Several years ago, I had this inkling that the reason why nurses (males and females, that is, and with exemptions to colored uniforms and scrub suits) don on white uniforms is to symbolize purity of heart and undying commitment to serve. I began to wonder if it is just the sole symbolism of the color or there might be others things that could be coined to it. After a long while during the course of my practice as a professional nurse, I realized something radical. It made me think of the reason why nurses wear the classic white uniform is to show the client we are there to get dirty just to make them clean. Quite ironic, because nurses embody cleanliness, but our uniforms are prone to stains because of bedside nursing care. I told myself it is ok to get a bit dirty, only a bit, while caring and nursing my clients for them to look clean, feel good and smell good. It is quite heartwarming to see clients looking good after you did something for them. That overrides the dirtiness of our uniforms. However, I guess this is where the creation of protective gowns started to function: to maintain cleanliness of BOTH the nurse and the client. It is therefore not a valid excuse for nurses to be poorly groomed and unhygienic simply because you nurse at the bedside. It is unsightly to be in a nursing unit where all the nurses look clean and smell good whereas their patients appear disheveled. I think of these nurses as professionals who may not have used the Theory of Self-Care Deficit.
In what ways would these nurses are liable to negligence because of failure to use the theory? First possible reason is that there are nurses who fail to address FEEDING, BATHING/ HYGIENE, DRESSING/GROOMING, and TOILETING needs of their patients. For me, these are the BASIC and CORE bedside nursing considerations and other complicated/sophisticated procedures, medications, equipment, nursing techniques and skills would come only secondary. If we can meet these properly, then we really are nurses and caregivers. Many nurses would instruct patients to do these tasks on their own even if they cannot perform it fully. Orem’s theory also advocates promotion of independence. However, nurses give clients full independence despite their actual failure to meet self care needs. Second reason might be that nurses are bombarded with several tasks in the unit (doing clerical works, poor nurse patient ratios, and the like) that their time to meet self care needs of patients is limited. Third perhaps is the attitude of nurses in general like laziness, disgust of patients’ excreta, aversion to touch and bedside nursing, and probably lack of interest to become a nurse per se. All of these and other possible factors may lead to the downfall of the profession if Orem’s theory is not evidently used in health care settings.
I have worked in some public and private hospitals here at Iloilo City and Metro Manila. There I have seen how unfair nurses are to clients especially if they differ in socio- and economic factors. If clients are affluent, rich, and influential in the society, nurses tend be so submissive to all their requests. Every call of clients in the intercom is answered promptly. But nurses behave differently in front of low income patients. Their needs for diet, medications, bathing hygiene, referrals, etc are most of the time delayed.
In my experiences, I have seen myself doing the same things.
It is only now that I am an instructor I have realized I bypassed Caring Procedures to my previous patients. I was so engrossed before to gaining knowledge and skills that I forgot the basic function of the nurse and that is to meet client self-care needs primarily. Now I am applying the concepts of Orem’s theory in my work as a nurse and instructor. I see to it that all my students would care for their assigned patients like the way they care for a loved one. I make sure that all of my patients are properly fed, bathed, groomed, and toileted regardless of race, color, socioeconomic status, and religion. We support independence of clients and involve them in their own care. I do bedside nursing myself to demonstrate to students and family members how caring needs can be met. I always remind myself and my students that a simple touch therapeutically used goes a long way in caring and treating clients, and that the appearance of their clients greatly reflects the kind of nurses they have. I spend some time to actually supervise students in bedside nursing care. We make sure our clients are comfortable and feeling good throughout the shift. If we have established it, then we can proceed to other aspects of nursing care.
The concepts of Orem’s Theory continue to reverberate in the annals of nursing practice and history. If we utilize this theory in our practice, time will come no nursing client around the world will be displeased of nurses, no client will ever be smelly and dirty, no client will suffer from malnutrition and elimination related problems, and no client will be naked and exposed of unnecessarily. We have satisfied our clients and our God in their bodies and spirits.
God bless all nurses around the world. We will continue to care more and give unconditional love to all our clients.