NUR 700 Discussion 2.1: Integrative and Transformative Theories in Practice
NUR 700 Discussion 2.1: Integrative and Transformative Theories in Practice
Dorothea Orem’s Self-Care Deficit Nursing Theory
The integrative theory that applies most to my clinical practice would be Dorothea Orem’s Self-Care Deficit Nursing Theory (SCDNT). The SCDNT is commonly seen in rehabilitative nursing because it focuses on teaching patients to care for themselves by giving them the knowledge and means to do so. I currently work in an 80-bed inpatient rehabilitation hospital that is stroke certified through The Joint Commission. This theory applies most to my clinical practice because a large part of my job is treating patients with some form of a self-care deficit. Nursing patients who have been newly affected by a cerebrovascular accident (CVA) or stroke will require teaching and education on new techniques and methods regarding how to care for themselves following a stroke. Patients affected by stroke commonly have to relearn many basic activities of daily living (ADLs). Common ADLs are eating, dressing, getting in or out of bed, toileting, bathing or showering, preparing meals, managing money, shopping, doing housework, using a telephone, etc. Using Orem’s SCDNT as the foundation for nursing interventions geared towards stroke patients helps to empower patients to not only participate in their care but to recognize and respond to potential future strokes (Sposito et al., 2018). The SCDNT is comprised of four concepts (Smith, 2020). The concepts are the Theory of Self-Care, the Theory of Self-Care Deficit, the Theory of Nursing Systems, and finally the Theory of Dependent Care (Irshad-Ali, 2018). The Theory of Self-Care focuses on intentionally performing tasks by one’s self that are necessary for life, human functioning, and health (Smith, 2020). The Theory of Dependent care focuses on the patient being in a dependent position or relationship, like that of a child and a parent (Smith, 2020). The Theory of Self-Care Deficit described why people need nursing such as health-related shortcomings for comprehending, determining, and yielding care to one’s self (Smith, 2020). Finally, the Theory of Nursing Systems encompasses the other three theories and adds the interpersonal relationship between the nurse and the patient (Smith, 2020).
One example of the application of the SCDNT is Ghani et al., (2019) description of a 62-year-old male patient affected by a CVA resulting in left hemiparesis and dysphagia. A holistic approach to the patient’s care was provided using the elements of the SCDNT. The care provided was based on creating a means for the patient to meet his own self-care needs. Using the SCDNT, the nurse was able to assist and care for the patient while supplying an environment appropriate for enriching the remaining self-care skills and nurturing the development of new ones (Ghani et al., 2019). All of this was achieved through nasogastric tube feeding to prevent dehydration or malnutrition, providing rest breaks during activities to reduce fatigue, checking vital signs frequently, providing aids for communication and means for orientation, teaching affected extremity self-positioning techniques, demonstrating the use of adaptive tools and techniques for ADLs, teaching stroke signs and symptoms, medication management and education, and collaborating with other departments such as physical therapy, occupational therapy, speech therapy, the dietician, and physician (Ghani et al., 2019). Despite attempting to teach stroke patients to care for themselves, some deficits may remain that they are unable to accomplish, which is known as dependency (Sposito et al., 2018). It was concluded that although the patient did not recover fully, he showed remarkable improvement and gradual development of the ability to care for himself, develop new skills, and prevent recurrent stroke (Ghani et al., 2019). This was all achieved through nursing care that was based on Dorothea Orem’s SCDNT.
References
Ghani, N., Suliman, M., & Fatima, A. (2019). Application of Orem’s nursing theory to a stroke patient: A case study. Journal of Saidu
Medical College, 9(2), 273–277. https://doi.org/10.52206/jsmc.2019.9.2.
Irshad-Ali, B. H. (2018). Application of Orem self care deficit theory on psychiatric patient. Annals of Nursing and Practice, 5(1),
1093–1095. https://www.researchgate.net/profile/Bibi-Hajira-Wali/publication/343125237_Central_Bringing_Excellence_in_
Open_Access_Annals_of_Nursing_and_Practice_Application_of_Orem_Self_Care_Deficit_Theory_on_
Psychiatric_Patient/links/5f17bc21a6fdcc9626a685df/Central-Bringing-Excellence-in-Open-Access-Annals-of-
Nursing-and-Practice-Application-of-Orem-Self-Care-Deficit-Theory-on-Psychiatric-Patient.pdf
Smith, M. C. (2020). Nursing theories and nursing practice (5th ed.). F.A. Davis.
