CARE OF THE CLIENT WITH PULMONARY TUBERCULOSIS UTILIZING DOROTHEA OREMS SELF CARE THEORY

The Philippines is among the 22 high burden countries for tuberculosis. TB is the 6th leading cause of illness and the 6th leading cause of deaths among Filipinos (WHO 2007)
o

INTRODUCTION
o Nursing has responsibility that focus more towards health promotion strategies that include a greater emphasis on teaching patients to assume more responsibility toward self-care. o This clinical research study is proposed to determine if there is significant effect in the health awareness and improvement on self care requisites of a patient with Pulmonary Tuberculosis using Orems Self Care Theory when applied in the nursing process. The aim is to give knowledge through education so that patient can perform self care activities to meet needs, and self care being adhering to treatment.

Statement of the Problem

Is

there a significant effect in the health awareness and improvement on self care requisites of a patient with Pulmonary Tuberculosis when Self Care Theory by Orem will be applied in the nursing process?

CONCEPTUAL/THEORETICAL FRAMEWORK
SELF CARE REQUISITES
UNIVERSAL SELF CARE REQUISITE

DEVELOPMENTAL SELF CARE REQUISITE

HEALTH DEVIATION SELF CARE REQUISITE

NOT MET

MET

SELF CARE DEFICIT

NURSING INTERVENTION (NURSING SYSTEMS)

SELF CARE

HEALTH

METHODOLOGY

The assessment tool was developed within the framework of Orems (1995) self-care requisites. The tool was designed to assess the universal, developmental, and health deviation self-care requisites of the client. Each self care requisite category (universal, developmental, and health deviation) is broken down into its categorical components. The tool is entitled the Self-Care Requisite Assessment Tool. For every question, there were 5 responses to choose from and the following weights were assigned to each response:
Response Weight

Always
Most of the time Sometimes Seldom Never

5
4 3 2 1

Clients response to universal self care requisites, developmental self care requisites and health deviation self care requisites were determined by utilizing the formula to find the mean (average) of each category.
x X= N

RESEARCH INSTRUMENT Requisite Assessment Tool (Adapted from Roque, F. Study on Acute Gastroenteritis with Severe Dehydration)
Self-Care

DATA ANALYSIS
Self-care Requisites Universal Self care Requisites Developmental Self-care Requisites Health Deviation Self care Requisites Total Mean Score of Initial Assessment Mean Score Description Good Mean Score of Final Assessment Mean Score Description Very Good Mean Difference

3.22 2.50 2.20

4.05 3.83 4.20

0.83 1.33 2.00

Fair

Good

Fair

Very Good

2.89

Fair

4.03

Very Good

1.14

The clients mean difference was obtained by subtracting the clients overall mean score of initial assessment and overall means score from the final assessment results.

PATIENTS BACKGROUND
Name Age Sex Civil Status Occupation Educational Attainment : : : : : : Mrs. MG 46 years old Female Married Housewife Elementary Graduate

o Patient does not have any regular medical and dental check-ups because of lack of time and financial insufficiency. o The patient has an anti-Tuberculosis drug with Fixeddose Combination for 8 weeks, then Isoniazid/Rifampin for 16 weeks . For the first 3 weeks, she is compliant with the treatment regimen. But after few weeks she seemed to be non-compliant with it.

NURSING CARE PLAN

ASSESSMENT NURSING DIAGNOSIS OBJECTIVES OF CARE NURSING INTERVENTIONS/ RATIONALE
Independent

EVALUATION/ OUTCOME

Subjective Data Wala ko kabalo nga may ara na ko sang balati-an kay daw okay man lang akon pamatyag. (I dont know that I already have the disease because I seemed okay). Nakuha ko ni siguro sa mga pagkaon nga gina kaon ko. (Maybe I got this disease from the food Im eating). Objective Data -Presence of cough -Not covering her mouth and nose when coughing -Body weakness -Poor personal hygiene and sanitation

Knowledge Deficit r/t lack of information and limited knowledge about condition, prevention and self-care of having Tuberculosis as evidenced by expressed misconceptions and practices towards health status.

