Applying Orem

The core of nursing is theory guided practice. Nurses uses concepts, principles and theories of nursing to meet the health needs of the patients. Nursing practice is the art and science of caring and healing. In order to provide holistic and effective interventions, nurses use the theories to develop plan of care. Nursing is a combination of theories and it always guides practice. Theory-based nursing practice is the “application of various models, theories, and principles from nursing science and the biological, behavioral, medical and sociocultural disciplines to clinical nursing practice” (Kenney, 2013, p. 333). As one of the oncology and rehab nurse we come across many patients who suffer from neurogenic bladder problems. The importance of this paper is to educate about self-care for the patients with neurogenic bladder, with emphasis on Orem’s theory. The intent of this paper is to show how nurses use the theoretical principles in practice. Neurogenic bladder problems are seen in spinal cord injury patients. An article from the Journal of Nursing stated that each year about 11,000 people are affected by spinal cord injuries in United States.

A number of cases have spinal tumors which may cause compression of the spinal nerves and cancer patients who have undergone sacrectomies, all end up with neurogenic bladder. This neurogenic bladder problems may be temporary or a permanent problem with lifelong intervention so as to prevent complications like the urinary tract infections and sepsis. As this is one of the major concerns among the rehabilitation group of spinal cord injury patients, creating awareness and helping the nurses understand its importance helps in providing the patients with optimum care. Understanding Orem’s theory and applying it to practice, will help the patient to perform self-care, which in turn will make the individual independent and help them maintain the quality of life. The article in the Journal of Nursing clearly states the problem patients face and what are the interventions required to improve the self-care deficits. Neurogenic bladder is a condition in which a person does not have bladder control. The main cause for the neurogenic bladder can be brain damage, spinal cord conditions or nerve conditions.

In patients with neurogenic bladder the problems can be of two different types: urinary incontinence and urinary retention. Urinary incontinence is a condition in which the patient has the urge to void, but by the time this message is relayed to the brain, there is urgency and incontinence occurs. The other condition is the urinary retention, in which the urine is retained in the bladder for long time. Patient does not have the urge or sensation to void. When the bladder is full, it can tend to overflow and lead to incontinence too. Here only the overflowed urine comes out and the rest of the urine is still retained within the bladder, which means the patient is unable to empty the bladder completely. This will end up in stagnation of urine and leads to urinary tract infections. For patients who suffer from neurogenic bladder, intermittent catheterization is one of the recommended intervention. The intervention of intermittent urinary catheterization is used to high lighten the importance of theories and principles from biology, physiology, and medicine into nursing (McEwen & Wills, 2014, p. 422). Intermittent catheterization is referred to “regular periodic use of a catheter to empty the bladder” (Bulechek et al., 2013, p. 406). This is done to eliminate the urine out of the bladder and reduce the risk of urinary tract infections.

This intervention can be done by the nurse, family or the client themselves. In this situation, the nurses have an important role of educating and helping patient to be independent and maintain their quality of life in the society. Orem’s Self-Care Deficit Nursing theory plays an important role here. The nurses use Orem’s theory as their motivation to attend to the need of the patient. Nurses must go above and beyond to help patients meet their needs, preserve their health, make them comfortable and so they can enjoy their family life. Nurses have an important role of acquiring knowledge and understanding the importance of bladder management and educating this for the patients, so that the patients can be independent about their self-care. Patients psychosocial state also needs to be taken into consideration and family involvement is important. The patient may be anxious and worried, the nurse need to maintain professional communication skills to make the care effective. Understanding the importance of neurogenic bladder problems, interventions and complications help in providing theory guided practice with effective outcome. Applying theory to a practice problem

The problem identified is care for patients with neurogenic bladder. The self-care deficit nursing theory by Dorothea Orem is implemented into practice in the care of patients with neurogenic bladder. Orem’s theory is outlined into three categories : theories of self-care, self-care deficit, and nursing system (McEwen & Wills, 2014, p. 143). BIOGRAPHY OF THE THEORIST

