Orem's Nursing Model Patients Perception

Orem's Nursing Model PATIENTS PERCEPTION ON DISCHARGE BASED ON OREM'S THEORY SELF-CARE DEFICIT This work conducts research and makes examination of the nursing model of Dorothea Orem and further examines through a qualitative review of literature in this subject area whether the post-discharge telephone interview is an effective method of assuring patient comprehension of instructions and knowledge provided by the nurse at the time of discharge. This work examines several studies, including meta-analyses of the effectiveness and outcomes of having conducted a post-discharge follow-up telephone interview with patients.

PATIENTS PERCEPTION ON DISCHARGE BASED ON OREM'S THEORY SELF-CARE DEFICIT OBJECTIVE The objective of this work is the research the perception of a patient as to their readiness for discharge based on Dorothea Orem's Self-Care Deficit through comparison of a pre-discharge with a post-discharge telephone follow-up. INTRODUCTION This work takes a look at the Orem Model of Nursing of Self-Care and what this model has as its goals in achieving the patient's realization of self-care through provision of knowledge by the nurse.

PROBLEM STATEMENT It is critical that a post-discharge interview be conducted in assessing the patient's understanding and comprehension of the plan for their achieving self-care which is based on the Orem Model of Self-Care. Failure to assess the patient's comprehension is likely to result in a readmission or reoccurrence of the illness. THEORETICAL FRAMEWORK Provision of proper instruction and knowledge to the patient by the nurse has been shows to be effective in assisting the patient in achieving self-care and independent living.

However, it is the theory of this researcher that the failure to conduct a post-discharge interview by the nurse results in a higher readmission and reoccurrence rate than if the post-discharge interview had been conducted.

HYPOTHESIS The hypothesis of this work is that conduction of post-discharge interviews with the patient in order to assess their understanding and comprehension of the information and knowledge conveyed by the nurse will result in lower readmission and reoccurrence rates including but not limited to secondary infections and the patient's failure to take their medication as prescribed.

LITERATURE REVIEW According to the work entitled: "Orem's Self-Care Model: A Professional Nursing Practice Model" there are three systems that exist within the Orem's Model which are those as follows: (1) Compensatory system - nurse provides total care; (2) Partially compensatory system: nurse and patient share responsibility for care; and (3) Educative development system - patient has primary responsibility for personal health, with nurse acting as a consultant.

(Mayo, nd) The Orem Model of Nursing is one based upon the philosophy that "all patients wish to care for themselves." (Orem Model of Nursing, 2006) This model of nursing is known as the 'Self-Care' Model of Nursing and is specifically used in rehabilitation and primary care settings for the purpose of providing encouragement to the patient for them to be as independent as they possibly can.

In the work of Dorothea Orem three groups of requirements are identified by Orem which are those of: (1) Universal self-care requisites; (2) Developmental self-care requisites; and Health deviation requisites. (Orem Model of Nursing, 2006) The patient is not able to provision their own self-care requirements the nurse is responsible to first determine those deficits of self-care and to then define a support modality.

(Orem Model of Nursing, 2006) Orem states specifically that: 1) Care demands recognition by the care agent of the essential freedom of the other as a developing person to grasp possible courses of action, to reflect, and to decide; (2) Care demands that the care agent view the person being taken care of as subject who lives, experiences, ahs awareness of self and environment, attaches meaning to what is experienced; and (3) Care demands that the care agent respect and accept the person being taken care of as a subject who has more and more to do with his or her becoming or developing." (p.22) (Banfield, 1997) According to the work entitled: "A Meta-Analysis Research Supporting Discharge Phone Calls to Hospital Patients" states that: "Twenty-nine journal articles published between 1981 and 2004 were reviewed to aggregate the research findings on the validity and value of hospital staff making discharge phone calls to patients." (Meade, nd) The studies were conducted in various medical settings and with various patient-types and as well some were "very scientific designs assigning patients to control and intervention study groups, while others were less scientific and more qualitative." (Meade, nd) The report of Meade states that: "it is clear the findings reveal that discharge follow-up phone calls provide an invaluable opportunity to evaluate patient education, identify trends that may require improvements in practice, improve patient quality of care, determine patient's compliance with discharge instructions and access overall impressions of hospital performance." (Meade, nd) In fact many of the studies show that discharge phone calls."..significantly increase patient satisfaction when compared to those not receiving discharge phone calls." (Ibid) In the study of Ahrens, et al.

(2003 in the work entitled: "Improving Family Communication at the End of Life: Implication for Length of Stay in the Intensive Care Unit and Resources Use" published in the American Journal of Critical Care 2003; 12(4): 317-232 evaluated is the "effect of a communication team had shorter ICU stays (6.1 vs. 9.5 days) and hospitals stays (11.3 vs. 16.4 days)" Further stated is that costs were lower ($15,559 vs. $24,080) and that variable costs are down as well $5,087 vs. $8,035.

In the work of Bjorklund and Fridlund entitled: "Cancer Patients Experiences of Nurse's Behavior and Health Promotion Activities: A Critical Incident Analysis" states that: "Personal consideration and the nurses' cognizance, knowledge, competence, solicitude, demeanor and statements of understanding were found to be important. Continuous health promotion nursing interventions were of considerable value for the majority of this group of cancer patients. Oncology nurses could reconfirm and update the care of head and neck cancer patients by including health promotion activities in individual care plans.

By more frequent use of health promotion models, such as the empowerment model, the nurses could identify and focus on those individuals who needed to alter their life-style as well as tailor their approach towards these patients by setting goals for well-being and a healthy life-style." (Bjorklund and Fridlund, 1999) DESIGN AND SAMPLING The research conducted within the scope of this work is one of a qualitative review which will be conducted through a qualitative review of the literature to determine the validity of the hypothesis of this work.

DATA COLLECTION & ANALYSIS Collection of data is this study.