Sposito, J., Zipf, A., Alhowaymel, F., Almutairi, M., & Breda, K. (2018). Community-based stroke recognition education and response:
An evidence-based intervention project. Creative Nursing, 24(4), 251–257. https://doi.org/10.1891/1078-4535.24.4.251
Discussion Guidelines
Initial Post
Which integrative or transformative theories would you identify as being the most relevant to your clinical practice? Find a nursing research article that applies the theory into clinical practice and describe its application; include the full APA citation for the article.
This discussion will be graded using the Discussion Initial Post and Replies Rubric found in your syllabus.
Response Post(s)
Using the reply to the initial posts of at least two of your classmates.
Submission
Post your initial and follow-up responses and review full grading criteria on the page.
Margaret Newman’s Theory of Health as Expanding Consciousness
The transformative and unitary theory that applies to my clinical practice would be Margaret Newman’s Theory of Health as Expanding Consciousness (HEC). As a nurse who works with breast cancer patients, Newman’s HEC theory helps embrace the skills needed to encourage patients and their families to engage openly and have meaningful relationships during their journey. Caring partnerships and relationships enable nurses to identify with cancer patients and helps patients going through the reconstruction process have a purpose during this difficult time. Relationships that are more open, meaningful, loving, caring, peaceful, and connected are expressions of an expanding consciousness (Smith, 2020). The evolution and transformation of patterns occur through the patient-environment interactions and how a patient relates to the environment (Endo, 2017). Newman defines patterns as “information that depicts the whole, understanding of the meaning of all the relationships at once” (Endo, 2017).
Nursing patients and families who have been affected by cancer is emotional, physical, and psychologically challenging. The order and disorder in the patient’s life are part of the expansion of consciousness, and there will be times breast cancer patients will have order in their life, and other times where it will be chaotic. Chemotherapy treatments, radiation, and surgical procedures can bring emotional and physical challenges, like increased weakness, radiation burns, not knowing how many other surgical treatments are in the future, or which surgical option is the best for their situation. Breast reconstruction can be a long process; this is not a one-and-done surgical option for women who choose this route after a mastectomy or lumpectomy. There is autologous-based reconstruction where women use their own body tissue to create a breast instead of expanders or implant base reconstruction. With autologous-based reconstruction, there is not a guarantee that flaps like a transverse rectus abdominis muscle (TRAM) or deep inferior epigastric artery perforator (DEIP) flaps will take. When surgical procedures do not go according to plan, this can become psychologically disappointing. Preparing patients for their breast reconstruction journey involves being present without judgment. I feel this quote by Newman holds true when caring for patients, “caring in its deepest, most respectful sense with a focus on what is important to the patient” (Smith, 2020).
Fujiwara & Endo (2017) chose to look at Newman’s theory of HEC from a unitary perspective based on caring partnership within the client-nurse relationship. This case study looked at a patient (Mrs. A) in her fifties diagnosed with advanced-stage IV cancer who lives with her husband, daughter, and mother-in-law. Unfortunately, treatment did not work, and Mrs. A avoided relating with people, including the nursing staff, and she shared vague information about her cancer diagnosis with her family. Newman’s caring partnership as a nursing intervention presented here provides a potential for connections between the patients and nurses, and at the same time, patients and their families (Fujiwara & Endo, 2017). The nurse senses that Mrs. A has a pattern of “being closed off,” she would find her hiding behind curtains. After developing a trusting partnership between the nurse and patient, Mrs. A began to open up. The key is pattern recognition. In this case study, the pattern was Mrs. A being “closed off.” Pattern recognition comes from within the observer (Fujiwara & Endo, 2017), and because of the benefit of this caring partnership that emerged between the patient and nurse resulted in more insight into the meaning of this patients’ pattern. Newman states, “ultimate consciousness has been equated with love, which embraces all experience equally and unconditionally: pain as well as pleasure, failure as well as success, ugliness as well as beauty, disease as well as nondisease” (Smith, 2020). These interactions that emerge between our patients can change us as nurses, just as nursing touches our patient’s lives.
Reference
Endo, E. (2017). Margaret Newman’s theory of health as expanding consciousness and a nursing
intervention for a unitary perspective. Asia Pacific Journal of Oncology Nursing, 4, 50-50.
Fujiwara, Y., & Endo, E. (2017). A patient with cancer and her family in caring partnership
based on Margaret Newman’s theory of health as expanding consciousness. Asia Pacific Journal of Oncology Nursing, 4, 265-268.
Smith, M. C., (2020). Nursing theories and nursing practice (5th ed.). F.A. Davis.
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