Relate the theory/theories to your current practice

Remember- these have two parts:

1. Discuss related theories to the case that you read about in this weeks’ reading assignment.

2. Relate the theory/theories to your current practice.

This case study introduces us to Mr. Duran who is a Diabetic. Mr. Duran has been told by his doctor that he must start administering insulin to control his diabetes. This creates problems for Mr. Duran who has limited vision and is very confused by the syringes and vials. Mr. Duran will have his wife administer the insulin, however, she speaks limited English and will also need instruction. Mr. Duran is also experiencing an added stressor of losing his daughter and taking on the care of his grandchild.

The two theories addressed in this case study that relate to Mr. Duran include Neuman and Orem. Neuman’s theory focuses on relieving stress to promote optimal health and balance. Neuman’s theory addresses physiological data, psychological data, sociocultural data, developmental data, spiritual data, and stress. Relieving stress will help Mr. Duran cope with his recent loss, and focus on his health. Orem believed that to survive and thrive, human beings need constant interaction and communication. Orem developed the Self Care Deficit Model to help individuals reach their maximum self-care potential. Orem addresses education, self-care, prevention needs, environment, diet, support, and culture. Orem’s Self Care Deficit Model is applicable to Mr. Duran in his ability to manage his diabetes safely at home.

The three parts of Orem’s theory that will help guide care for Mr. Duran include self-care, self-care deficit, and nursing systems. Mr. Duran’s deficits include his limited vision and his wife’s limited English. Self-care needs to be addressed are appropriate diet and insulin administration. The nursing system includes teaching Mr. Duran and his wife as well as any follow up. The nurse should set up a meeting with Mr. Duran and his wife to go over the correct administration of insulin, diet management, and discuss concerning symptoms related to hyper and hypoglycemia. The nurse should be fluent in Spanish or have a Spanish interpreter during teaching so that the Mr. Duran and his wife are clear on how to manage his diabetes. While discussing the plan with Mr. Duran and his wife the nurse can assess any visual or physical deficits that his wife may have that could further impair his ability to manage his diabetes effectively.

Neuman states that stress directly affects the ability to maintain optimal health and stability . Mr. Duran has the stress of losing a child, raising a grand-child, and managing a new medication. Steps to relieve these stressors involve connecting Mr. Duran with a therapist, social worker, and home nursing assistance. A therapist could help Mr. Duran work through his emotions related to his loss as well as provide community resources and support groups. Social work would be beneficial in helping Mr. Duran care for a young child. Home nursing care could be used until Mr. Duran and his wife feel completely comfortable managing his Diabetes.

In my current nursing practice, I deal with a situation similar to Mr. Duran and involves the concepts of both Neuman and Orem. I frequently admit patients that are in Diabetic Ketoacidosis. These patients require extensive teaching on how to manage their Diabetes. One specific case is a teenager who has been admitted multiple times for failure to comply with her insulin and diet regimen. The patient is rebellious and non-compliant to diet and insulin administration.

To help this patient comply with care, multiple health care team members are required. Social work, nursing, and endocrinology work together to come up with an effective plan of care. Neuman’s theory of stress affecting care is evident in her lack of compliance. A major stressor that affects her diabetes management involves wanting to fit in with peers. To help manage this the social worker introduced the patient to other teens also managing diabetes. This helped with her feelings of being an outcast, and gave her an age appropriate outlet to vent her frustrations. Orem’s theory of self-care and prevention needs are addressed by the endocrinology team. Endocrinology spoke extensively with the parents on monitoring the patient until she can be trusted to manage her care independently. Endocrinology along with Social work and nursing developed a rewards system to help motivate the patient to be proactive in her care and reach her full self-care potential.