Nursing Theory Application

Nursing theories which can be used in medical surgical nursing

Dorothea Orem - Self-care theory Betty Neuman - System model Sister Calista Roy - Adaptation theory Imogene King - Goal Attainment theory Florence Nightingale - Environment theory Virginia Henderson - Need Theory Fay Abdella - Twenty One Nursing Problems Lydia E. Hall - The Core, Care and Cure Ernestine Wiedenbach - The Helping Art of Clinical Nursing Rosemarie Rizzo Parse - Human Becoming Theory Dorothy Johnson - System model

Orem's theory
Orems general theory of nursing in three related parts: Theory of self care Theory of self care deficit Theory of nursing system

1. Theory of self care

Self care Self care agency Self care requisites -Universal self care requisites- air, water,food, activity, elimination, social interaction, prevention of hazard, health promotion -Developmental self care requisites -Health deviation self care requisites Therapeutic self care demand

2. Theory of self care deficit

5 methods of helping:

Acting for and doing for others Guiding others Supporting another Providing an environment promoting personal development in relation to meet future demands Teaching another

3.Theory of Nursing Systems

Wholly compensatory system Partly compensatory system Supportive educative system

Application using nursing process

Self care, Agency, Requisite Assessment of self care requisite Nursing diagnosis Therapeutic self care demand Self care deficit Nursing system

Planning and Intervention includes choosing the nursing system and helping the patients

Evaluation

Application
Areas Name Age Sex Education Occupation Marital status Religion Diagnosis Symptoms Medical Treatment Patient details Mrs. X 56 years Female No formal education House hold Married Hindu K/C/O Congestive cardiac failure Dyspnoea , oedema, fatigue, palpitation , anorexia, nausea. Digitalis, Indwelling catheter, fluid restriction, diuretics, Bed rest

Assessment

Assess the level of self care Not adequate Asses the self care agency- Not adequate Assess the self care requisite
-Universal Air( Dyspnoea), water (oedema) , Fatigue ( Activity & rest), Food ( Anorexia) -Developmental role change -Health deviation Poor adherence, knowledge, Poor lifestyle adaptation to illness

Nursing diagnosis
Therapeutic self care demand Common diagnosis Impaired gas exchange Fluid volume overload Activity intolerance Altered nutrition less than body requirement Impaired family process Ineffective therapeutic regimen Knowledge deficit

Planning and implementation

Choose the best system and method of helping to combat the problem Evaluation Ascertain the self care level and patient self care agency adequacy.

Nursing process
Assessment Subjective data Pts verbalizes difficult in breathing Diagnosis Impaired gas exchange r/t fluid extravasion of fluid in interstitial space Goal To relieve dyspnoea, Planning As appropriate Nursing system Partially compensatory Helping acting for patient Interventions As appropriate Evaluation Ascertain the normalcy of self care deficit, self care agency as evidence by clinical parameters as appropriate

Objective data Pts RR =34, SPO2=85%, crepitus on auscultation

Therapeutic self care demand Pts not able to meet o2 demand for his equilibrium

Self care deficit area Air (Oxygen),

Self care agency inadequate

Assessment Subjective data Pts verbalizes discontinuation of medication for past 1 week due to side effects

Diagnosis Ineffective therapeutic regimen r/t poor knowledge about drug regimen

Goal To improve compliance

Planning As appropriate Nursing system supportive system helping teaching

Interventions As appropriate

Evaluation Ascertain the normalcy of self care deficit, self care agency as evidence by clinical parameters as appropriate

Objective data Pts serum digitalis concentration is inadequate Self care deficit area health promotion

Therapeutic self care demand Pts be compliant with medication

Self care agency inadequate

Case study

Mr .x 63 years old male, a known case of CAD after strenuous exercise and smoking in home developed acute onset of substernal chest pain got admitted in ICCU with diagnosis as MI

Nursing process
Assessment Diagnosis Goal Planning Interventions Evaluation

Subjective data Pts verbalizes crushing nature pain in chest, palpitation, profuse sweating, dyspnoea

Ineffective tissue perfusion r/t atherosclerosis Physiological mode affected (oxygenation)

Short term goalTo improve perfusion , oxygenation,(Fo cal stimuli) long termgoal preventive education( Contextual stimuli)

As appropriate

As appropriate

Ascertain the adaptation to physiological mode by checking the clinical parameter

Objective data Pts ECG shows ST segment elevation, Elevated troponin level Focal stimuli Reduced o2 and blood Contextual stimuli Exercise, smoking, age, CAD

Therapeutic self care demand Pts not able to meet o2 demand for his equilibrium

Residual stimuli