Two Questions About Nursing Assessments

Dorothea E. Orem's Self-Care Deficit Nursing Theory focuses on the need for all patients to develop self-reliance, particularly after traumatic injuries or in cases of disability. A self-care deficit exists when patients lack the ability to care for themselves, such as by feeding the self, performing personal hygiene, or by behaviors that might be harmful to self or others. Nurses are defined as self-care "agents" within the Orem theoretical construct, as nurses are uniquely trained to provide evidence-based interventions that can help the patient achieve the goal of self-caring.

To help patients achieve their goals, the nurse will need to understand the health assessment process within the Self-Care Deficit Theory. The Self-Care Deficit Theory (also referred to more simply as the Self-Care Theory) conforms to the fundamental tenets of healthcare assessment including the design of a plan of care. Data is to be collected on the patient's health history and current health status, followed by the input from the health care team including physician ("Dorothea Orem's Self-Care Theory," n.d.).

Subsequently, the nurse collects information related to patient perception of health, the patient's health care goals. Finally, attitudes towards self-care and self-care behaviors are specifically assessed, which is what distinguishes Orem's theory from similar nursing theories that stress patient independence. During the assessment process, the nurse must also analyze the need for interventions, being open and honest about the role the nurse intends to play in the process (Wayne, n.d.). The nurse can then develop a coherent system of care including a plan for care delivery (Wayne, n.d.).

Finally, Orem's theory ties in with systems theories that show that both assessments and interventions reflect overarching systemic issues. 2. Therapeutic communication refers to the communication that takes place within the therapeutic context between patient and nurse. As Kourkouta & Papathanasiou (2014) point out, "good communication between nurses and patients is essential for the successful outcome of individualized nursing care of each patient," and good communication itself entails "courtesy, kindness and sincerity," (p. 65).

Therapeutic communication also requires the nurse to possess "self-awareness, self-understanding, and a philosophical belief about life, death, and the overall human condition for effective therapeutic use of self," ("Therapeutic Communication in Psychiatric Nursing," n.d.). Because communication is vital throughout the therapeutic process, the concept of therapeutic communication has become salient in nurse education and ongoing professional development. During the health assessment process, the nurse often initiates the tone for further therapeutic interactions. Techniques used include both oral and nonverbal communication and active listening.

Oral communication is only one aspect of therapeutic communication. Nonverbal communication includes physical appearance, dress, posture, gesture, use of touch, eye contact, and tone of voice, all of which the nurse can become trained to pay attention to, recognize, and respond to in order to promote the goals of therapeutic interventions ("Therapeutic Communication in Psychiatric Nursing," n.d.).

The therapeutic relationship between nurse and patient depends on the gathering of information during the assessment process that can be used to help the patient, but that information often requires the use of instruments, tests, and procedures. Those instruments, tests, and procedures need to be thoroughly explained to the patient, who should be encouraged to express fears and feelings as well.