Friday, July 16, 2010

Mohammad Yousaf

There exist many nursing theories. From Florence Nightingale’s “Notes on Nursing” in mid nineteenth century till now many nursing theorists has worked on different theoretical models for nursing practice, knowledge and research. Despite there differences and similarities, strengths and limitations the focus of all these nursing theories was to improve the patient care in different situations and different areas of clinical nursing practice. These provide a foundation for best possible nursing, teachings and nursing research. But there elapsed almost a century between Nightingale’s very primitive concepts to modern developed nursing theories.

Off course all these theories have some limitations and strengths, some are easy to understand and more practicable, while some are still in practice in limited fields of vast areas of nursing practice. Previously I had a very limited knowledge about the nursing theories, and only after having started this course and after my BScN program, I was able to understand and to know some about the nursing theories and how these were developed, After having gone through all the theories stated in this course, I came to conclude that the best out of existing nursing theories is the Orem’s Theoretical Model of self care deficit. I also impressed much from Leininger’s theory of culture care which is very much practicable in modern nursing while caring the multicultural clients. No doubt the basic needs of human being and the demand of better earning sources have forced the human to migrate from one area to another and other vital factor in migration of people from one place to another is the political upsets in different countries. It changed most of the societies to multicultural societies, developing some new norms and needs for adjusting in new societies. But still some basic cultural values remained unchanged within the specific group of people. Advances in the technology of communication, means of traveling, have made the whole world a global village. From its creation, human nature always sought of socialization, a very few groups of people or societies have remained isolated otherwise no place is left where multicultural people cannot be seen. Keeping all this in view Leininger’s culture care theory can be considered the best but this is not the only criteria to award it with the title of best nursing theory. We have to see which one theory is most commonly being utilized in nursing practice, for research and teaching purposes. Utilization of a theory in practical field is more important than having many theories in the body of knowledge of a particular discipline, from this point of view I see the Orem’ model more practicable providing better guidance for nursing practice, curriculums and research leading to an evidence based practice rather than an experience and observational based practice.

Dorothy Orem’s nursing theory was first published in 1971 and soon it gained popularity and acceptance among the nursing professionals (Kozier, ERB, Blais & Wilkinson 1998). According to Kozier et al, (1998), it stresses over the achievement of maximum individual’s self care so he could be able to achieve and maintain an optimal state of health. Orem defined individual as an integral whole, health a state of wholeness. She considered environment an external element to an individual. Man and environment, the both to her are the part of an integrated system which cannot be separated. Nursing to her is a service, an art and technology which helps an individual or a group of individuals or the whole community to fulfill its deficits whether these are physical, spiritual or psychosocial or relates to his lack of knowledge or information.

It is a client centered theory while the best nursing practice and goals are also considered client centered. The clients require nursing intervention most often are deficit of some physical ability, knowledge regarding it or some lack of information and/or motivation. It describes 3-dimentional aspects of individual life when he is able to perform his/her self care alone without assistance, when he/she is unable to do so and nursing interventions and in a condition where he is partially handicapped to fulfill the demands of self care. It helps nurses to set client oriented goals and provides a theoretical model to attain these goals.

It is very helpful in my area of clinical practice as oncology specialist nurse. The cancer patients in reality require more holistic nursing care , apart from their physical problems they face psychosocial and financial problems. They do not need only physical care but psychological support more than it. As cancer treatment is costly and prolonged, they face financial issues frequently. They lack knowledge about Chemotherapy and its side effects, Radiation therapy and its complications and management at home. So they need nursing intervention wholly and partly, they need education and support to maintain their optimal state of health. I think Orem's model addresses all these very well and utilized in practice here by our oncology nurse.

Basically Orem’s theory of Self-care Deficit is about the relationship between the nurse and the patient which became crucial in the process. The most interesting part is both parties have to do something in order to attain the stability of the patient.

As a Nurse, we are the first line of health care provider to attend the needs of the patient and expecting that we may experience several cases a day. Relating my own learning with Orem’s theory to clinical practical setting, supposing an unconscious patient was rushed into the hospital and a resident doctor found out t is stroke. A nurse should be oriented that the patient could no longer do certain activities for the moment and as Orem’s theory applies the nurse must act based on the three nursing system. 

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