Grand Nursing Theories Based on Human Needs

Grand Nursing Theories Based on Human Needs

Grand Nursing Theories Based on Human Needs

Use relevant journal articles to support your answers.

Grand Nursing Theories Based on Human Needs Case Study

Mr. Juan Duran is a 60-year-old patient who has been coming to the Diabetes Clinic at the VA for a few months. One day, the Clinic Director, Jim Carlson, finds him wandering the hallway, appearing somewhat dazed, with a bag of supplies for blood glucose testing and insulin administration. Mr. Duran tells him that he has been instructed to start insulin for his diabetes but doesn’t know how. He doesn’t recall receiving any appointment or instructions. Mr. Carlson finds the Diabetes Nurse Educator, Jenny O’Connell, and asks her to fit Mr. Duran in for an unscheduled appointment.


Jenny O’Connell starts the appointment with a thorough assessment of Mr. Duran. In addition to the physical assessment, she covers psycho-social-spiritual issues. She discovers that Mr. Duran has had diabetes for about 10 years and, recently, his blood glucose levels and HgbA1c cannot be controlled with oral medications and exercise. The physician wants to start him on insulin. Here are notes that she took from her assessment:

Sixty-year-old Mexican American patient. He is exceedingly polite and respectful of health care personnel (and does not like to interrupt or ask too many questions). He has been in the United States more than 50 years; he is a Navy veteran. Grand Nursing Theories Based on Human Needs.
Married; lives with wife in a comfortable apartment in Chula Vista, CA.
Duran speaks fluent English, but his wife’s English is limited. They speak Spanish at home.
Because Mr. Duran has limited vision, his wife has to administer the insulin.
Had one (single) daughter, who was found murdered in the apartment parking lot less than 2 weeks ago, leaving Mr. and Mrs. Duran to care for her child.
Duran seems befuddled by the insulin and syringes and is stoic when he talks about the loss of his daughter. Grand Nursing Theories Based on Human Needs.

Review the situation
Select one of the nursing models/theories from this chapter that will help Jenny in assessing Mr. Duran and planning for his care. Grand Nursing Theories Based on Human Needs Discuss why that particular model was selected.
Based on the model selected, what additional information would Jenny want to collect/assess?
Based on the model selected, how would Jenny initiate a plan of care (education) for Mr. Duran?
Do you think that Jenny would assess and plan differently for Mr. Duran’s care if she used a different model (than the one your group selected) for Mr. Duran? Why or why not.

Grand Nursing Theories Based on Human Needs Internet Resources

Clayton College Department of Nursing’s Nursing Theory Link Page—contains comprehensive links to sites containing information for grand and middle range nursing theories:


Grand Nursing Theories Based on Human Needs. The Hahn School of Nursing Theory page—contains links to sites for information on many grand and middle range nursing theories:


Nurse Scribe’s Nursing Theory page—contains links to many grand nursing theorists’ home pages as well as links to other reference materials related to nursing theory:


Nursing theory—contains links to information about nursing theory and nursing history:

Current websites devoted to the theorists in this chapter:





Brief interview with Johnson: Grand Nursing Theories Based on Human Needs.



Brief interview with Neuman:





Grand Nursing Theories Based on Human Needs Brief interviews with Orem:

Student project: Application of Orem in practice:


Grand Nursing Theories based on Human Needs Essay

Select one of the nursing models/theories from this chapter that will help Jenny in assessing Mr. Duran and planning for his care. Discuss why that particular model was selected.

Mr. Duran is best assessed and his care planned using the self-care deficit theory proposed by Orem. The theory holds that an individual must be at the fore-front of self-care by actively carrying out activities to maintain good health. In Mr. Duran’s case, Jenny must review his capacity to perform self-care while acknowledging that the capacity is influenced by basic conditioning factors that include family system, health care system, gender, and age. In essence, it places a demand on the health, developmental and universal deviation as self-care requisites such that any inadequacy in the self-care requisites would be interpreted as a self-care deficit or the patient’s need for self-care. Jenny is expected to identify the deficit then select a nursing system to provide care with the nursing system taking the form of educative, supportive, and compensator system (Didisen, Binay & Yardimci, 2017). Grand Nursing Theories Based on Human Needs.

Based on the model selected, what additional information would Jenny want to collect/assess?

