Introduction
Nursing models involve special approaches to work that differ from one another by the target audience, the nature of the interventions, the technologies used and other aspects of the activity. As the concept for analysis, the Orem’s model of nursing will be considered. Its second name is The Self-Care Deficit Theory. According to the peculiarities of this approach, the person is viewed as a single whole, and the primary principle of care is the activity aimed at preserving life, health, and well-being that people start and carry out independently (Shahdadi, Dahmardeh, Salari, & Ahmadidarehsima, 2017). In this model, much attention is paid to the human’s personal responsibility for his or her health. However, it is also of great importance for nursing interventions to prevent diseases or injuries and train patients (Zarandi, Raiesifar, & Ebadi, 2016). For a complete description of this theory’s application, its use will be considered as a method of nursing intervention for the care of patients with physical injuries. Also, the features of introducing the model into practice and recommendations for its most successful implementation will be discussed. It is supposed that the scope of the concept’s use is large, and a significant contribution to the care of injured patients can be achieved through its application.
Description of the Issue
The lack of self-care in injured patients is an urgent problem since in case of the absence of any outside help, a person can experience severe discomfort and anguish. In order to exclude such problems, it is possible to resort to the help of the Orem’s nursing model. Its essence lies in the provision of appropriate qualified assistance to people with temporarily limited opportunities (Shahdadi et al., 2017). Moreover, this conception considers not only practical but also theoretical approaches to the solution of health problems and, in particular, the process of recovery from trauma. Therefore, its application, in this case, will be appropriate and relevant.
Nurses’ Concern about the Issue
Nursing activities should demonstrate special attention to people with physical injuries. According to Dobrina, Tenze, and Palese (2014), such patients, as a rule, cannot independently provide themselves with all the necessary conditions for a normal life. Recovery periods usually depend on the severity of a certain injury; nevertheless, the term should not influence the degree of nursing interest, and assistance to patients should be provided. Otherwise, the refusal of assistance will contradict the moral and ethical code of nursing, which is unacceptable in this profession.
Facts from the Nursing Literature
The mention of Orem’s nursing model in the scientific literature confirms the fact that much attention is paid to finding appropriate methods of interventions and analyzing existing theories. Thus, Moura et al. (2015) note that the use of the model in patient care helps them to improve the knowledge of the possibilities of self-care and serves as an effective theoretical basis. Also, the features of the model are touched upon in the work by Wong, Ip, Choi, and Lam (2015) who argue that self-care behaviors are largely shaped by the availability of the Orem’s theory and its provisions as a guide for nursing staff. Another opinion is expressed in the article by Mohammadpour, Rahmati Sharghi, Khosravan, Alami, and Akhond (2015); they confirm the validity of the model as a useful source of information for patients. The authors clarify that the use of the concept in practice makes it possible to significantly motivate patients, teach them useful skills, and achieve fast recovery (Mohammadpour et al., 2015). Thus, references in the literature confirm the relevance of the use of the theory in practice and prove its usefulness with concrete examples.
Stakeholders Affected by the Issue
The provisions of the described nursing model cover a certain range of stakeholders, and each of the participants’ categories is determined on the basis of performed functions. Thus, for example, nurses are assumed to supplement the patient’s ability to practice self-care (Mohammadpour et al., 2015). The nursing intervention allows a person to maintain health and cope with the consequences of injuries, which is important in case of partial or complete disability. Another interested party is patients who are in urgent need of care and qualified assistance. Their interests are key in the decision process regarding certain interventions. However, due to the fact that the Orem’s model is not designed for complete non-participation of patients and the maximum possible involvement of nurses, a certain balance is observed between the stakeholders (Wong et al., 2015). The positions of the concept do not provide for nursing assistance as unique and exclusive. Patients should be motivated to help themselves independently, and the role of medical personnel is to control this activity. It is this close interaction of patients and nurses that is such an effective intervention and allows both parties to benefit from collaborative work.
Application of the Self-Care Deficit Theory
The use of the Orem’s model directly in practice requires the preliminary preparation and assessment of the forthcoming intervention. Work with patients should be carried out individually since all the traumas are different, and specific cases should be taken into account. Each patient should maintain a balance between the needs for self-care and the ability to implement it. Having determined the therapeutically necessary behavior during the trauma, the nurse together with the patient finds the way and type of relevant intervention. Accordingly, the whole work process involves close cooperation between two stakeholders without shifting all the responsibility to one of the participants.
