29. Partly Compensatory Nursing System Nurse action Performs some self-care measures for patient Compensates for self-care limitations of patient Assists patient as required Regulates self-care agency Patient Action Performs some self-care agency Accepts care and assistance from nurse
32. Orem’s General Theory of Nursing Self care Nursing Agency Deficit R R R R R Conditioning factors Conditioning factors Conditioning factors Therapeutic Self care demands Self Care / Dep. Care Agency
45. BASIC CONDITIONING FACTORS Age 56 year Gender Female Health state Disability due to health condition, therapeutic self care demand Development state Ego integrity vs despair Sociocultural orientation No formal education, Indian, Hindu Health care system Institutional health care Family system Married, husband working Patterns of living At home with partner Environment Rural area, items for ADL not in easy reach, no special precautions to prevent injuries Resources Husband, daughter, sister’s son
46. UNIVERSAL SELF-CARE REQUISITES Air Breaths without difficulty , no pallor cyanosis Water Fluid intake is sufficient . Edema present over ankles. Turgor normal for the age Food Hb – 9.6gm%, BMI = 14.Food intake is not adequate or the diet is not nutritious. Elimination Voids and eliminates bowel without difficulty . Activity/ rest Frequent rest is required due to pain. Pain not completely relieved, Activity level ha s come down . Deformity of the joint secondary to the disease process and use of the joints. Social interaction Communicates well with neighbors and calls the daughter by phone Need for medical care is communicated to the daughter. Prevention of hazards Need instruction on care of joints and prevention of falls. Need instruction on improvement of nutritional status. Prefer to walk bare foot. Promotion of normalcy Has good relation with daughter
47. DEVELOPMENTAL SELF-CARE REQUISITES Maintenance of developmental environment Able to feed self , Difficult to perform the dressing, toileting etc Prevention/management of the conditions threatening the normal development Feels that the problems are due to her own behaviors and discusses the problems with husband and daughter.
48. HEALTH DEVIATION SELF CARE REQUISITES Adherence to medical regimen Reports the problems to the physician when in the hospital. Cooperates with the medication, Not much aware about the use and side effects of medicines Awareness of potential problem associated with the regimen Not aware about the actual disease process. Not compliant with the diet and prevention of hazards. Not aware about the side effects of the medications Modification of self image to incorporates changes in health status Has adapted to limitation in mobility . The adoption of new ways for activities leads to deformities and progression of the disease . Adjustment of lifestyle to accommodate changes in the health status and medical regimen. Adjusted with the deformities. Pain tolerance not achieved
51. Area of Inadequacy!!!! Air Breaths without difficulty, no pallor cyanosis Water Fluid intake is sufficient. Edema present over ankles. Turgor normal for the age Food Hb – 9.6gm%, BMI = 14.Food intake is not adequate or the diet is not nutritious. Elimination Voids and eliminates bowel without difficulty. Activity/ rest Frequent rest is required due to pain. Pain not completely relieved, Activity level ha s come down. Deformity of the joint secondary to the disease process and use of the joints. Social interaction Communicates well with neighbors and calls the daughter by phone Need for medical care is communicated to the daughter. Prevention of hazards Need instruction on care of joints and prevention of falls. Need instruction on improvement of nutritional status. Prefer to walk bare foot. Promotion of normalcy Has good relation with daughter
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64. Theory of Goal Attainment IMOGENE KING, RN, MSN, EdD, FAAN
111. Nursing process method Nursing process theory (King) A system of oriented actions A system of oriented concepts Assessment Perception, communication and interaction of nurse and client Planning Decision making about the goals Agree on the means to attain the goals Implementation Transaction made Evaluation Goal attained
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113. ASSESSMENT What other information do I need to assist this patient to achieve health? History Identification details Present History of Illness Past health history Family History Socioeconomic Status Life Style Physical examination Review of Systems Laboratory Investigations Other investigations What does this information mean to this situation? Patient neglected a health problem for 35 years Patient has acute pain at the site of surgical wound Patient has family history of inguinal hernia and risk for recurrence Patient has a risk for recurrence due to constipation. Patient has risk for infection due to inadequate knowledge and age. Patient is at risk of developing complications of hypertension Patient requires education regarding health maintenance
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117. IMPLEMENTATION Am I doing what the patient and I have agreed upon? Yes How am I carrying out the actions? On a mutually acceptable manner in accordance with the goals set. When do I carry out the action? According to priority, a few interventions require immediate attention. Other interventions are carried out during the period of hospitalization till 5 th April. Why am I carrying out the action? Patient’s condition demands nursing care. Is it reasonable to think that the identified goals will be reached by carrying out the action? Yes
118. EVALUATION Are my actions helping the patient achieve mutually defined goals? Yes How well are goals being met? Short-term goals are met before discharge from hospital Long-term goals are expected to be met, because the patient is motivated to continue home care. What actions are not working? What is patient’s response to my actions? Patient is satisfied with my actions Are other factors hindering goal achievement? Patient’s age is a hindering factor in goal achievement regarding health maintenance. How should the plan be changed to achieve goals? Health teaching can be modified according to developmental stage. Involvement of family member in care of the patient.