Other than the patient’s medical history and physician’s perspective of Mr. Duran’s condition, Jenny would collect information on basic conditioning factors that include available resources, environment, living patterns, family system, health care system, development state, and sociocultural orientation. Additionally, information on universal self-care requisites should be collected to include promotion of normalcy, prevention of hazards, social interaction, activity and rest, elimination, food, water and air. Besides that, information on developmental self-care requisites should be collected to include prevention and management on conditions threatening normal development, and maintenance of developmental environment (Didisen, Binay & Yardimci, 2017). Also, information on health deviation self-care requisites should be collected to include lifestyle adjustment to accommodate medical regimen (insulin) and health status changes, self-image modification to incorporate health status changes, awareness of potential problems linked with the regimen, and adherence to the medical regimen (Shah, 2015).
Based on the model selected, how would Jenny initiate a plan of care (education) for Mr. Duran?

Based on the self-care deficit theory, Jenny should first present a nursing diagnosis based on the self-care deficits. The second step would entail her preparing an outcomes plan that presents prescriptive operations to include the appropriate method of helping Mr. Duran, design a suitable nursing system, outline the nursing objectives and goal, and identify the desired outcome. The third step would entail implementing the plan through control operations that collaboratively work with the patient to include reducing the self-care deficit, meeting the self-care needs, and promoting Mr. Duran as a self-care agent. Grand Nursing Theories Based on Human Needs. The final step would entail evaluating the education plan through regulatory operations that include reviewing the selected nursing system’s effectiveness to meet the patient’s needs. In addition, the final step would review the effectiveness of the nurse-patient action to reduce the self-care deficit, meet the self-care needs, and promote Mr. Duran as a self-care agent (Didisen, Binay & Yardimci, 2017; Shah, 2015).
Do you think that Jenny would assess and plan differently for Mr. Duran’s care if she used a different model (than the one your group selected) for Mr. Duran? Why or why not.

Yes, Jenny would assess and plan differently for Mr. Duran’s care if she used a different model from the self-care deficit theory. That is because different models apply different approaches and focus on unalike aspects of the patient’s life even though the ultimate objective remains the same. The applied model focuses on the existing shortfalls that limit the patient’s capacity for self-care. Other models would not focus on the existing deficits. For instance, the Human Caring Theory presented by Jean Watson focuses on the spiritual dimension of caring and love. Applying the Human Caring Theory to Mr. Duran’s case would entail identifying the patient’s family as an integral part of the care team with everyone involved considered as a caregiver. Additionally, care would be offered at home where the patient has the most support and comfort to ensure that his goals and best interests are served. As such, it’s planning and assessment would revolve around the family (Clark, 2016). Therefore, Jenny would assess and plan differently for Mr. Duran’s care if she used a different model from the self-care deficit theory. Grand Nursing Theories Based on Human Needs.


Clark, C. (2016). Watson’s Human Caring Theory: Pertinent transpersonal and humanities concepts for educators. Humanities, 5(21), 1-12. doi: 10.3390/h5020021

Didisen, N., Binay, S. & Yardimci, F. (2017). Orem’s Self-care Deficit Theory and Nursing Care in Relation to Pneumonia: A Case Report. Studies on Ethno-Medicine, 11(4), 311-317. doi: 10.1080/09735070.2017.1357223 Grand Nursing Theories Based on Human Needs.

Shah, M. (2015). Compare and Contrast of Grand Theories: Orem’s Self-Care Deficit Theory and Roy’s Adaptation Model. International Journal of Nursing Didactics, 5(1), 39-42. doi: 10.15520/ijnd.2015.vol5.iss01.28.39-42 Grand Nursing Theories Based on Human Needs.

This is the case of Mr Duran Juan  , X years old, Mexican  America, visiting the diabetes clinic at the VA hospital. Mr Duran speaks English and Spanish fluently but speaks Spanish at home as his wife’s English  is limited. He is a Navy Veteran. Mr Duran just has been placed on insulin for his diabetes management. Patient lives with his wife in their apartment in Chula Vista , CA. patient with limited vision , wife must administer insulin. Mr and Mrs Duran has one single daughter, who was found murdered in the apartment parking lot less than 2 weeks ago, leaving Mr and Mrs Duran to care for her child. Mr Duran seems befudded by the insulin and syringes and he is stoic when he talks about the loss of his daughter.

