I will now consider Dorothea Orem’s model of nursing, also recognized as the ‘Self Care Model’. This model promotes specific goals of the autonomy and patient self care. The aspects of the model require input and control from the patient, so would be unsuitable for a patient that is not mentally able. The nurse or healthcare professional is to supplement any deficit in the patients care, therefore supporting them instead of controlling their care. Deynes (1988) says that the model contains several propositions important to health promotion, and Orem (2001) states that adults in our modern society are expected to be self reliant and responsible for themselves. Therefore self help is a desirable activity and must be considered most important when caring for and teaching our patients. If we considered using this model for the patients care, we would allow Edna to define what activities of living she can perform without help, and then support her by filling in the ‘deficits’. As an independent lady, this model may help Edna herself identify any areas when she may require help or assistance and avoid any unnecessary doing from the nurse.
Taking into consideration the different styles and views of both models, I would find it hard to decide which would best suit the patient unless it was put into practice. I think that the Roper, Logan and Tierney model met Ednas needs for her stay at the hospital, as it was simple and helped the nurse to identify any particular requirements that Edna felt were necessary to her. I do however like the section of Dorothea Orems model that promotes normality. Normality is unique to us all, and so the promotion of normality would also be unique to the patient. As every nurses’ values, beliefs and opinions differ, so will the results of Edna’s care plan using either model. As Ellson (2008) quite rightly tell us, personal observations of the nurse using the model show us the naivety of its use, many nurses unaware of the complex nature of the model and the conflicts that can arise. She says there could be many reasons for different observation and usage of any model, stating time constraints, and prioritizing the patients’ most urgent needs. However, as nurses we must view and assess a patient holistically, and take in all of their beliefs and values, regardless of our own. I think that each model of nursing would suit a certain patient perfectly, but as all the models differ, so do our patients. So to conclude we need to use a model of nursing that best fits the majority of our patients, and train the staff of its correct use, as too many models on one ward would be very confusing.
Edna cultural needs were based on her age and the way she was brought up. As an elderly lady she was very well spoken, and socially she was a popular person and a leader figure in her family. Fox (2004), wrote the book Watching the English, and many of the traits she wrote about were of Edna’s generation. Some of these are common courtesy for others and manners, being uncomfortable in strange social environments, such as the hospital and being private about family life. Edna’s social needs were to be around her family and friends, and culturally, she wished for her business to be kept private and not to be a burden on anyone else.
Before discharge, Edna’s catheter was removed and she was taught to self catheterize by the urology nurse, then she returned to the ward. She went to the toilet and I found her crying. She explained that she was finding it painful and awkward to perform self catheterization due to arthritis in her neck, and was very embarrassed that she would have to do such a thing. Edna was terribly humiliated to be touching herself in the way self catheterization requires and felt that it was morally wrong. The nurse and I explained that an indwelling flip flow catheter would increase the risk of infection and might reduce the rate at which she could re-train her bladder to empty. Edna stated that she was not happy to self catheterize so a decision was made between the urology nurse and consultant to insert an indwelling catheter. Edna was happy and was not going against her morals and beliefs that her generation had embedded into her.
The history of nursing shows commitment to spiritual and cultural care, as it is essential in providing holistic care for the patient. Although as nursing care has become more technologically advanced, the spiritual and cultural components of care may be neglected on continued assessment. Literature tells us that there may be many reasons for this, Dossey and Keegan (2000) explaining one possibility being the nurses own perspective on spirituality. They state that nurses must identify their own spiritual requirements in order to provide competent spiritual care. The role of the nurse in maintaining the patient’s needs, is to support the patient in whatever they believe, regardless of their own beliefs. Nightingale (1996) believes that spiritual care is fundamental to our needs and is an essential part of the healing process. So if we take this into consideration, the spiritual and cultural components are of most importance in our patient care. Chung, Wong and Chan (2006) define holistic care as mind, body and spirit, helping us to understand that the mind and spirit are essential elements in the process of healing the person, and must not take a back seat to the medical needs of the body. We have learned that holistic care must mean just that, and take into consideration our patients needs on a spiritual and cultural level. As Dossey and Keegan (2000) have shown, this may mean that the nurses role is to examine her own spiritual and cultural beliefs before she can provide competent holistic care to ensure that the patients beliefs are maintained.
Health promotion and patient education, regardless of age can enhance health and motivate the individual. (Kelley and Abraham, 2007) Health promotion is a pro active section of nursing care that can provide the patient with the knowledge to manage their situation more effectively. It should be routinely offered to patients because if it was not, the prevalence of chronic health problems and demand on healthcare services would surely increase. (Department of Health, 2000) Wanless (2002) explains how patients must actively take responsibility for their own health, and to do so must have high quality health promotion and education advice available. As nurses provide the majority of care for patients, it is crucial that health promotion is part of nursing care. This is obvious, but problems occur when health promotion is integrated into the patient’s routine care. There are many constraints on a nurse’s time, but patient education and health promotion is essential to empower the patient and prevent any further unnecessary hospital stays. It is not only beneficial to the patient, but also to the health service.