Within 14 days of nursing intervention, Mrs. MG will be able to:

1. Verbalize understanding of disease process/prognos is and prevention.

2. Initiate behaviors/lifesty le changes to improve general well-being and reduce risk of reactivation of TB.

1.Baseline data gathering about Mrs. MG on the records from the City Health Office and Brgy. Health Station. (Baseline data are essential for comparison of any significant changes). 2.Establish rapport with Mrs. MG by visiting in her house and identifying the purpose of the home visit. (To establish trust and cooperation in the patient. 3.Assess patients ability to learn, e.g., level of fear, concern, fatigue, participation level; best environment in which patient can learn; how much content; best media and language; who should be included. (Learning depends on emotional and physical readiness and is achieved at an individual pace).

Within 14 days of nursing intervention , Mrs. MG was be able to: 1.Verbalized understandi ng of the disease process and prevention. 2. Discuss food choices and lifestyle change base on individual needs. .

3. Identify symptoms requiring evaluation/inte rvention.

4. Describe a plan for receiving adequate follow-up care.

5. Verbalize understanding of therapeutic regimen and rationale for actions.

4.Provide instruction and specific written information for patient to refer to, e.g., schedule for medications and follow-up sputum testing for documenting response to therapy.(Written information relieves patient of the burden of having to remember large amounts of information. Repetition strengthens learning). 5.Emphasize importance of maintaining highprotein and carbohydrate diet and adequate fluid intake. (Meeting metabolic needs help minimize fatigue and promote recovery. Fluids aid in liquefying/expectorating secretions). 6.Explain medication dosage, frequency of administration, expected action, and the reason for long treatment period. Review potential interactions with other drugs/substances.( Enhances cooperation with therapeutic regimen and may prevent patient from discontinuing medication before cure is truly effected. Stress need to abstain from alcohol while on INH.( Combination of INH and alcohol has been linked with increased incidence of hepatitis.) 7.Perform daily home visit to note down observation in taking her medication and practices. (To assure patients compliance.)

3. Understand the need to report any untoward drug reactions. 4. Reports adverse effects of medications to health care personnel to allow for early intervention. 5. Verbalized individual treatment regimen and its purpose.

FINDINGS
1. During initial assessment, the results are as follows: Universal Self Care Requisites Good, Developmental Self Care Requisites Fair and Health Deviation Self Care Requisites Fair. The clients mean score was 2.89, indicating a Fair level of clients self care requisites. 2. In the Final assessment, the following are the results: Universal Self Care Requisites Very Good, Developmental Self Care Requisites Good and Health Deviation Self Care Requisites Very Good. Clients mean score was 4.03, which showed a Very Good level of clients self care requisites.

3. There was an increase of 1.14 noted between the initial and final assessment using the same assessment tool. From 2.89 it increased to 4.03 which demonstrate an improvement in the level of clients self care requisites.

CONCLUSIONS
o

Based on the findings of this study, the utilization of Dorothea Orems Self Care theory has a significant effect in the health awareness and improvement on self care requisites of a patient with Pulmonary Tuberculosis. Furthermore, Orems theory indicates that supportive educative system is one of the nursing systems to meet self care requisites of the patient.

RECOMMENDATIONS
Nursing

Practice. The application of Orems Self Care Theory should be used in nursing practice as an effective approach for the future development programs related to tuberculosis which aims in patients education and health promotion in a systematic and holistic way. Education. The educators and nursing students should enhance their teaching and learning strategies in order to have proper knowledge in the application of Orems Self Care Theory. This goes in assessing the needs and providing health education to tuberculosis patients.

Nursing

Nursing

Research. The application of Orems Self Care Theory can also be used in conducting studies for other diseases and medical cases. The theory will serve as a guide in patient assessment and intervention to ensure quality nursing care.