Personal Theoretical Framework for Advanced Practice Nursing
It has been twenty-six years since I finished my nursing degree in my home country, the Philippines. I have always believed that nursing is a helping profession or endeavor. It is a helping endeavor primarily aiding or assisting those who are unable to help themselves s on account of a physical infirmity that impairs them temporarily or long term. Abraham Maslow described the ranking category of the basic needs of humans. It is shaped like a pyramid or triangle. The wide base is represented by the physiologic needs. Physiologic needs are what humans need to survive and are the most vital. The requisites for humans to subsist consist of food, clothing, water, clothing, sex, oxygen sleep, excretion, etc. Next comes the needed for security such as freedom from the elements or harm. The need for love and belongingness comes next, where people's need for affection will be met. Having fulfillment in belongingness, the need to be thought of by oneself as well as by others. After this, the pinnacle where a person has accomplished much and has reached full potential and can help or teach others fulfill their potentials. My first clinical exposure was with pediatrics. I was assigned to an adoption agency. Here, I fed babies, kept them warm, changed their soiled diapers and cuddled them and. I made sure they are hydrated. I made sure that nasal passages are clear. Every nursing measure for infants and toddlers is geared toward support of their physiologic needs. During my years in college, we were taught nursing theories in the Fundamentals of Nursing but there was no real application. The nursing practice in the Philippines is medically oriented. Nursing is too doctor dependent meaning nurses’ practice "behind" the doctor and not alongside them. It’s probably because of the unwritten hierarchy in the medical field. In addition to this, the nurse to patient ratios is horrendous. Nurses are also underpaid and would only give effort commensurate to their salaries. An overworked underpaid nurse will not think about the high ideals that nurses ought to be. Nevertheless, I reject the idea of a mechanized nurse dependent on the doctor's order to function. My nursing philosophy will be one of helping the patient attain their basic physiologic need in the period of illness when they are impaired in their functional abilities, aid them in their recovery efforts or achieving equilibrium. I believe that the provision of nursing care that is concentrated on identifying and addressing the areas with self-care deficits will assist the person in a position that will help them regain their health and functionality. I shall do this with compassion, empathy, regard for the whole individual, with consideration of their unique attributes buoyed by a strong desire to help everyone with prejudice to no one and I will do this to the best of my abilities. I started my nursing practice with this philosophy in mind. Illness impairs an individual’s ability to fulfill their most basic needs. Nursing has a unique appreciation of Maslow’s hierarchy of needs because threats to homeostasis as the result of stress and illness can impair an individual’s ability to satisfy even the most basic of needs (Linton, 2016 p. 1273).
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The nursing theory that fits my nursing philosophy is Dorothea Orem’s Self-Care theory. Orem’s theory is composed of three theories; the theory of self-care. The theory of self-care deficit and the theory of nursing process or nursing systems. These three theories are interrelated. According to Younas (2017), the theory of self-care describes why and how human beings care for themselves. The theory of self-care deficit clarifies why and how human beings can be helped through nursing. The theory of nursing systems describes relationships between nurses and patients and the importance of these relationships for quality nursing care.
Self-care pertains to the person’s activities to maintain and sustain health and wellbeing. These are the activities one does regularly such as eating, bathing, dressing, grooming, relaxation, sleeping. These activities may be impaired temporarily because of illness. As my first clinical exposure as a nursing student was pediatrics, this self-care requisite has to be fully provided by nursing. My first job in the United States was at a skilled nursing facility. The residents of the facility have lost that capacity to perform some or all of the activities that will allow them to perform activities of daily living. Extremes of age, the very young, the very old and those who are ill will have self-care deficits. As an infant progress through its growth and development, they will be taught or will pick up skills necessary to maintain health and well-being. As a person matures, he picks up the expertise to properly take care of his health and maintaining it.
