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Nursing Theories Applied in the Emergency Setting

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on 10 December 2014

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Transcript of Nursing Theories Applied in the Emergency Setting

Nursing Theories that can be implemented successfully in an Emergency Room
Orem's Self-Care Deficit
Patricia Benner's Novice to Expert
Peplau's Interpersonal Theory of Nursing Process
Dorothea Orem, MSN
Born in Baltimore in 1914, Dorothea orem went on to complete her Master's in Nursing at the catholic University of America in 1945. Dorothea developed the Self-Care Deficit Theory also referred to as the Orem Model of Nursing (Theorists, 2011).
Theory Applied in the Emergency Department...
All to often in the emergency department we receive patient's who live alone, have fallen, and unfortunately have gone unnoticed for hours and sometimes days. Patients come in with fractures, soiled from top to bottom, and in a great deal of pain. As the primary nurse, we clean them up, assist in pain management, and help to replenish food and nutrients they were physically unable to maintain after their accident. We can help guide doctors to apply the assistance needed to get our patients back on their feet whether that be suggesting physical therapy or transitional rehab prior to discharge.
Another example is patients with dependence to drugs or alcohol. Due to their addictions they are unable to care for themselves in a safe manner. We are able to get these patients in touch with resources necessary to lead them in the direction of a strong recovery.
Dorothea Orem's Self Care Deficit Theory
Nursing Theories Applied in the Emergency Setting
Orem's Self-Care Deficit
Based on the philosophy that "all patient's wish to care for themselves."
Self-care compromises a person ability to perform activities required to maintain good health.
A deficit occurs if a patient is not physically capable of performing these activities causing their health to deteriorate.
Dorothea Orem focused on the idea that patients would essentially recover faster when they were actively participating in their care.
Proper self-care would also help to decrease chance of illness in the future (Orem's Theory, 2013).
Patricia Benner's Novice to Expert Theory
Patricia Benner completed her PhD at Berkeley in 1982. She is well known for her book From Novice to Expert: Excellence and Power in Clinical Nursing Practice published in 1984. Her book describes a five stage career path detailing stages from novice to expert. The model was developed from observing chess players and pilots.
Patricia Benner
Novice to Expert
Knowledge learned in school is only a foundation that expands on clinical practice.
5 levels of expertise include
Advanced Beginner
Through time and experience one perfects their critical thinking skills and can provide a higher quality of care to each individual patient.
Theory Applied in Emergency Department...
The seasoned emergency nurse will describe their job from their first day to their last as a constant learning process. As a novice nurse in the ED you are presented with unfamiliar situations daily. Over time and experience you begin to anticipate the orders to be received before the ED MD has even assessed the patient. Over years of experience connecting the dots between symptoms and diagnosis become second nature.
Also in the instance of evidence based protocols, over time the expert nurse no longer needs to refer to charts or protocols. Life saving measures are implemented quickly with confidence and precision. With MD guidance, experienced nurses help to save lives everyday. That is not something many people have the chance to say in their lifetime, let alone when describing their profession.
Peplau's Interpersonal Theory of Nursing Process
Born in Pennsylvania
Received Master's and Doctoral degrees in psychiatric nursing from Columbia
Emphasized the importance of the nurse-patient relationship
Created the Middle-Range Theory of interpersonal relations in the nursing process.
Her theory was also well known as Psychodynamic Nursing, which is the understanding of one's own behavior (Theorists, 2011).
Hildegard E. Peplau
Theory of Interpersonal Relations
Based on focus that the foundation of nursing is to help others.
Nurses need to apply the principles of human relations to communicate effectively with their patients.
Nursing is therapeutic and allows us to help those sick or in need.
This theory consists of an interpersonal process involving interaction between two or more people.
Role of Nurse must vary-
Leader (Interpersonal Relations, 2013)
The nurse-patient interpersonal relations can apply to the principles of human being, health, environment, and nursing
Theory Applied in Emergency Department
There are many different ways an ER nurse can approach each patient and situation. Patients utilize the emergency room not only for critical care but also for minor ailments due to inability to get in with primary care practitioners. It is vital that in order to deliver high quality care to these patients, we must evaluate all aspects of patients lifestyle. The first step, the orientation phase, is identifying problems that can effect their care or outcome. Not only will their living arrangements play a role in the time needed to recover, but ability to afford prescriptions recommended. During the identifying stage, the nurse AND patient can work together to determine a feasible goal to work towards together.
On many occasions, patients are brought in to the ED by family or caregivers due to inability to adequately continue care as a result of lack of resources or deteriorating health conditions. As part of the exploitation stage, patients and families are reaching out, seeking care that we as nurses can assist them to find what works best for them. We are able to provide patients and families with resources available for home health care if applicable and local facilities available for long term care if needed. These are examples of problem solving techniques finalizing the resolution phase of Peplau's Interpersonal Model of Nursing.
In Conclusion
There is a lot to gain by seriously implementing tried and true nursing theories in the emergency room setting. Nursing Theorists are the "experts" of this practice we all love, and we are blessed that they took the time to share their knowledge with the rest of us. Our patients can benefit now and in the future from our guidance and direction. By involving them in their care and educating them on their conditions, we can and will make a positive difference.

Application of Interpersonal Relations in Nursing Practice. (2013). Retrieved from

Application of Orem’s Self-care Deficit Theory. (2013). Retrieved from http://

Benner, P. (1982, March). From Novice to Expert. The American Journal, 82,
402-407. Retrieved from http://www.jstor.org/stable/3462928.

Benner, P. (2004, September 24). Using the Dreyfus model of Skill Acquisition and
Clinical Judgement in Nursing Practice and Education.
Bulletin of Science
Technology Society.

McEwen, M., & Wills, E. M. (2014). Theoretical Basis for Nursing (4th ed.).
Philadelphia: Wolters Kluwer Health

Nursing Theorists. (2011). Retrieved from http://currentnursing.com/nursing_theory/
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