Patient education played a large part in Edna’s case as we quickly and efficiently had to show her how to use a flip flow catheter and its attachments, and how to effectively clean the area. As Richardson (2008) explains, it is of upmost importance to maintain high standards of personal hygiene to prevent urinary tract infections. The health education was delivered in a private treatment room by myself and the registered nurse. We explained the procedure of cleaning the area, and she was happy with this. We then showed Edna how to use the flip flow and let her practice emptying the catheter herself. When she was comfortable doing this we introduced the day and night urine bags and demonstrated how to attach them. Edna did this a few times and felt that she could manage it herself at home. The nurse’s role in health education is to deliver the knowledge at the correct level for the patient and to ensure the patient fully understands. I think the method of delivery was perfect as we could actually watch the patient perform the procedure and decide on her competency.
The multidisciplinary team includes everyone who has input in a patients care including the patient themselves. A patients needs cannot be met by one professional alone, so we must work together to provide the best care to our patients. This is achieved by effective communication between all members of the team and ensuring all patient records are kept up to date and relevant. The role of the nurse is to act as an advocate for the patient and get them the help they require, especially when specialist nurses or doctors are required. This leads to better quality decisions made for the patient and increased professional satisfaction for the nurse. When a multidisciplinary approach to care provision is used correctly, it can benefit the patient and the whole team. The patient is satisfied, it increases their compliance with treatment and decreases reason for readmission. The benefit to the multidisciplinary team is sharing of responsibilities, complimentary strengths and mutual support. Literature tells us that there are many benefits to inter and multidisciplinary team approaches to care provision. Carter, Garside and Black (2003) say the patient feels more confident knowing a full team are involved in their care rather than just one clinician, and the continuity of care is easier to provide with more ‘hands on deck’. Team working within the NHS also provides each member with a sense of purpose and gives the opportunity for friendship and support. Communication between members of the team also enhances the quality of care for all patients, each team member gaining knowledge that they would not have if working alone.
Many of the multidisciplinary team were involved in Edna’s care from the specialist urology nurse at pre-op, to the consultant who performed the operation. The students, healthcare assistants and nurses who cared for Edna on the ward also had a large input in Edna’s care. Literature has proved that the multidisciplinary approach to care provision is best to deliver high quality care for our patients.
On discharge Edna felt comfortable with the health education she received and felt confident in her own ability to care for herself. We made her an appointment for the catheter to be changed, and also gave her telephone numbers for the ward and the specialist nurse if she was ever to become unstuck. I think the friendly nature of all members of the team caring for Edna made her feel more at ease, and I think with the advice and support she was given, she would be more likely to call if she required any help. The level of the knowledge and the method that it is delivered must suit the patients needs, otherwise we may confuse our patients, by using ‘medical jargon’ that they cannot understand and therefore would not find useful.
To conclude, I think a nursing model should be based holistically on a particular patient, however the need for a different model for every patient is not viable in clinical practice. The Roper, Logan and Tierney model is an excellent model to use, and is probably the main model utilized in the NHS in the UK, because it is easy to use and simple to understand. The model identifies any important deficits in the patients care, and seeks to provide alternatives. The professional taking the details from the patient however needs to realize the limitations of the model and use their knowledge and common sense.
We have discussed the cultural components of Edna’s care and why these and spiritual components are essential to our care provision. To repeat, we as nurses need to look at our own beliefs and spirituality before we can give effective spiritual care. Only when we discover how important spirituality is to ourselves will we realize the importance it plays in our patients lives.
Health education and promotion within the multidisciplinary team is vital, not only to the patient but also to ourselves as healthcare professionals. Giving good advice and support can make a huge difference to the outcome of a patients health and only by working as a team can we achieve this.
Carter, S., Garside, P., & Black, A. (2003) Multidisciplinary team working, clinical networks and chambers; opportunities to work differently in the NHS. Available at URL: . Last accessed 12 December 2008.
Chung, L.Y.F., Wong, F.K.Y., &Chan, M.F. (2007) Relationship of nurses’ spirituality to their understanding of spiritual care. Journal compilation. Jan Original Research: USA
Data Protection Act (1998) HMSO: London
Deynes, M. J. (1988) Advances in nursing science. Nursing Times no 11(1) pp13-21
Dossey, B. & Keegan, I. (2000) Self-assessment: facilitating healing in self and others. IN Holistic Nursing: a handbook for practice, 3rd edition. Aspen: Rockville.
Ellson, R. (2008) Assessment of patients, IN Clinical skills for student nurses. Reflect Press; UK
Fox, K. (2004) Watching the English: The hidden rules of English behaviour. Hodder & Stoughton: New York
Hannah, D. & Alimo, A (1989) A heart warming scheme. Nursing Times. No 85 pp11
Newton, C. (1991) The Roper-Logan-Tierney Model in Action. The Macmillan Press Ltd: London
Kelley, K., & Abraham, C. (2007) Health promotion for people aged over 65 years in hospitals: nurses’ perceptions about their role. Journal of Clinical Nursing. No 16, pp 569-579.
Nightingale, F. (1996) Notes on Nursing. Dover: New York
NMC (2008) The Code. NMC: UK
Orem, D.E. (2001) Nursing: Concepts of practice. 6th Edition. Mosby: St Louis
Richardson, R. (Editor) (2008) Clinical Skills for student nurses: Theory, Practice and Reflection. Reflect press: UK
Roper, N. (1976) Clinical experience in nursing education. Churchill Livingstone: Edinburgh