Dorothea Orem's self-care deficit nursing theory and ethical dilemmas

Dorothea Orem: Nursing Theory Analysis

Nursing Theory Analysis

There are numerous nursing theories available for analysis and they are all decent theories. For the purposes of this paper, Dorothea E. Orem's nursing theory was chosen and will be analyzed. There are actually three nursing theories that Orem is known for: Theory of Self-Care, Theory of Self-Care Deficit, and Theory of Nursing Systems. The nursing theory discussed in this paper will be Orem's Self-Care Deficit Nursing Theory. This nursing theory may seem straight forward because of its name, but there are many components to it that when analyzed give a clearer picture of what the theory stands for and why Orem developed it.

The self-care deficit theory explains when nursing care is needed and this is generally when the patient is unable to care for himself. This theory encompasses everything from the patient needing full care to the patient needed education in order to meet his own self-care needs. This theory consists of five methods of help:

1. Providing complete care or acting for others -- This is when the patient depends wholly on nursing care because he is unable to care for himself.

2. Providing guidance -- Sometimes the patient may be able to care for himself, but needs direction on what to do in his particular situation.

3. Providing support -- Patients need to know that they have someone in their corner to assist them as well as provide guidance to them in their time of need.

4. Providing a positive environment for the patient -- In order for the patient to be able to care for himself, he must have all the necessary components to do this. This could include assistance from such sources as a social worker or even close family members.

5. Provide teaching -- Not only is guidance needed, but patients need to be educated on their particular situation so that they will know what to do in times of crisis.

The self-care deficit theory is assuming that patients will need some type of care because they cannot fully care for themselves. When a person cannot fully care for themselves, it does not always mean that they are physically incapable of doing this although sometimes physical incapability is the cause. A person may be in a medical situation where hospitalization is not needed, but assistance with everyday tasks such as bathing or changing a dressing is needed. Or, the patient simply may not know how to clean his wounds and dress them and will need guidance and teaching on this matter. Another issue a patient may have need of is something as simple as transportation to and from a doctor's appointment. This is where the nurse can assist with providing an environment in which the patient can fulfill whatever is necessary to get well.

TWO VALUES THAT MAY CREATE ETHICAL DILEMMAS

Providing a Positive Environment

Of the values contained in the self-care deficit theory, the two most likely to create ethical dilemmas for both the nurses and their patients are providing a positive environment and providing teaching. The first value mentioned, providing a positive environment may create a dilemma because now the nurse has to involve other people aside from the patient. When other people are involved in the care of another person, it is only right that they know what is going on just in case something unforeseen happens. The problem is that a patient's medical records are supposed to be confidential and the sharing of the information can pose ethical problems. The nurse must find a way to work with the patient and his family members or others involved in order to relay pertinent information in a way that does not cross any ethical boundaries.

Patient records and ethics are a serious issue in the healthcare field. Although not impossible, it would probably be difficult for a person to go into the nursing field and not care genuinely about the patients and their well-being. Nursing programs today require courses in ethics, but the subject of sharing patient information with the family is touchy because the nurse could find herself in a world of trouble if she discusses an issue regarding the patient with a family member that the patient does not want known. In order to avoid such a situation, perhaps the nurse can get in writing exactly what she can and cannot or should not discuss with the family. Privacy and confidentiality are issues that are important to patients and the nurse must respect this and not assume that everything can be told to the family members. This is one of the reasons ethics classes taught in nursing curriculums is so important. Not only do the classes teach the nurses what to do, they also provide guidance for the nurse to use her critical thinking skills in situations such as this (Griswold-Pierce and Smith, 2008).

CAN THESE VALUES STILL BE USED GIVEN THEIR DILEMMAS?

For the most part, all of the values within each theory will have some type of dilemma. A dilemma does not make the value useless because there are ways to work around it or to manage it so that the potential dilemmas can be contained successfully. Some values may have more dilemmas than others and with the self-care theory, the two values of providing a safe environment and providing teaching seemed to be the two that have the most potential for posing problems. Given the potential for problems, these values can still be used and used successfully.

