Nursing Therapeutics

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Nursing Therapeutics

• Self-Care Deficit Energy Conservation
• Alyson Conway, Sally Ericksen, Neal Fromm, Patty
  Lynch Sarah Palmer

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Dorothea Orem (1914-2007)

• Born 1914 in Baltimore, Md
• Earned her diploma at Providence Hospital
  Washington, DC
• 1939 BSN Ed., Catholic University of American
• 1945 MSN Ed., Catholic University of American
• Involved in nursing practice, nursing service,
  and nursing education

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Influences for Theory Development
Definition of Nursing (1949-1957) Orem worked
for Indiana State Board of Health. Her goal was
to upgrade the quality of nursing. It was in
this role that she became aware of the ability of
nurses to do nursing, but noted their inability
to talk about nursing.

• What do nurses do?
• Why do they do what they do?
• What are the outcomes of their care?

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Influences for Theory Development

• Nursing Curricula
• (1958-1960) Worked for US Dept of Health,
  Education and Welfare where she published
  Guidelines for Developing Curricula for the
  Education of Practical Nurses
• Served as acting dean of CAU School of Nursing,
  where she introduced self-care concepts.

Hartweg, D. (1991). Dorothea Orem Self-Care
Deficit Nursing Theory. Newbury London, Sage
Publications Inc., pg 4.
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The Self-Care Deficit Theory
Published Orems Nursing Concept of Practice in
1971, and subsequently in 1980, 1985, 1991, 1995,
and 2001.

• Foundational Assumptions
• People should be self-reliant and responsible for
  their own care and others in their family needing
  care
• People are distinct individuals
• Nursing is a form of action interaction between
  two or more persons
• Successfully meeting universal and development
  self-care requisites is an important component of
  primary care prevention and ill health
• A persons knowledge of potential health problems
  is necessary for promoting self-care behaviors
• Self care and dependent care are behaviors
  learned within a socio-cultural context

Goal of nursing is to render the patient or
members of his family capable of meeting the
patients self care needs.
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Self Care Deficit Theory Components

• Comprised of three interrelated theories
• Theory of Self Care
• Theory of Self Care Deficit
• Theory of Nursing Systems

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Theory of Self Care
(3) Categories of Self Care Requisites Universal
Self Care - common to all people and include
physiological and social interaction needs (food,
air, water, activity rest, solitude social
interactions, promotion of normalcy,
etc.) Developmental Self Care needs that occur
as the individual grows and develops (toilet
training, adjustment to new job, new baby,
etc.) Health Deviation Self Care needs
produced by disability, illness, or injury
Purpose is to maintain life, to keep the
essential physical and psychic functions going,
to maintain the integrity of functions and
development of the person within the framework of
conditions that are essential to life. Based on
the presumption that individuals learn self-care
practices through experience, education, culture,
scientific knowledge, growth, and development.
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Theory of Self Care Deficit

• Applies to individuals who are completely, or
  partially, unable to know or to engage in self
  care.
• Delineates when nursing care is needed (e.g., if
  there is a self care deficit between what the
  individual can do and what needs to be done to
  maintain optimum functioning, then nursing care
  is needed.)

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Theory of Nursing System
3 Types of Self Care Needs Wholly compensatory
nurse provides complete health care for the
individual (ex. newborn, or comatose
patient) Partially compensatory nurse and
patient contribute to meeting patients needs
(ex. CVA patient with some physical
limitations) Supportive-Developmental nurses
primary supportive role is patient education,
enabling the patient to independently address
their own self care needs (ex. teaching a patient
glucose monitoring)
Addresses the ability of the nurse to aid the
person in meeting current and potential self care
demands. Focus is on the person, within or across
particular support modalities (e.g., nursing
systems) Nursing systems are determined by
whether the clients self care needs are met by
the nurse, the client, or both.
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Theory Limitations Orientation Context

• Appears illness oriented
• Leans more to providing care to adults
• May not be as beneficial for prevention and
  health promotion
• Has Western focus, failing to address cultural
  groups valuing interdependence harmony
• Biomedical orientation of theory fails
  incongruent with folk health practices

Meleis, A. (2007). Theoretical nursing
Development and progress. Philadelphia
Lippincott Williams Wilkins. Robertson, M. and
Kelly, J. (1996). Using Orems theory in
trans-cultural settings a critque. Nurse Forum.
3122-28.
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Contribution to Nursing
Though Orems theory contains elements of systems
theory, an interaction model, and a developmental
theory, Meleis classifies the self care deficit
theory as therapeutic. Why? Because the theory
focuses on action, with both nurse and patients
engaging in deliberate actions, and these actions
form the basis on the practical science of
nursing.

• Provides framework for nursing care.
• Though developed around the ill person, it is
  used for all ages and in all settings (ex.
  diabetes management, chronically ill, critical
  care, hospice care, oncology, etc.).
• Operationalized and used in research, practice,
  nursing administration, and nursing curriculum.

