Essay on Theory Guided Practice

Theory Guided Practice

Introduction/ The Practice Story

The case study is about a 50-year female who for a long time has struggled with type 2 diabetes due to non-compliance. Besides, the woman has a history of hypertension and hyperlipidemia. Her recent visit to a clinic indicates that the patient has developed a hyperglycemia-a condition characterized by high blood glucose in the blood. On this visit, the glucose level of the patient was 500mg/dl- a figure much higher than the recommended 160mg/dl. The patient also revealed that she has not been taking her diabetes medication regularly.

Essay on Theory Guided Practice

Clinical Presentation

A clinical evaluation of the patient showed that the patient was not in acute distress when she presented herself to the clinic. However, tests revealed elevated sugar levels in her blood. She also informed the doctor of physical pain in her lower extremities which was described as a feeling of being pricked by needles. The patient also indicated that her vision had become blurry.

Nursing Consideration

Elevated blood sugar levels cause blurry vision that can be temporary but can turn permanent if not taken care of early. Increased sugar levels in the body cause the swelling of the eye lens leading to blurry vision. It is easy to correct blurry vision by simply lowering the blood sugar to acceptable levels. Compliance with diabetes medication and diabetes management education is the best way to intervene and help this patient.

Middle-Range Nursing Theory

  1. Middle Range Nursing Theories.

This category of nursing theory provides effective theoretical frameworks which bring together nursing theories and the nursing practice. Middle-range nursing theories are more specific, concrete, and narrower compared to grand theories. The concepts and propositions in middle-range nursing theories are limited and are written at very specific levels. Some examples of commonly used middle-range nursing theories include; Jim Watson’s theory of human caring, the theory of the deliberative nursing process, and Peplau’s theory of interpersonal relations. There are many more examples of middle-range nursing theories used by nurses such as the theory of chronic sorrow, theory of health promotion, and the theory of reasoned action among others.

  1. Purpose of Middle Range Nursing Theories

Middle-range nursing theories offer nurses/health practitioners a concrete way of intervention in complex health situations. Because it is specific and narrow, middle-range nursing theories are less abstract and provide effective empirical testing (Hoeck & Delmar, 2018). What this analogy means is that middle-range nursing theories provide nurses with avenues of creating quick, specific, and effective medical interventions.

Middle-range nursing theory is critical to nursing meta-paradigm which connects nursing theories to nursing practice. Through the meta-paradigm, middle-range nursing theories help to improve the nursing practice by boosting the knowledge of nursing, education, experience, research, and philosophy (Liehr, P., & Smith, 2017 Essay on Theory Guided Practice). In short, nurses can make better decisions through middle-range theories because it helps practicing nurses to improve their knowledge.

III. Nursing Philosophies

A good nursing philosophy is based on critical values and beliefs such as compassion, integrity, human dignity, and altruism. These factors enable nurses to get a clear and accurate patient diagnosis treatment as well as identifying areas of priority. Key responsibilities that define the conceptual framework of nursing practice are based on improved patient outcomes. A nurse’s core duties include promoting patient safety, managing the patient environment, providing individualized care, creating a positive interpersonal relationship with patients, and using evidence-based practices in inpatient intervention. As a nurse, some of the values and beliefs that are critical are a combination of a set of principles that include altruism, human dignity, caring, and integrity. If integrated well, these core values produce satisfaction both for nurses and patients. The provision of a safe environment for patients is a duty that nurses should take seriously because it determines patient satisfaction and outcomes.

Nursing philosophy makes nurses critically think and reflect on how their core personal values impact their profession. Among other things, the nursing theory makes nurses better professionals through the acquisition of further knowledge. Besides, the nursing theory provides a foundation for the practice of care. Most importantly, nursing theories help to develop quality care based on effective definition, description, guidance, and proper clinical decision-making.

