NR 351 Week 7 Discussion Application of Nursing Theory to Practice
NR 351 Week 7 Discussion Application of Nursing Theory to Practice (Graded
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Question
You are a professional nurse caring for Mr. R, a 58-year-old patient who recently underwent surgery for colon cancer that resulted in a temporary colostomy. Select one of the nursing theories from our textbook and address the following:
• How you would provide professional nursing care for Mr. R. using the theory you have selected? Be sure to use terminology from the selected nursing theory to explain your interventions.
• How can patient-centered care and the patient's cultural preferences be enhanced by use of this theory?
• Relate applications of legal and/or ethical standards to this case study.
Answer
Of the theories covered in our textbook, the one that I am most familiar with is Dorothea Orem's Self-care Deficit Theory. The AND program I attended was based on this theory. Orem's Self-care Deficit Theory is based around the idea that a nurse's role is to "do for others what they cannot do for themselves. (Hood, 2014, p. 136). Orem's theory is based around five key concepts: Self-care, self-care deficit, self-care requisites, self-care demand and agency. In the case of Mr. R, his self-care needs are challenged by the addition of this new colostomy. His activities of daily living needs have changed. He will now have the challenge of having to learn how to care for the colostomy. Additionally, his diet needs will change and he will need the appropriate training and teaching in order for him to be able to meet his own needs. This lack of knowledge is the self-care deficit concept behind Orem's theory. Patient education regarding proper stoma care is essential to meet Mr. R's self-care demands. Mr. R will need to be instructed to on how to clean the stoma; to wash his hands before and after care and to use the appropriate hand and soap to clean it. He will also need teaching on what signs and symptoms to look for to ensure there are no complications. The stoma should remain pink or red and will shrink as the days after the surgery pass. Additionally, he will need to report changes in stoma color that could be indicative of infection or compromised circulation. Also, he will need to be taught how to apply and manage the pouching system. Application of proper stoma care is the self-care requisites that Mr. R will need to meet in order to meet the self-care demands of his new condition. Finally, his capability to carry out these new tasks in is the agency portion of the theory. According to Orem's theory, it is the nurse's role to ensure all these needs are met while he is in the hospital. But, ultimately, the goal will be to empower the patient to be able to successfully meet these needs on his own after his discharge.
By focusing on Mr. R's personal knowledge deficits with relation to this colostomy, we can ensure our care is patient-centered. Other cultural and personal preferences must be taken into consideration. While Mr. R is fairly young, other things to consider are his present state of health. Before the surgery, was he his primary caregiver? Or did he require assistance with his ADL's already? Does he live at home? Alone? With family? Or is he perhaps a resident at a long-term facility such as a nursing home? Are there other comorbidities to consider? What is his level of cognition? Can he be taught? Or is there a family member or caregiver that should be involved?
One ethical issue that I find to struggle with just about daily is the sharing of information with family members. Family members mean well and want to be informed of the patient's condition, but there is a level of confidentiality that should be kept to protect the patient's rights. Then there is the possibility of violating HIPPA laws. This may be a case where Mr. R doesn't want to share this new health state with some family members, but nonetheless, there will be family asking for updates.
Hood, L. J. (2014). Leddy & Pepper’s conceptual bases of professional nursing (8th ed.). Philadelphia, PA: Wolters Kluwer Health | Lippincott Williams & Wilkins. [Show Less]