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Part I of this portfolio is an illustration of a professional nursing practice model applied to ambulatory settings.

Orem's Self-Care Model: A Professional Nursing Practice Model

Person (client/patient) self-care deficits are the result of environmental situations.

3 systems exist within this professional nursing practice model

Compensatory system-nurse provides total care

Partially compensatory system-nurse & patient share responsibility for care

Educative-development system-client has primary responsibility for personal health, with nurse acting as a consultant

Self-Care Theory in the Ambulatory Setting

Nurses have always recognized the rights of clients of all ages to be both informed and active participants in care.

Prior to discussing "Self-Care" it is important for readers to understand that the role of the professional nurse is to promote & maintain healthy systems.

Currently, in the Ambulatory Setting nationwide, there is an added job/dimension for the RN of assisting physicians. This is an equally important support-role/job for the provision of overall care but should not be confused with the professional "nursing" role. To differentiate, this physician assisting role includes collecting data for the physician (to determine cause & effect), as well as, performing minor procedures (which supports the "cure" medical model).

Nursing models (such as Self-Care) are not directly or easily applied to a physician-centered model. Nursing models are client-centered.

Self-care is a universal requirement for sustaining and enhancing life and health. Competence in self-care determines quality of life and has an impact on longevity. Nurses assist clients to achieve competence in self-care. Health education (an example of a self-care service) informs, motivates and helps people adopt healthful life styles.

Self-care: "activities initiated or performed by an individual, family, or community to achieve, maintain or promote maximum health" (Steiger & Lipson, 1985. Self-care Nursing: Theory and Practice.).

Self-care is ongoing and a competence which is in continual development.

Informal self-care accounts for 75% of all health care in the US. In addition, of the remaining 25%, one-quarter of the those health problems seen by MDs could have been taken care of by individuals and families without professional help. (Levin, 1976).

The goal of self-care is to empower our clients and families.

Areas Applicable to Self-Care Theory

Direct Nursing Care (nurse has direct contact with client and/or family)

Providing care or teaching in the following areas:

Nutrition

Hygiene

Mobility

Medications

Behavior

Maintaining health and/or enhancing health with client/family:

Exercise & physical fitness

Nutrition and weight control

Stress management

Maintenance of social support systems

Environmental control

Areas not applicable to Self-care Theory

Indirect Activities

Obtaining equipment/supplies for patient procedures

Making appointments for patients

Completing patient paperwork

Assisting MD/NP's with patient procedures

Module Activities

Coordinating nurse and extender work flow, breaks, etc.

Checking module supplies

Checking crash cart

Ordering stock meds

Examples of Self Care applied to Ambulatory Nursing

Compensatory system- nurse provides total care

Bedridden oncology patient arrives via ambulance for chemotherapy. Family insists upon keeping patient at home; however, leaves patient alone with nurse in chemo clinic for treatment. Patient requires O2 at 2L/min, continuous tube feeding at 90cc hour, foley catheter, bedpan. Nurse in clinic administers chemo premeds and chemo; changes dressing around g-tube due to leaking; administers O2 at 2L; empties foley at end of treatment; places patient on bed pan one time. With the expception of administering chemotherapy, the nurse is providing total self care for this patient (that which the patient cannot perform by self). Administering chemotherapy is the "assisting physician" role.

Partially compensatory system- nurse & patient share responsibility for care

Preterm labor patient regularly visits clinic for BP monitoring, etc. Patient on bedrest (at home), except for weekly visit to module. Nurse assists patient out of wheel chair into bathroom, assists with urine sample collection, and onto exam table. Nurse administers injection of terbutaline and educates patient regarding oral terbutaline.

Educative-development