  1. Major Theory Concept/Theory of Self-Care of Chronic Illness

The theory of self-care is a critical middle-range nursing theory because it emphasizes primary prevention. Today, 50% of adults in the world have at least one or more chronic diseases Gil, & Oh, 2018). Based on these statistics, self-care has become an essential way of managing chronic illnesses. Self-care theory is characterized by self-monitoring, self-management, and self-maintenance. Many factors influence self-care theories such as experience, cognition, support from others, and skills.

Self-care theory is critical in the long-term intervention of chronic illnesses. This theory was created to capture a holistic approach where patients suffering from chronic ailments are empowered to take care of themselves. In this approach, societies are empowered through education programs to adopt health behaviors that promote good health. The self-care approach asserts that people who practice self-care have a better quality of life compared to those who do not. Further, the number of hospitalizations among people who practice self-care experience less morbidity and mortality.

  1. Theory Application

Self-care theory relies on three major characteristics that act as its pillar. Self-maintenance, self-care monitoring, and self-care management. Concerning self-maintenance the theory of self-care advocates for people to adopt lives styles that promote good health. Once a good is achieved, people must continue to observe their health to keep away from chronic diseases and other diseases. Self-care management refers to managing health conditions. This means that people who already contracted chronic diseases must find ways to manage their conditions. From the case study, apart from high blood pressure and some discomfort from pain, the woman can perform many of her self-care duties which are good for her recovery process.

Grand Theories

Orem Self Care Deficit Theory

Primarily, Orem’s theory of self-care deficits emphasizes maintaining patient autonomy. This theory is based on the self-reliance approach by focusing on the four nursing concepts central to the nursing metaparadigm that is; the person, environment, nursing, and health. Concerning the person, quality care can be achieved through how a person/people interact with their surroundings. These interactions are critical to the bearing of a person’s wellness and health. According to Dorothea Orem, nursing care is critical to the fulfillment of a patients’/clients social, developmental, biological, and psychological needs.

  1. Self-care Deficits

Self-care deficit refers to a person’s inability to perform some daily functions due to ill-health. A self-care deficit can arise from physical and or mental health problems/impairment. Some factors that lead to self-care deficit include old age, accidents leading to physical/psychological impairment, and depression among others. Orem’s self-care deficit theory asserts that patients recover better when they have some autonomy/independence over their self-care program (Younas, 2017). This analogy asserts that autonomy is critical in the process of healing. Based on this analogy, nurses must evaluate patients to find out the level of their care need before completely taking over all roles from the patient.

  1. Purpose of Dorothea Orem’s theory

Orem’s self-care nursing theory is especially critical in the ambulatory surgery setting as it guides practitioners on the nature of care given to patients. In this case, a nurse acts on behalf of a patient through education, guidance, general support, and provision of an enabling environment for recovery. The nursing practitioner must assess the level of help a patient requires. For example, in the partly compensatory system, a patient can perform some self-care duties but might need a nurse to aid her in some duties. In some cases, a patient may be able to provide all their self-care needs by themselves whereas in some cases a patient may be fully dependent on a nurse for their needs. However, the ultimate goal of Orem’s theory of self-care is to make people/patients self-reliant because they stand to gain more from it as far as healing is concerned.

III. Development. Orem’s theory of self-care aims to give guidance to nursing practitioners explains how to intervene to help patients maintain autonomy during the healing process. As mentioned earlier, nurses must evaluate the condition of their patients and the level of care they need. Ultimately, patients must be encouraged to perform some duties by themselves if they can or when they can.

  1. Philosophical Elements. Orem’s self-care theory focuses on the improvement of human functioning. People must carry out activities to maintain their health. It is in the best interest of patients to continue to perform their normal daily activities as a way of maintaining their health. A self-reliant person/patient has a better chance of recovery than one who is fully dependent on other people/nurses.
  2. Major Concepts of Orem’s Self-Care Theory. One of the concepts that define this theory is self-reliance. According to Orem, people/patients who retain all or some level of autonomy over their self-care have a better chance of recovery. Other major concepts under Orem’s self-care theory include; having or maintaining some rational powers, the ability to make or do beneficial things, and the ability to control/maintain social, biological, and psychological functioning.
  3. Evaluation of Theories
  4. Strengths and Weaknesses of Self-care Theory

Dorothea Orem’s self-care theory promotes human functioning. Autonomy and independence in self-care help patients/people to maintain their human functionalities psychologically and physically which is critical for the healing process. At the same time, this theory a positive developmental environment. Through this theory, people can establish appropriate health goals and adjust their behaviors to achieve these goals which are critical in self-care.