Strategy to Use in Resolving the Issue
Conducting an initial examination of the patient’s condition in a medical institution, the nurse determines whether her assistance is needed. Thus, for instance, if gypsum is applied to the patient because of the shin bone fracture, the nurse may assume that her ward is not able to immediately move on crutches without assistance. In this case, according to Moura et al. (2015), there is an imbalance among some universal needs of the patient and his or her ability to self-drive (actively move, use the toilet, take a shower, etc.), and the patient needs help. Self-care deficit is associated with the absence of some walking on crutches skills. New experience could help the person in need to cope with his or her current situation in order to return the ability of self-care.
Nursing assistance is planned depending on the capabilities of the self-care of both the patient and his or her loved ones. A planned intervention will be the part of a compensatory and training system (Wong et al., 2015). As Shahdadi et al. (2017) note, the patient with the trauma can independently satisfy such universal needs as consumption of air, food, and liquids. However, the nurse’s ward needs assistance in moving, in particular, even to meet his or her other universal needs. A junior medical specialist plans to teach the patient safe transportation skills to prevent the risk of re-trauma.
Peculiarities of the Intervention
The goal of nursing intervention is to restore the balance between opportunities and needs for self-care. Thus, a patient who is forced to move with crutches needs a nurse to help him or her put on or take off pants, using a fully compensating intervention since the medical worker acts for the patient. At the same time, the nurse teaches the ward how to safely move on crutches, as well as new skills that will allow the patient to independently dress and move. All these actions happen in a friendly atmosphere when the ward does not experience any psychological pressure and is ready to make efforts to achieve the result.
In order to effectively and successfully cope with the task, nursing staff should have sufficient educational base for such an intervention. Otherwise, the patient can be harmed because of the medical worker’s mistake related, for instance, to prohibited procedures in a certain injury. The use of the Orem’s model at the same time makes it possible to cope with the task of caring for the ward and achieve his or her faster rehabilitation. After the end of work, some time is required to ensure that the patient does not experience complications caused by too active actions of self-care. If no negative factors are identified, it can be claimed that the intervention is successful.
Assessment of the Results of Care and a Suggestion for Future Research
When assessing the effectiveness of nursing care, the medical specialist, first of all, takes into account what has been achieved by the patient by the appointed time. Thus, in case of an intervention for a person with an injury, the evaluation will be positive if the patient learns to walk in new conditions and can live most of the time without outside help. Such a quick adaptation to a new lifestyle will be the evidence of the intervention’s success of the intervention and will help the injured to quickly recover without experiencing an acute need for nursing care.
As a further area of research, it is possible to analyze the Orem’s model’s impact on patients with other health problems. In addition to helping people with injuries of varying degrees of severity, the considered nursing concept can be applied to other cases when patients are unable to help themselves on their own or do not know how to do it. These questions can be covered in more detail to draw up the complete picture of the effectiveness of the Orem model’s application in practice.
Conclusion
Thus, the scope of the application of the universal Orem’s nursing model is wide enough, and one of the central advantages of using this concept is to help patients in restoring the self-care ability. Mentioning in the scientific literature confirms the effectiveness of this model and its relevance in modern practice. As a further area of research, the impact of model features on caring for patients with other health problems can be discussed. Nursing care is considered effective if it is possible to maintain or restore the balance between the opportunities and needs of self-care.
References
Dobrina, R., Tenze, M., & Palese, A. (2014). An overview of hospice and palliative care nursing models and theories. International Journal of Palliative Nursing, 20(2), 75-81.
Mohammadpour, A., Rahmati Sharghi, N., Khosravan, S., Alami, A., & Akhond, M. (2015). The effect of a supportive educational intervention developed based on the Orem’s self-care theory on the self-care ability of patients with myocardial infarction: A randomised controlled trial. Journal of Clinical Nursing, 24(11-12), 1686-1692.
Moura, P. C. D., Braga, L. M., Domingos, C. S., Rodrigues, N. V., Correia, M. D. L., & Oliveira, L. V. A. (2015). Diagnoses and nursing interventions in hypertensive and diabetic individuals according to Orem’s theory. Northeast Network Nursing Journal, 15(6), 1039-1046.
Shahdadi, H., Dahmardeh, H., Salari, S., & Ahmadidarehsima, S. (2017). The effect of a self-care instructional program based on Orem’s model on the stress of multiple sclerosis patients. Indian Journal of Public Health Research & Development, 8(1), 280-285.
Wong, C. L., Ip, W. Y., Choi, K. C., & Lam, L. W. (2015). Examining self-care behaviors and their associated factors among adolescent girls with dysmenorrhea: An application of Orem’s self-care deficit nursing theory. Journal of Nursing Scholarship, 47(3), 219-227.
Zarandi, F. M., Raiesifar, A., & Ebadi, A. (2016). The effect of Orem’s self-care model on quality of life in patients with migraine: A randomized clinical trial. Acta Medica Iranica, 54(2), 159-164.