Orem’s Self-Deficit Theory

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Kuya Eddie, a 45 year-old jeepney driver suffered a vehicular accident along the highway of EDSA after an almost direct collision with a delivery truck. He was lucky though, having been found still alive by the paramedics and rescue squads upon their arrival. He was rushed to the hospital, where he was given emergency treatment for severe blood loss. Eddie’s lower left leg was torn off upon impact. Upon examination by the physician and nurse, it was revealed that he suffered complete fracture of the leg, severe injury to the right inner thigh and foot, massive muscle damage and head injuries. Emergency surgery was initiated to repair extensive damage. After the surgery though, Eddie went into a coma, due to a developed blood clot, and it was very successful. Eddie however, did not wake up after surgery. The physicians are starting to give up on him, knowing that few patients mange to recover from a comatose state. His family prayed for a miraculous recover.

Then, after a month, he woke up. His body however, became like a vegetable. The physicians said that Eddie would be paralyzed for life, but he, being a man of faith, did not accept this. “Walang impossible sa Diyos, Dok. Siya lang ang paniniwalan ko nang lubos,”  he told the medical staff surrounding his bed. Everyday with the desire burning in a focused mind he willed himself to walk. Eddie imagined himself walking, and held that mental picture as the nurses old range-of-motion exercises, massaged cared and cleaned his body.

After a few months of therapy, the attending physicians were stunned. One morning, Eddie suddenly sat in the bedside. It was a miracle. He could move his legs a little at first, then some more, until after a few weeks he could stand and walk with a limp. The physicians ordered that the patient be given and taught the use of crutch as assistive device. Lissa, an orthopedic nurse was tasked to perform health teaching and guidance to Kuya Eddie.

Assessment

Keeping Orem’s Self-Care in mind, the nurse would then identify probable needs and evaluate client’s potential for independence. Nursing care would start at the patient’s compensatory state, which is from comatose to paralysis. Then it would proceed to partially compensatory state, wherein the client is taught the use of assistive device to aid in mobility nurse would recall the principles of crutch walking, including correct usage, posture and pacing. The client’ support system in also taken as an important consideration, including Eddie’s perception of disability and possible lifestyle adjustments and considerations.

Diagnosis

• Self-care deficit related to total paralysis
• Knowledge deficit related to use of crutches

Planning

The nurse would collaborate with patient in setting attainable goals with emphasis on client empowerment and attaining independent as quickly as possible.

Implementation

1. Assess client’s perception on disability, lifestyle changes, and coping mechanisms.
2. Demonstrate use of crutch walking pacing using visual aids, proper therapeutic communication and demonstration.
3. Involve support system (family, loved ones) on the discussion and address their questions and concerns.  
4. Refer the client to a physical therapist for collaboration and further guidance.
5. Ask the client to demonstrate knowledge and competency to evaluate self-care capacity.

Evaluation

The nurse, together with the patient, after a few days of instruction and  counseling, would agree on whether the goal is met  or not. Eddie would then ne encouraged to set new goals for himself.