Younas (2017), mentions that Orem proposed three main assumptions concerning self-care requisites. First, human beings possess common needs for the consumption of materials necessary to sustain life (universal self-care requisite). Second, human beings require various actions to promote their growth and development throughout different life stages (developmental self-care requisite). Third, deviation from the normal structure and functional well-being requires actions to reduce occurrences and also to control the effects of any deprivation (health deviation self-care requisite). Self-care deficits can occur when the patient does not have the requisite knowledge and skills to self-manage. Orem’s theory shows why people need nursing when they possess limited knowledge and lack the ability to engage in self-care (Gomez, Castner & Hain, 2017).
Self-care includes careful measures to meet this requirement. The infant, the hospitalized person, the elderly in the nursing home stricken with dementia will not be able to meet these self-care requirements and thus will require nursing assistance. Being cognizant of this realization, it is clear that nursing will be beneficial to these individuals. Simply put, let us nurse them back to health. I learned early in my fundamentals of nursing care that nursing is an act. Orem mentions assumptions about deliberate action in which there are two: deliberate action and patients and deliberate action and nursing. Deliberate action and patients – to perform this, patients should be aware of their conditions and situations and the difficulties associated with them. They should have the capacity to manage these difficulties in the best possible ways. Deliberate action and nursing – nursing practice is a deliberate action that is performed by members of a social group to benefit others in specified ways (Younas, 2017). Nursing actions are geared toward self-care deficits identified using the nursing process. Assessment is the part where the nurse interacts with the patient gathering bio-psycho-social-psychological information regarding the patient and their illness. The nursing diagnosis is the part where the nurse makes judgment about functionality, the extent of interventions or the patient will just need health teachings. Intervention stage is the part where the nurse employs the actions needed to assist the patient overcome their illness state or this is the part where education or health teachings are given. Evaluation, the last part of the nursing process, is the part where the plan is assessed if it has been helpful by seeing the patient improve or patient condition deteriorated to some degree. Let us say for example a patient who has difficulty breathing will lack oxygen to satisfy metabolic demands. This is the self-care deficit identified. The nursing diagnosis is that there is potential for inadequate oxygenation. Our independent nursing intervention would be to raise the head of the bed to help the lungs expand. The intervention helped the patient by verbalizing relief from dyspnea and pulse oximetry of 98%.
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According to Hagran and Fakharany (2015), Orem's theory appears to be illness oriented. Orem also neglected the dynamic nature of health care. So in Orem's theory there has to be an identification of self-care deficit for nursing assistance to commence. Furthermore, this theory is a general systems theory which does not take into account individualized variables. Orem treats the nursing system as a single entity instead. This causes some individuals who may have physical, mental, or emotional deficits that prevent self-care from possibly receiving the primary care they need. Health is also a dynamic entity, always changing. Under the guise of this theory, this is not always the case. The theory is also oriented to illnesses, so the traumas and other health concerns are not addressed whatsoever. If someone is consistently in good health, the assumption is that they are maintaining their self-care appropriately (Dorothea Orem self-care deficit nursing theory explained, 2017).
- Dorothea Orem self care deficit nursing theory explained [Web log post]. (2017, January 17). Retrieved from https://healthresearchfunding.org/dorothea-orem-self-care-deficit-nursing-theory-explained/
- Gomez, N. J., Castner, D., & Hain, D. (2017). Nephrology nursing scope and standards of practice: Integration into clinical practice. Nephrology Nursing Journal, 44(1), 19-27. Retrieved from https://search.proquest.com/docview/1870848858?accountid=131932
- Critique of Orem's theory. (2015). The Journal of Middle East and North Africa Sciences, 1(5), 12-17. Retrieved from https://pdfs.semanticscholar.org/5761/17009ae992dc2e2ee652cb66c03020d633f2.pdf
- Linton, A. D. (2016). Psychologic response to illness. In Introduction to medical-Surgical Nursing (6th ed., p. 1273). Philadelphia, PA: Saunders.
- Younas, A. (2017). A foundational analysis of Dorothea Orem’s self-care theory and evaluation of its significance for nursing practice and research. Creative Nursing, 23(1), 13-23. doi:10.1891/1078-45184.108.40.206
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