Orem’s Self-Care theory includes three other theories: theory of Self-Care, Self-Care deficit theory, and the theory of Nursing Systems. In our case study, Orem model deals with selfcare and Mr Duran will need to care for his diabetes with the help of his wife. Nursing theories have four concepts that are central to their metapardigm: person, environment, health, and nursing. The person (or patient) is the central focus of nursing care. According to Orem, the person’s health state is mediated by his/her environment. A person, who is healthy, is capable of self-care. When there is illness in the person’s health state, the person is not able to complete all self-care requisites. When this occurs, nursing care is needed to assist the person in completing his/her self-care. Nurses must assess the person’s ability to provide his/her own self care and the environmental context of the person in order to overcome health-associated limitations. In our case study, Mr Duran requires insulin injection for his diabetes,  nurse Jenny  knows that Mr Duran will not be able to self-administer his own insulin due to his poor vision and will need his wife to assist him with that. Moreover, Mr Duran is also dealing with the recent death of his only child. Orem’s assumptions is that patients are to care for themselves along with their health care team and family and friends. As there needs to be clear and open lines of communication to help promote autonomy. Patients can make clear decisions for themselves when educated properly. In this case , Mr Duran did communicate his fear about dealing with insulin and syringes but also talks about the death his daughter so the communication is open between this patient and his nurse.  When using Orem, nurse Jenny interacts with the medical team to plan, and administer care, assists Mr Duran and wife in learning to care for themselves. Nurse Jenny referred patient and wife to a dietician, counselors to help cope with the loss, social workers to help with caring for their grand-daughter . The model also includes the family and culture within the environment. In Orem theory, the nurse would want to assess the Duran’s family current knowledge of diabetes, insulin , diet and self care . In addition, the nurse should be concerned about aspects of his environment such as family support and culture. In this case, Mr Duran has a very caring wife who is willing to assist him with his insulin injection. Once the care is provided, the nursing activities and the use of the nursing systems are to be evaluated to get an idea about whether the mutually planned goals are met or not.  Orem identifies 5 methods of helping :Acting for and doing for others, Guiding others, Supporting another, Providing an environment promoting personal development in relation to meet future demands and Teaching another. In this case, Mr Duran is receiving diabetes counseling at the VA hospital and will be required to follow up with his doctor and health team on a regular basis for a better management of his diabetes. I believe Neuman’s theory not only helps me provide my patients with holistic care, but it also helps me understand the importance of systemic and environmental variables on a person’s mental health

Betty Neuman’s Neuman Systems Models comprises of the concept that human interventions can be done in order to relieve stress in the subject’s life. In Mr  Duran’s situation , the role and amount of stress are vitally important. The assumptions of the Neuman Model include the idea that: each client is unique, there are various stressors that exist (known and unknown), humans have various range of responses to their stressors, wellness is ongoing in order to support the client’s stability, and there are primary, secondary and tertiary preventions that can be taken in order to promote and reduce client stressors. For Mr Duran , the main stressors identified were the newly insulin management that he has to manage with the help of his wife,  the loss of his only child and the responsibilities that he has to raise his grand-daughter at his age. The primary preventions that nurse Jenny and the health team can implement is stress management activities, relaxation techniques. Secondary preventions would be to provide medications to treat symptoms of anxiety, insomnia but also opportunities to verbalize feelings and concerns. The tertiary preventions would be to re-assessing Mr Duran’s ability to independently perform and maintain variables of health , regular consult to counselor, support group,  psychologist to cope with the loss of his daughter, home health visits for nurse to instruct family how to perform proper administer insulin but also educating patient and his family about diabetes management and maintaining his support system. In addition , the five interactive variables –physiologic, psychological, sociocultural development and spiritual, all will be important in his care. When applying Neuman , nurse Jenny would assess the 5 interacting variables such as 1) Physiological variables bodily structure & function : Mr Duran has limited vision so unable to self-administer is insulin). Psychological variables: his mental processes & relationships. 3) Sociocultural variables: his social & cultural functions. 4) Developmental variables: developmental processes of life. 5)  Spiritual variables: his continuum of spirituality. Nurse Jenny and the health team have to look at the need both interventions as well as prevention activities , and consider how stress is impacting both his diabetes control and his ability to learn. The Neuman model implies that stressors can be identified and treated with nursing interventions. In Mr Duran ‘s situation , the nurse would want to collect and assess the physiological data, psychological data, sociocultural data, development data , spiritual data ( how  he is coping with the death is child, does he practice religion ) and stress ( the death of his only child, caring for his grand-daughter, his insulin management)

Example of Orem ‘s theory within my home health practice.