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Myra E. Levine (1921-1996)

• Education
• Born 1921 in Chicago, IL
• Earned diploma at Cook County School of Nursing,
  1944 (Chicago, IL)
• Earned SB from University of Chicago, 1949
• Earned MSN from Wayne State Univ, 1962
• Post-Graduate coursework at Univ of Chicago

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Myra E. Levine

• Career
• Private duty nurse, civilian Army nurse, clinical
  instructor, surgical supervisor, Nursing Dept
  Chair, Graduate Nursing Oncology Coordinator,
  Prof Emerita Univ of Illinois (Chicago), visiting
  Prof at universities in Israel.
• Focus on medical-surgical nursing
• Active in Illinois ANA, dynamic speaker, gave
  workshops
• Theory development Instructor first, theorist
  second
• Graduation teaching
• Teaching publication
• Publication theorizing
• Tomey, et al (2002)

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Myra E. Levine -Publications

• The Four Conservation Principles of Nursing
  (1967)
• Adaptation and Assessment A Rationale for
  Nursing Intervention (1966)
• For Lack of Love Alone (1967)
• The Pursuit of Wholeness (1969)
• Culminated in Introduction to Clinical Nursing
  (1969)
• 2nd Ed, 1973
• Introductory nurse bible
• Received AJN Book of the Year Award both
  editions
• Her theories came out of this publication
• The Four Conservation Principles 20 Years Later
  (1989)

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Myra E. Levine - Influences

• Beland (mentor at Wayne State Univ)
• Historical viewpoints of diseases
• Guided Levine towards influential authors
• Gibson, Erikson, Selye, Bates, Rogers
• Schaefer, et al (1991)

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Theory of Energy Conservation

• Assumptions Science vs. Nursing
• Trophicognosis nursing care via scientific
  method
• Requires nursing knowledge, logical thought
• Argued for utilizing scientific knowledge to
  support nursing, not to supplant it
• Not used in practice, but helped differentiate
  b/w nursing medicine
• Medicine ? scientific method ? diagnosis tx of
  disease
• Nursing ? scientific method ? diagnosis tx of
  whole persons
• Meleis (2007), Tomey, et al (2002)

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Theory Elements - Wholeness

• Pt is a whole being
• Adaptive to internal external environments
• Nurse acts as liaison between whole person and
  environment
• Nurse acts as conservator
• Draws on Eriksons principles of wholeness
• Remain integrated as whole being understand
  parts
• Tomey, et al (2002)

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Theory Elements - Adaptation

• Beings change in order to remain whole
• Historicity, specificity, redundancy
• Environment nurse - patient partnership
• Perceptual
• Response by pt via sense organs
• Operational
• All that affects individual physically
• Conceptual
• Includes symbols, values, culture
• Response adaptation to environment
• Fight/flight
• Inflammation
• Stress response
• Perceptual awareness
• Tomey, et al (2002)

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Theory Elements - Conservation

• Outcome of adaptation facilitation
• Energy
• Balance renewal to maintain life activities
• Challenged by healing aging
• Structural Integrity
• Nurse intervenes with adaptation facilitation
• Limit amt of tissue involved in disease
• Personal Integrity
• Psychosocial issues, self-worth, privacy
• Resume private life, no longer patient
• Social Integrity
• Assist pt in preserving social relationships
• Care for families, address spiritual needs
• Assist in adapting and reintegration into social
  groups
• Tomey, et al (2002)

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Theory into Practice

• Example
• 67 yo male COPD patient
• Psychosocial issues addressed guilt, family
  effects, etc.
• AP nurse can incorporate work as social
  worker/nurse to address all aspects of life

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Principles of Conservation In Practice

• Energy conservation
• importance of resting
• using energy wisely for healing activities
• Structural Integrity conservation
• Manage airway and secretions, maintain function
• Chronic illness contributes to deterioration,
  prevent further decline develop inflammatory
  response?
• Impact of environment?
• Personal Integrity conservation
• Address guilt issues, incorporate spirituality,
  privacy self-worth
• Social Integrity conservation
• Treat family as part of illness, incorporate them
  into healing practice
• Incorporate broader community friends
• Tomey, et al (2002)

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Critiques

• Blurs the line between science nursing
• Takes away purity of nursing theory
• Response we must incorporate nursing into other
  disciplines learn from each other
• Principles useful only with sick patients
• Esposito Leonard (1980), Piper (1983) focuses
  on dependency of pt, focus on illness
• Response it can be applied to any nursing
  situation
• Schaefer, et al (1991)

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Research Questions Potential Improvements

• Includes ideas about energy addressed by Martha
  Rogers (1964 1970), Florence Nightingale
  (1969), Todaro-Franceschi (2001)

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• Ethical behavior is not the display of ones
  moral rectitude in times of crisis. It is the
  day-to-day expression of ones commitment to
  other persons and the ways in which human beings
  relate to one another in their daily
  interactions.
• Myra Levine, 1977

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References

• Cox, R.A. (2003). Using NANDA, NIC, and NOC with
  Levines conservation principles in a nursing
  home. International Journal of Nursing
  Terminologies and Classifications. Retrieved
  September 25, 2008 from, www.findarticles.com/p/ar
  ticles/mi_qa4065/is_200310/ai_n9310962
• Levine, M.E. (1973). Introduction to Clinical
  Nursing (2nd Ed). F.A. Davis Company
  Philadelphia, PA.
• Levine, M.E. (1977). Nursing ethics and the
  ethical nurse. AJN, 77(5), p.846.
• Meleis, A.I. (2007). Theoretical Nursing
  Development progress (4th Ed). Lippincott
  Williams Wilkins Philadelphia, PA.
• Schaefer, K.M., Pond, J.B., Levine, M.E.,
  Faucett, J. (1991). Levines Conservation Model
  A framework for nursing practice. F.A. Davis
  Company Philadelphia, PA.
• Tomey, A.M. Alligood, M.R. (2002). Nursing
  Theoriests and Their Work. Mosby Elsevier St.
  Louis, MO.