Friday, July 16, 2010

Ailene Mangahas

Dorothea Orem’s self-care deficit theory can be applied to almost all settings, not just in the hospital, clinic, or nursing homes, but most especially at your own homes. The goal of the theory is to help person to perform self-care, irregardless of his age and developmental stage he/she is in. Assistance will only be needed if the individual is unable to meet his basic needs. At home, the mother is the primary caregiver just like a nurse in the clinical setting. She determines which among the fundamental needs are not met by her child from infancy to adulthood, what steps to take to enable her child to meet them, and how much self-care her child is able to perform. It is the mother’s goal to increase her child’s ability to independently satisfy these needs.

For me, child’s developmental milestones are part of childs’s premature awareness to self-care like learning to hold milk bottle with his own little hands, being toilet-trained, learning simple hygiene like handwashing, bathing, etc. At an early age, individual has learned about his universal self-care requisites and how to meet these needs for his survival like eating when hungry, drinking when thirsty, sleep during the night, rest when tired, get along with friends, and protect himself from injury. Having Orem’s theory of self-care in mind, as a mother and a nurse to my children, I must instill to them that these self-care practices they learned must be maintained in order to keep them healthy and will prevent them from being ill.

However, at certain points an individual experiences an inability to meet self-care needs and demands due to limitation like a presence of a disease or illness. Here comes the unique roleof the nurse to identify the self-care deficit, perform ways to compensate. The role of the nurse is not only limited to covering up the deficit but it also extends to educating the individual about the disease process including its causes, signs and symptoms, treatment regimen and its side effects, complications and how to prevent complications. A condition, like diabetes mellitus,is considered to be a lifetime condition. The goal of the treatment is not to cure the patient from being free of it but to keep the sugar as close to normal level as possible as to prevent its deadly complications.

My 69-year old mother-in-law, who is living with us, has been diabetic (insulin-dependent) and hypertensive for more than 20 years already. I am proud to share that being well-equipped with nursing knowledge,I have applied my supportive-educative role as a nurse to her care. I acted as her advocate, redirector, support person and teacher in the entire struggle for her condition. I help her revise many of her health practices and lifestyle. I taught her a lot of things about proper insulin administration like rotating sites of injection to avoid tissue atrophy (before she used to inject at 1 site only-the abdomen); single use of insulin needle/syringe to prevent infection; correct way of cleaning the site prior to injection-applying the principle of asepsis and antisepsis, cleaning from inner (the cleanest) to outer (the dirtiest); no rubbing after insulin injection to avoid abrupt absorption of insulin to the system that may lead to hypoglycemia; disinfecting the vial port with alcoholized cotton to prevent insulin from being contaminated. I also discussed with her the signs of hypoglycemia and to keep candies on hand if in case this happens or an intake of sweetened juice will also help reverse hypoglycemia. I explained to her the importance of adhering to antihypertensive maintenance drugs, to keep her blood pressure from shooting up. I also did counseling about diabetic and low salt low fat diet. Moreover, I encouraged her to have regular check-up with her endocrinologist and cardiologist and have her laboratory tests be routinely monitored. So far, her latest glycosylated hemoglobin indicates that her sugar is in good control, and her blood creatinine level is still within normallimits indicative of adequate renal functioning. She has now fully understood that it is not diabetes that will make her more ill but the complications the diabetes will bring her. So she has maintained self-care and promoted activities that that will keep health and well-being. She has taken full responsibility to care for herself despite the presence of a disease entity.

I mother three children, aged 10, 8 and 2 who have asthma, a condition that they inherited from their father. When they were younger, my role is partly compensatory in their adaptation to their condition. I have taught them ways to recognize the symptoms of an attack, and how to operate the nebulizer using the prescribed ratio of ventolin and saline solution, how to use the metered dose inhaler (but when they were a year old they used a special device called babyhaler), which steps to take when attack happens in school, the do’s and don’t’s to prevent it.The success of these interventions will be made possible if there is give and take actions between me and my client( my children, in this case). As their nurse, I perform, compensate for their limitation, assist them as needed. At the same time, their participation plays an integral part in the process. Like with the inhaler,after demonstrating to them its correct use , they must able to show me the proper way to do it with perfect timing for breathing/puffing in and holding breath for seconds after the pump.The condition is already given, they have to live with it and learn ways to adapt to it as part of their self-care so as to maintain their well-being. Now, my goal here is to be just a part of their supportive-educative system, that they will be participating and performing in most of their self-care, and I will just simply monitor and regulate their self-care.

In the clinical setting, such as in the operating room where I am assigned to work for more than a year now, Orem’s theory is not really that applicable since it is more appropriate in setting that requires long term care. However, post-operatively, the nurses act for the patient in the performance of therapeutic self-care especially those who were subjected under general anesthesia and spinal anesthesia.Immediately after the operation, the patient is transferred to post anesthesia care unit or recovery room, where the patient is continually evaluated until he/she becomes stable and fully awake. The immediate needs that the PACU nurse will give particular attention to the patient are: oxygenation, ventilation, circulation, level of consciousness and temperature. The patient is hooked to patient’s monitor to check oxygen saturation, blood pressure and pulse rates. Most of them are hooked to oxygen inhalation via nasal cannula mask if breathing mechanics has not yet fully recovered from effects of anesthetics and sedation. Respiratory rate and body temperature are also recorded every 15 minutes. It is the PACU nurses’ responsibility to help the patient maintain these needs since the patient is incapable of doing so because he/she is not fully awake, drowsy and disoriented brought by the anesthetics. Patients who had surgery under spinal anesthesia cannot move their legs and has decreased or no sensation from nipple line down to toes. Caregivers will help them get comfortable lying in bed. The sensation will go back 1-4 hours when the medication wears off. Oftentimes, post-surgery the patient experiences difficulty in urinating, then a straight catheter will be indicated to help them eliminate fluid. Thus, in the operating room, nurses’ role is wholly compensatory.

Therefore, I conclude that Dorothea’s self-care theory applies to many settings, not only in the execution of the nursing process in clinical areas, but also in our own home settings. Her theory is part of our daily living. Its application reflects how well we value our own lives, our own health and which steps are taking in order to keep one’s well-being especially our loved ones. I definitely agree with her proposal that each of us is responsible for our own self-care, and we, as nurses, are also accountable for health of the individual, family and community.

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