The nurse can and must work with not only the patient, but all others involved in the patient's care. The first step would be to assess the current environment that the patient is in. This can be done only through constant communications with the patient. By doing this, the nurse can determine who she will need to communicate with next. She can also find out from the patient he wants her to tell them and what issues she should keep private. In order to have some assurance that she is doing the right thing, the nurse should probably have the patient sign some type of form in front of a witness stating what she can and cannot discuss with the family members.

Once this is done, the nurse should try to schedule a time to talk with all family members at the same time and be available to answer any questions that may arise. She has to be able to stress the importance of how everyone involved can contribute to making the patient's environment as stress free and conducive to a speedy recovery as possible. Handing out information and pamphlets pertaining to the issue will also be helpful because everyone can use these as a reference. The nurse should also leave a number where she is easily accessible in case any emergencies should arise.

In order to provide teaching to the patient, the nurse must be keen enough to at least determine somewhat the level of comprehension the patient possesses. No matter what, she cannot go in with the attitude that the patient will have a full and complete understanding of the issue as she does. What she should do first in order to gauge the patient's level of understanding is to have a general conversation about the topic and perhaps take mental notes of the responses. This will give her a good idea of the level of understanding the patient has and then she can tailor her teachings to fit the patient's level of understanding.

It is also a good idea for the nurse to give the patient as much printed information on the topic as she can because the patient can always use these materials as a reference in case the nurse is not readily available. If he teaching is about following a menu plan that will assist the patient in a speedy recovery, the nurse can have the patient keep a food journal of what he ate for a week or so and they can go over it together to determine what is working and what isn't. The same goes for the patient needing to be educated on any type of physical activities he must perform in order to improve and maintain his health. A weekly journal of the patient's planned physical activity should be kept and shared with the nurse at perhaps weekly intervals to determine what else is needed.

Another example would be a patient who needs to be taught wound care and how to change the dressing on his wound. The nurse can explain and teach him over and over again, but the best test is to allow the patient to clean and change the wound in her presence. This way she can guide him if he is doing something wrong and encourage him if he is doing a good job. Once the patient learns to care for himself properly and sees that his recovery is progressing smoothly, he is more apt to further engage in the self-care process. The nurse along with the patient must make sure the lines of communication are always open.

The safe environment and teaching portion of the self-care theory would more than work well with adult patients who are willing to actively participate in their own healing and recovery process. However, Orem's self-care theory may not always be applicable to adolescents. Children and younger people sometimes do not possess the level of understanding or maturity that an adult would. This is not to say that the adult patients are more qualified to follow the self-care theory, but sometimes children will need more guidance. Most children also have very little control over the environment that they live in, so it is up to the parents or other responsible adult care giver to step in and work with the nurse to make sure the recovery process is on track.

This does not absolve the child from taking some responsibility for his recovery. Baker and Denyes note that the younger the child, the more difficult it is to get him involved in his own self-care routine. The children may perform some takes, but not as efficiently as they should be. They suggest getting children into the habit of self-care early on so that it will become routine in their lives (2008). At some point, the child may even be able to care for himself fully without the help of an adult.

CONCLUSION

Orem's self-care theory is important because it encourages patients to take ownership and responsibility for the aspects of their healthcare that they can manage themselves. This can cut down on the length of the hospital stay and in the long run, it can save the patient from being responsible for the rising costs of a hospital stay. The values contained within this theory are relevant to the theory itself because each one ties into the fact that although the patient will be caring for himself, support, training and guidance will be provided every step along the way. There will be dilemmas with each of the values in Orem's theory, but the skilled nurse will know how to find ways to make those dilemmas manageable so that they do not pose any problems. The self-care theory is not a means of putting the patient out on his own, but it is a way to provide open communications between the nurse, the patient and all family members involved. If everyone involved work together, the patient can be assured of a smooth and fast recovery.