Concerning the weakness of Orem’s theory of self-care, the major barrier is the inability of patients to achieve self-care requisites. In some cases, patients may be in bad shape physically or mentally such that they are unable to perform any self-care duties. This problem is a barrier because patients in such circumstances have no level of independence or autonomy to undertake self-care management.

  1. Biblical World View

Worldview is a critical concept that is used to teach nurses the beliefs, understandings, and explanations used by patients and their families to give meaning to nursing. People believe in the role of God in healing illnesses. In this regard, religion is a critical influence on the behavior of patients, nurses, and physicians. A thorough understanding of people’s religious beliefs can lead health practitioners to effectively deal with the needs of their patients (Santos, Ramos, & Fonseca, 2017). Religion plays a key role in promoting members of society to live healthy lifestyles. Nurses must adopt biblical values such as compassion, empathy, honesty, and integrity in performing their duties.

  1. Implications for Nursing Practice

Theory-guided practice plays a critical role in influencing patient outcomes. Nurses that have an understanding of this concept positively impact their patients’ well-being. For starters, knowledge about theory-guided practice helps healthcare providers to acquire knowledge to improve the quality of care given to patients (Veloza-Gómez, et al., 2017 Essay on Theory Guided Practice). Physical and mental impairment is a critical concern as far as self-care is concerned. By embracing theories of self-care practice, nurses and physicians help patients in managing their health leading to a better and quick recovery. Patients that are allowed and encouraged to observe their self-care are had better chances of maintaining control of their human functionality and hence recovery


Orem’s self-care theory advocates self-reliance, independence, and autonomy in patients. An autonomous patient has a higher chance of recovery by being able to maintain control of her/his human functionalities such as psychological, social, and physical functioning. Self-care theory is critical in the prevention and management of chronic diseases because it focuses on primary prevention as well as the management of chronic diseases when one already has them. It promotes positive health behaviors that keep diseases at bay. Besides, Orem’s self-care theory helps nurses to let patients maintain control of their recovery process through self-care.

References for Essay on Theory Guided Practice

  • Gil, E., & Oh, H. (2018). Testing a middle-range theory of self-care of chronic illness: a validation for Korean adult patients with severe hypertension. Journal of Korean Academy of Nursing48(5), 521-533. DOI: 10.4040/jkan.2018.48.5.521
  • Hoeck, B., & Delmar, C. (2018). Theoretical development in the context of nursing—The hidden epistemology of nursing theory. Nursing Philosophy19(1), e12196. DOI: 10.1111/nup.12196.
  • Liehr, P., & Smith, M. J. (2017). Middle Range Theory: a perspective on development and use. Advances in Nursing Science40(1), 51-63. DOI: 10.1097/ANS.0000000000000162
  • Santos, B., Ramos, A., & Fonseca, C. (2017). Training to practice: Importance of Self-Care Theory in Nursing Process for improving care. Journal of Aging and Innovation, 6(1), 51-54.
  • Younas, A. (2017). A foundational analysis of Dorothea Orem’s self-care theory and evaluation of its significance for nursing practice and research. Creative Nursing23(1), 13-23. DOI: 10.1891/1078-4535.23.1.13
  • Veloza-Gómez, M., Muñoz de Rodríguez, L., Guevara-Armenta, C., & Mesa-Rodríguez, S. (2017). The importance of spiritual care in nursing practice. Journal of Holistic Nursing35(2), 118-131. DOI: 10.1177/0898010115626777