Dorothea E. Orem one of the nursing theorist of America, was born in Baltimore, Maryland in 1941. She received her diploma in nursing from Providence Hospital School of Nursing in Washington, DC, and her baccalaureate degree in nursing from Catholic University of America (CUA) in 1939 and later in 1945, earned her master’s degree from the same university (Taylor, 2006). She practiced in different roles like private duty nurse, hospital staff nurse, operating room nurse, supervisor and as educator. She took the position as a curriculum consultant in 1957 at the US department of health Education and welfare (McEwen & Wills, 2014, p. 142). She was the assistant professor of Nursing education and an acting dean of the school of nursing at CUA (Taylor,2006). She has published books and had numerous honorary doctorates and other awards as members of the nursing profession have recognized the value of the self-care deficit theory (Taylor, 2006).

Dr. Orem died in 2007 and nurses will remember her as one of the pioneers of nursing theory (Bekel, 2007) The main goal of the theorist was to upgrade the quality of nursing in general hospitals at all state. She was influenced by her association with other nurses and as well as by the writings of the psychologist M B Arnold, who focused on individuals emotions and personality. The theory explains the relation between patients abilities to perform the action and to meet the self care need (para. 3). Currently the theory is referred to as self-care science and nursing theory (Taylor & Renpenning, 2001). CONCEPTS AND PROPOSITIONS

Theories usually emphasis on four different concepts: nursing, health, environment and human being. Each theorist explains the concept according to their specific theory. In Orem’s theory the main concepts are: Nursing: is an art of caring. The nurses use the theory to render care to the patient depending upon the needs of the patient and to maintain a state of health and well being. The goal of this theory is to offer care to the patient or help the members of the family to meet the needs of the patient. Care is taken to prevent complication, and to preserve the health. Health: is “being structurally and functionally whole or sound”(A, 2011, p. 2). Health reflects on one’s own self, what they experience and how they communicate. Environment: is the surrounding where the patient is and the stimuli that occurs from external source.

The environment can be health team members, family, community, culture, physical, chemical or biological factors that influence the client. Human being: are defined as “men, women, and children cared for either singly or as social units”(McEwen & Wills, 2014, p. 143). They have the capacity to interact and react. Other than these main concepts, numerous additional concepts were formulated to Orem’s theory of nursing. They are: Self care, Self-care requisites, Universal self-care requisites, Developmental self-care requisites, Health deviation self-care requisites, Therapeutic self-care demand, Deliberate action, Nursing system and Product of nursing (McEwen & Wills, 2014, p. 144). OREM’S THEORY

Orem’s theory is logical in nature and interrelates the concepts, to the particular problem. Orem’s theory is used a guide to implement and improve the practice. Humans maintains a continuous interaction with their environment to restore their ability and remain functioning. Humans involve in identifying the need and making adjustment to live accordingly. There are few strengths and weakness that have been identified. The strengths is that the theory provides a comprehensive base for the practice and specifies the nursing need. Orem’s theory consists of three nested theories: theories of self-care, self-care deficit, and nursing systems (McEwen & Wills, 2014, p. 143). Theories of self-care: includes self care which the individual perform by themselves to maintain their health and well being.

Therapeutic actions with modified techniques are performed to meet the basic needs. Theories of self care deficit: includes care offered based on specific needs. The individual is unable to care for self due to disabilities or disease conditions and the patient receives care from a dependent adult, parent or care giver. This involves identifying the need, helping, guiding, providing care and teaching. Theory of nursing systems: includes patient’s self care is done by the nurse, the patient or both. The patient may take guidance from the nurse and perform the self care, or the nurse does the care for the patient. The nurse and the patient need to maintain a professional relationship and interpersonal communication. APPLICATION OF THE THEORY

Orem’s theory is used to assess the patient’s condition and identify the need of the patient. For effective assessment and problem identification, maintain good interpersonal relationship between the nurse and the patient is very important. Based on the needs, the theory is used to implement plan of action and care. After these the final step is evaluating the outcome. The article from current nursing theories explains the applications of Orem’s theory into practice(“Nursing theories-a companion to nursing theories and models,” 2013, p. 3). The application of self care theory helps to identify and prioritize the need of the patient. The main aspects or the basic needs of humans are specified as: air, food, water, elimination need, rest and activity. The interventions are prioritized depending upon the patient’s condition and need. The intervention are planned to obtained optimum level of care. The mode of helping can be by guidance, teaching, supporting and providing suitable environment. Applying theory to practice problem:

The problem identified here is care for patients with neurogenic bladder. An article from the Journal of Nursing (Cenk, 2013, p. 129) showed evidence of problems, patients face due to neurogenic bladder as a result of spinal cord or spinal nerve injuries. Neurogenic bladder is a condition in which a person does not have bladder control or may not have the urge or sensation to void. This can be due to brain damage, spinal cord injuries or spinal nerve injuries. The cause is identified and interventions are carried out to meet the elimination need of the patient and give comfort to the patient and prevent complication. In these conditions, intermittent catheterization is one of the recommended intervention. The intervention of intermittent urinary catheterization is used to high lighten the importance of theories and principles from biology, physiology, and medicine into nursing (McEwen & Wills, 2014, p. 422).

Intermittent catheterization is referred to “regular periodic use of a catheter to empty the bladder” (Bulechek et al., 2013, p.406). This intervention can be done by the nurse, family or the client themselves. The patients need to be educated about the importance of intermittent catheterization , the equipments and resources. Self catheterization is where patient will do self-care, but if there is a deficit in self-care due to physical disabilities and medical conditions, then the family or the care giver help the patient by performing the needs necessary for the patient. The condition in which the patient is unable to take care of themselves, is called self-care deficit. Orem’s theory of self-care deficit is used in clinical practice to help the patients meet their basic needs to live a optimum life . By keeping Orem’s theory as the guidance, nurses engage themselves in carrying out interventions to the patients. The role of the nurse can be in three different ways: 1) the nurse or the family, does the total self-care of the patient –this is because of the self-care deficit capabilities of the patient, where the patient is not able to perform any activities due to physical or mental limitation. 2) the patient can perform half of the action and the nurse does half.

The nurse may set up the equipments needed for the patient and provide guidance for doing the catheterization. There is equal participation from both parties. 3) in certain conditions the nurses are just providing guidance and hints for the patient to perform the action and the patient is able to perform the catheterization by themselves. In this situation, the underlying aspect of Orem’s theory is to engage humans in continuous communication and participation among themselves and their environment to keep them alive and functioning by performing self-care or dealing with self care deficits (McEwen & Wills, 2014, p. 144). In clinical practice the nurses play an important role of acquiring knowledge and understanding the importance of bladder management, educating and guiding the patient and the family.

REFERENCES

(2013, Jan 2013). Self-Care for neurogenic bladder in people with spinal cord injury-Integrative Review. Journal of Nursing. http://dx.doi.org/10.5205/reuol.4843-39594-1-sm.0801201418 McEwen, M., & Wills, E. M. (2014). Theoretical basis for Nursing (4th ed.). Philadelphia: Lippincott Williams & Wilkins. Nursing care plan/NCP neurogenic bladder. (). . Retrieved from www.enurse-careplan.com › Nursing Care Plan (). Orems theory (Doctoral dissertation). Retrieved from
Oremstheory.webs.com/theoretical influences A, G. (2011). The self-care deficit nursing theory [Theoretical Foundations of Nursing]. . Retrieved from http://currentnursing.com/nursing_theory/self_care_deficit_theory.html Application of Orem’s self-care deficit theory [Nursing theories]. (2013, Sept 9, 2013). . Retrieved from currentnursing.com/…theory/application_self_care_deficit_theory.html Cenk, V. (2013, Jan 2013). Self-Care for neurogenic bladder in people with spinal cord injury-Integrative Review. [Journal of Nursing]. , 1, 128-136. http://dx.doi.org/10.5205/reuol.4843-39594-1-sm.0801201418 McEwen, M., & Wills, E. M. (2014). Theoretical Basis for Nursing (4th ed.). Philadelphia: Lippincott Williams & Wilkins. Nursing care plan/NCP neurogenic bladder. (). . Retrieved from www.enurse-careplan.com › Nursing Care Plan