As a provider I will utilize Orem’s theory of self care deficit to identify appropriate and validated measures required by self-care requisites. Professional nursing practice is based on the assumption that patient’s desire and need the self-care agency. The ability to engage in self-care activities is innate as well as learned. As a provider, I will assist patients in learning as well as performing self-care activities. My role is to facility the self-care agency of the patient. Utilizing the theory of self-care, along with the theories of self-care deficit and nursing systems, I will be able to identify self-care deficits and the degree and competency of the patient’s self-care requisites and abilities. With this data, the appropriate nursing system of action with interventions can be implemented. This theory will assist me in identifying and encouraging appropriate self- care activities across the lifespan. For example, the supportive-educative role indicates that the patient is participating in most of their self-care, and the nurse’s role is simply to monitor and regulate the client’s self-care. Last week, a newly patient got admitted to home health services for diabetes management. Upon home health visits, I reviewed patient’s glucometer reading for the past few days and noticed patient’s blood sugar was reported highly variable BS/chemstrip readings and errors readings. I suspected patient may be performing procedure incorrectly. I assessed that patient has been cutting some of his chemstrips in half to save money. Please note that patient is using a glucometer and supplies from Guadalaraja. I  instructed patient that cutting strips exposes chemicals and inaccurate readings may result. I also ordered a new glucometer , strips and lancet from a local DME company. Instructed patient and caregiver on how to perform blood sugar check via glucometer. After two visits, patient and wife were able to return demonstration.  Additionally, I assessed that patient’s wife (who does family cooking) did not receive any nutritional education while patient was hospitalized. Nurse begins nutritional education/teaching and provided wife with referral to registered dietician services. Upon discharge from home health service’s, patient and wife demonstrated understanding of diabetes management , diet and proper use of the glucometer.

Example of Neuman’s theory within my home health practice.

Last month, I provided home health services for this young female patient as she developed DVT on her bilateral lower extremities and infection to surgical C-section area  after giving to her daughter 2 weeks ago. She needed IVATB infusion for 14 days, Lovenox Injection for 2 weeks and daily wound care. This new mom is already facing a lot of stressors. One condition that brings extrapersonal stress is the unemployment of the husband. Their financial source is not enough to meet their needs. This relationship poses as an interpersonal stress to her. This patient is having difficulties breastfeeding at that time, and her poor nutritional (underweight) and emotional status (sadness and anger at her mother-in-law as they have to move in with them due to financial difficulties) create intrapersonal stresses. I know, based on Neuman’s Systems Model that the reaction to stressors would depend on the strength of the lines of defense. The woman, due to financial constraints and anxiety is suffering from poor nutritional status. She is not able to sleep a lot due to her newborn child.  This creates a breach to her flexible line of defense. Her coping abilities are also affected because she is sometimes preoccupied with her relationship problems with her mother-in-law. These conditions put my patient on the verge of developing various illnesses. Hence, my interventions focused on restoring system stability, by helping the patient’s system adapt to the stressors. Starting with primary prevention, I tried to educate their family on the importance of having good nutrition. I also suggested some nutritious but cheap food choices but also refer her to our social worker for evaluation . For the secondary prevention, I advised that she seeks for local supports such as food stamp, WIC program, and make use of the available services of the nearby health center. After about 1 month of constant visits to these clients, I really observed noticeable improvements in her health conditions. My patient began to show weight gains. The husband started to work as a production operator in a nearby factory. Before the home health services ended, we were able to initiate tertiary prevention by supporting and commending the positive behavioral changes exhibited by the family, her husband is more hands on with their child, the mother in law is now babysitting so the couple can spend some time alone. I, also dwelt on strengthening the positive attributes of the family, such as their unwavering faith in God, and their strong devotion to each other. I learned from this experience that no problem is unsolvable with the use of consistent and well-contemplated nursing care.



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