Vincent Duncano

As a former critical care nurse assigned in the coronary care unit, I took care of patients whose usual diagnoses would be status-post coronary artery bypass graft, post cardiac arrest secondary to severe myocardial infarction, coronary artery disease, dyslipidemia, s/p thrombolytic therapy secondary to unstable angina/myocardial infarction, status-post percutaneous transluminal coronary angioplasty or PCI with stenting, congestive heart failure, etc. Patients, especially those who are admitted comatose, may have numerous contraptions on them such as but not limited to endotracheal tube/tracheostomy tube hooked to mechanical ventilation, Swan-ganz for hemodynamic monitoring, arterial line for BP monitoring, with central access for continuous renal replacement therapy or the conventional dialysis among others. These aside from the usual foley catheter, nasogastric tubes, chest tubes, and multiple parenteral lines, etc. We categorized patients as level III and level IV according to their dependency and to the number of hours required for nursing. Imagine that and for a novice nurse, I’m sure, that is enough reason not to report for duty, just like what happened to me on my first day.

Having considered my profession as a vocation, I adhere to the principles and concepts postulated by Dorothea Orem on her self-care deficit theory. I took it to heart that every time I am on duty, my patients will have my utmost care in a very compassionate manner. I was their voice when they can’t speak, their hands when they can’t feed, their cane when they have hard time moving around, and their “yaya” when they can’t bath. They were always informed on what’s going to be done to them. I always have stored supplies of shampoo, soap, toothpaste and comb for those whose relatives forget to bring. On many occasions I also feed their spiritual needs by encouraging them to watch religious shows on TV. It takes patience, understanding, and compassion to serve those who can’t physically, emotionally, psychologically and spiritually take care of themselves. And it needs additional dedication to learn new ways to help such patients. 

Hay, those were the days… and now I miss working in such a tedious, “toxic” environment. And you ask why? The satisfaction you’ll get in helping people recover from their illness and seeing them move out of your unit in stable condition, with a big smile plastered on their face, and verbalizing unending praises of thanks, is really priceless. It compensates for the meager income you receive as a staff nurse.

And now that I am an educator, I try to impart to my students the value of respecting every person, regardless of his stature in life, age, gender, spiritual beliefs and health condition. I emphasize the importance of being a nurse, a member of the health team and co-equal of the doctor in dispensing care. I teach them that nurses should be patient advocates, giving utmost quality care in the most compassionate manner. And that nurses should not underestimate the importance of education, skills and attitude on patient care.

According to Orem, self-care is the “the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health and well-being” (Meleis, 2005). Care of self is not only an activity limited to that person but it can also be provided by his significant others, the community where he belongs or by nurses and other members of the health team. Such is true when the person is suddenly unable to perform self-care independently due to an illness. It is at this point of time that the services of the nurse are needed. It is required though that the nurse should possess the skills needed to perform activities and procedures, knowledge to comprehend the reason for the condition and for the actions to be taken, and the right attitude to deal with an entity that is by himself very dynamic in nature. The nurse is required to possess such characteristics so as to help/assist the client recover from his disease state without harm.

In Orem’s point of view, the nurse is the client’s partner, the personality who will act on behalf of the patient when needed. A nurse should be a patient advocate; advocate for the welfare of his patient. For her, the nurse should possess interpersonal and social processes and technologic-professional operations to be an effective self-care agent. And since nursing is an art based on science, the nurse, as a professional, should observe the nursing process of assessment, planning intervention, and evaluation to be effective and efficient in taking care of patients who are wholly or partly dependent on the health team for their recovery.

The concepts, principles and assumptions of Dorothea Orem’s Self-care deficit theory are very much applicable to the critical care unit setting. In this specialized nursing area, most of the clientele really are dependent on the nurses’ assistance for their nutritional, physiological, emotional, physical and spiritual needs. They need our help/services until such time they recover and perform those on their own.

It is for the above-stated reasons that some say this theory is applicable to all situations regardless of time, condition and place. Let me say this though. I do believe that other nursing theories are also applicable to the critical setting such Nightingale’s Note’s on Nursing, Maslow’s Hierarchy of Needs, Leininger’s Transcultural Nursing Theory, Orlando’s Dynamic Nurse-Patient Relationship, Abdellah’s Patient-Centered Approaches among other. It is only that as a critical care nurse, one can really experience the dependency of those who are critically ill and thus value the importance of a nurse in such a setting to the fullest.

Godspeed to us all!