NU702 Unit 2 Theory Application Paper Example

Who Gives the Insulin After Thursday: A Unit 2 Theory Application Paper Using Orem's Self-Care Deficit Theory

[Student Name]

Purdue University Global

NU702: Translating Evidence into Nursing Practice

Unit 2 Theory Application Paper

[Instructor Name]

[Date]

The hospital, patient and figures are composite and illustrative; the theories and sources cited are real.

The Practice Problem

Across 5 West and 6 West, the medical-surgical floors of a composite Dubuque, Iowa, hospital, 214 patients went home last year on insulin that was new to them. Within a month, 31 of them were back, in the emergency room or on a ward, because their blood sugar had swung too low or too high. Chart review showed that "diabetes education complete" was documented for 92 percent of them, but a return demonstration of the insulin pen for only 18 percent. Nationally, insulin is among the medicines most often linked to emergency visits for adverse drug events, and reduced food intake and dosing errors are common precipitants (Geller et al., 2014).

Mr. Halvorsen, a composite patient, illustrates the pattern. Admitted with pneumonia and found to have a hemoglobin A1c of 11.2 percent, he started basal insulin. Nurses gave every dose. On the day before discharge he watched a video and a nurse explained the pen. He went home on Thursday, and on Saturday his wife found him sweating and confused after he had taken his evening dose twice.

Orem's Self-Care Deficit Theory

Orem (2001) described nursing through three connected theories. In the first, the theory of self-care, adults keep themselves alive and well through purposeful, learned activity. Self-care requisites are the needs those actions meet: universal requisites such as food and rest, developmental ones and health deviation requisites, which arise from illness and its treatment. A new insulin regimen creates a health deviation requisite: daily injections, glucose checks and recognizing and treating lows.

Orem's second theory, self-care deficit, asks one question of Mr. Halvorsen: can he do what his illness now asks of him? Where he cannot, nursing fills the gap. Orem named his ability his self-care agency and the requirement his therapeutic demand for self-care. Mr. Halvorsen's demand rose sharply when insulin began; his agency for that demand was close to zero.

The third theory, of nursing systems, sorts nursing's response into three designs. Wholly compensatory care means the nurse acts in the patient's place. Partly compensatory care splits the work between them. Supportive-educative care leaves the action with the patient, who is coached, guided and encouraged by the nurse.

Every insulin dose given by a nurse is wholly compensatory care, and the unit was still giving it on discharge day.

What the Theory Explains

Seen through Orem's theory, the unit's process placed Mr. Halvorsen in a wholly compensatory system for four days and then moved him, overnight, to self-care with no supportive-educative period in which he performed the task under supervision. The checklist recorded that information was given, but Orem's theory locates the deficit in agency, which is the ability to act, not in knowledge alone. A video can supply knowledge; only practice builds agency.

The theory also explains why some patients struggle more than others. Orem described basic conditioning factors, such as age, health state, family system and resources, that shape both demand and agency. Mr. Halvorsen's age, his slight tremor and the fact that his wife had never seen the pen all lowered his agency. His wife's presence was a resource the unit did not use. She visited every afternoon, sat through the video with him and would be the person beside him at home, yet no one asked her to hold the pen, dial a dose or practice treating a low. In Orem's terms the family system could have added agency, and the unit left it untapped.

Comparison With Henderson's Need Theory

Henderson (1966) saw the nurse's unique work as helping a person, ill or healthy, carry out the activities of health or recovery that he would manage alone if he had enough strength, will or knowledge, with the aim of making him independent quickly. Her fourteen basic needs include eating and drinking adequately and avoiding dangers in the environment.

Henderson's definition supports the same conclusion as Orem's, that nursing should move the patient toward independence. Its strength is its simplicity; its limitation for this problem is that it does not specify how nursing should be structured during the transition. Orem's three nursing systems do. They make it possible to say that the unit skipped a stage, and to design the missing stage. For a DNP project aimed at changing a process, Orem's theory offers more specific guidance.

What the Theory Recommends

Applied to the discharge process, the theory points to four changes. First, assess self-care agency for insulin specifically, not general readiness, by having the patient perform the task. Second, create a supportive-educative period: from the second day of insulin, the patient gives his own doses under supervision, so that discharge does not coincide with the first unsupervised injection. Third, include the family member who will share the care, since the family system is part of agency. Fourth, judge readiness by performance, a correct return demonstration with the patient's own prescribed pen, rather than by documentation that teaching occurred.

These recommendations fit evidence on teach-back. When Talevski and colleagues reviewed twenty studies of teach-back, all but one reported benefit, on measures ranging from recall to readmission, although few of them described how the method was put into routine use (Talevski et al., 2020). Orem's theory explains why teach-back that includes return demonstration should work: it tests and builds agency rather than recording that teaching occurred.

Outcomes the Theory Suggests

If self-care agency is the target, outcomes should measure it. The project will track the proportion of patients who complete a correct return demonstration before discharge, the proportion whose caregiver also completes one when applicable, and 30-day emergency visits or readmissions for hypoglycemia or hyperglycemia. The first two measure agency; the third measures whether agency was enough.

Limitations

Orem's theory centers on the individual and family; it says less about system factors such as whether the pen is available at discharge or whether the patient can afford it. Those will need to be addressed through the implementation framework and the interprofessional team in later units. The theory also assumes a deliberate, rational actor, while illness, fatigue and fear can make learning difficult even with practice.

Conclusion

Orem's self-care deficit theory explains Mr. Halvorsen's Saturday night as the predictable result of moving from wholly compensatory care to independent self-care without a supportive-educative stage. Henderson's need theory agrees on the goal but offers less guidance on the transition. For the planned DNP project, Orem's theory defines the target, self-care agency for insulin, and supplies outcome measures that test whether the unit built that agency before discharge.

References

Geller, A. I., Shehab, N., Lovegrove, M. C., Kegler, S. R., Weidenbach, K. N., Ryan, G. J., & Budnitz, D. S. (2014). National estimates of insulin-related hypoglycemia and errors leading to emergency department visits and hospitalizations. JAMA Internal Medicine, 174(5), 678-686. https://doi.org/10.1001/jamainternmed.2014.136

Henderson, V. (1966). The nature of nursing: A definition and its implications for practice, research, and education. Macmillan.

Orem, D. E. (2001). Nursing: Concepts of practice (6th ed.). Mosby.

Talevski, J., Wong Shee, A., Rasmussen, B., Kemp, G., & Beauchamp, A. (2020). Teach-back: A systematic review of implementation and impacts. PLOS ONE, 15(4), e0231350. https://doi.org/10.1371/journal.pone.0231350