nurses since she lives alone.

The patient will also need to be made to understand that the therapy is important in ensuring that she meets her own medical care goals.  This means that the importance of self-care is ensuring the patient has benefited from the reflection about the importance of her behavior and ensuring that she is able to perform the behavior. One of them being to attend the dementia lessons and an on-going evaluation of the effectiveness and benefits of the activities.  To add on the above, adaptation of the self-care behavior should also accommodate the changing lifestyle of the patient. There is need to ensure adherence as a very important part of self-care maintenance. The patient needs to adhere to therapies as they form a great part of the outcome of medication.  During this time, the main goal for the health care provider or the nurse will be to work in collaboration with the patient. They should negotiate the adoption of as many self-care behaviors as they can be tolerated by the patient and accepted (Dickson, Deatrick, & Riegel, 2014). At this, the health provider needs to put more emphasis on these therapies with the best evidence in supporting them.  This can be done well through self-care monitoring. During monitoring, the health care provider will assign a task that will conduct a process of routine vigilance of the patient adherence to self-care behavior. They will also constantly conduct checkups on how the patient is responding to medication and therapy and other Norman human behavior. They will for example monitor the patient’s memory, weight, breathing and acidity level to understand the gains and losses. Other patients will visit the dentist to monitor success or avoid other caries.  Monitoring constant is important as it will reveal whether a care has occurred or not (Good, 2009). This can be related to the diagnosed chronic illness or the patient behavior in adhering to dementia classes or taking medication and exercise.  Ways this can be recognized is through somatic awareness or sensitivity to physical sensations and bodily activity.

References

Alfaro-LeFevre, R. (2011). Critical thinking and clinical judgement: A practical approach to outcome-focused thinking. . Journal of Nursing Education, 10-16.

Brown, C. (2011). Nurses role in health promotions in school. . Canadian nurse, 107, 20-23.

Cameron, L., & Leventhal, H. (2013). The self-regulation of health and illness behavior. . London: Routledge.

Carlson, B. R., Moser, D., Sebern, M., Hicks, F., & Roland, V. (2009). Psychometric testing of the self-care of heart failure . Index. J Card Fail , 10(4), 350-360.

CL, C. L., & Lung, M. (2013). General principles of asthma management: symptom monitoring. . The Nursing clinics of North America. , 38(4), 585-596.

Dickson, V., Deatrick, J., & Riegel, B. (2014). A typology of chronic illness self-care management in non-elders. Eur J Cardiovasc Nurs., 7(3), 171-181.

Endsley, M. (2010). The role of situation awareness in naturalistic decision making. In Naturalistic decision making: (p. 436). NY: Lawrence Erlbaum Associates.

Good, M. (2009). middle-range theory of acute pain management: use in research. . Nurs Outlook, 46(7), 120-124.

Grant, R. (2013). Nursing Preceptors speaks out. Journal or professional nursing, 29(1), 30-38.

Hofmann, K. (2011). Decision making in clinical nursing. . Journal of Advanced Nursing, 53-62.

J.L.Donovan, & Blake, D. (2012). Patient non-compliance: deviance or reasoned decision-making? Soc Sci Med. , 34(5), 507-513.

Jaarsma, T., Stromberg, A., Martensson, J., & Dracup, K. (2012). Development and testing of the European Heart Failure Self-Care Behaviour Scale. . European Journal of Heart Failure. , 6(2), 363-370.

Jaber, W., Lennon, R., Mathew, V., Holmes, D., Lerman, A., & Rihal, C. (2010). Application of evidence-based medical therapy is associated with improved outcomes after percutaneous coronary intervention and is a valid quality indicator. . Journal of the American College of Cardiology, 46(8), 1473-1478.

Jurgens, C. (2014). Somatic awareness, uncertainty, and delay in care-seeking in acute heart failure. Res Nurs Health., 31(3), 74-86.

Malmstrom, R., Roine, R., & Heikkila, A. (2008). Cost analysis and health-related quality of life of home and self-care satellite haemodialysis. . Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - EEuropean Renal Association. , 23(9), 1990-1996.

McElmurry, B., & Zabrocki, E. (2009). Ethical concerns in caring for older women in the community. The Nursing clinics of North America, 24(4), 1041-1050.

Patel, H., Shafazand, M., Schaufelberger, M., & Ekman, I. (2007). Reasons for seeking acute care in chronic heart failure. . Eur J Heart Fail, 9(7), 702-708.

Register, M., & Herman, J. (2009). middle range theory for generative quality of life for the elderly. ANS Adv Nurs Sci. , 29(6), 340-350.

Riegel, B., & Dickson, V. (2010). A situation-specific theory of heart failure self-care. J Cardiovasc Nurs., 23(5), 190-196.

Wangberg, S. (2008). An Internet-based diabetes self-care intervention tailored to self-efficacy. Health education research. , 23(1), 170-179.