Term Paper on "Dorothea E. Orem Nursing Theory Analysis"

Term Paper 7 pages (2299 words) Sources: 4

[EXCERPT] . . . .

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).

Providing Teaching

Providing teaching to the patient is another area where ethical dilemmas can occur. This issue is of importance because the nurse wants to be sure that the patient understands the health issues he is facing and how to deal with them effectively. Even though there may be several patients with the same ailment that the nurse is caring for, each patient must be treated as an individual. Some patient's comprehension may be far about another's. Some may be more educated than other patients and can therefore understand what is being taught to him. As a result, the nurse may assume that all of her patients are at the same level of understanding as a few. Hanssmann et al. say that it is a good idea for the nurse to be thoroughly trained before even attempting to provide training to the patient (2010).

Being thoroughly trained not only means being trained in the subject matter at hand, but the nurse must also know how to talk to the patient so as not to seem condescending and must have a keen sense of the patient in order to know whether the patient is actually understanding what she is saying. At this level, the relationship between the nurse and the patient becomes more personal and it provides the perfect opportunity for the nurse to bond with the patient and show that she is involved and concerned about his well-being. It is important to note that the nurse should try to maintain a close, positive relationship with those in the patient's family because they are the ones that deal with the patient on the daily basis and can actually give the nurse tips regarding the patient (Cleary and Freeman, 2006).

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… READ MORE

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