Purpose: Comment the Discussion

To Comment

Dorothea Orem's Self-Care Theory speaks to my future advanced nursing practice. Some of the assumptions in this theory are that people need a nurse when their illness is greater than their self-care capabilities, that people need to know about possible health problems to be able to provide self-care, that people have a responsibility to care for themselves and their family, and that each person is unique (Current Nursing, 2012).

This theory speaks to me in several ways. I will be using these assumptions to give specific examples of how this theory will fit in my new role, possibly as a palliative care APN.

As an APN, I will continually be interacting with people whose illnesses are greater than their self-care capabilities. This is when people are most vulnerable. Using Orem's theory, these are the people who need a nurse, a competent nurse. The best service I can offer them is competent nursing care. Nursing competence has been described as skills learned through training and clinical experience, which research has shown to provide a base for quality palliative care.

(Dobrina, Tenze, & Palese, 2014). I plan to provide competent care by keeping up to date with my skills and knowledge by attending educational meetings in the Austin area, regularly reading APN journals, and gleaning the latest information from other qualified healthcare professionals.

Another assumption that I will put into practice, is that people need to know about possible health problems to be able to provide self-care. This is where I will provide education to help my patients and their families develop a plan of care and be prepared for possible health problems.

A study done discussing the contributions of Orem's Theory in ALS patients, showed that a big part of the nurse's role is developing the plan of care, and, in this instance, the goal of the self-care plan was to slow the symptoms of ALS (de Medeiros Nobrega, Pessoa, & de Miranda, 2012).

The article pointed out that in creating this plan of self-care it must be supported by the nurse-patient-family relationship. The only way patients and families can be prepared for possible health problems is through education. I plan develop healthy nurse-patient-family relationships to create a good learning environment to reach these goals of patient and family self-care.

This brings me to another assumption that people have a responsibility to care for themselves and for others in their family. Family responsibility is a requirement for hospice at home and is one of the reasons hospice provided me with such job satisfaction. I see myself putting this into practice by providing patients and families with education about pain control, personal care, what to expect throughout the dying process, and spiritual and emotional resources. This education will lead them to be competent and confident to take responsibility for themselves and their loved ones.

Another assumption found in the Orem theory that I am going to incorporate in my practice, is the fact that each person in unique. This uniqueness plays a critical role in reaching the goal of self-care. Patients abilities to provide self-care are directly affected by their life circumstances, depression, feelings of worthlessness, character traits, beliefs, culture, relationships with the healthcare team, politics, economics, and education (Hasanpour-Dehkordi, 2016). No two people are alike.

As an APN, I will need to ask the right questions, not make assumptions, be a good listener, be patient, be curious, and be willing to see things from their perspective. I will need to delve into their complex history to make an appropriate plan of care to help them reach their self-care potential.