NURS 8250 Week 11 Theory Reflection Paper Example

What Self-Care Kept Out of View: A Reflection on Using Orem's Theory for Pediatric Asthma Self-Management at a School-Based Clinic

Student Name

College of Nursing, Walden University

NURS 8250: Advanced Theoretical and Scientific Perspectives in Nursing

Instructor Name

Month Day, Year

What Self-Care Kept Out of View: A Reflection on Using Orem's Theory for Pediatric Asthma Self-Management at a School-Based Clinic

The Framework I Chose

For most of this term I worked with Orem's self-care deficit theory on a problem at a composite school-based health clinic in an urban elementary school: children with asthma who miss school days and visit the emergency department because their asthma is poorly controlled. The theory seemed an obvious fit. Orem (2001) describes self-care as the actions people take to maintain life, health and well-being, and self-care agency as their capacity to take those actions. For children, much of that capacity belongs to parents or other caregivers, whose capacity Orem calls dependent-care agency. When the demands of a condition exceed a person's agency, a self-care deficit exists, and nursing responds through wholly compensatory, partly compensatory or supportive-educative systems.

Applied to asthma, the theory organized my thinking well. The therapeutic self-care demand included recognizing symptoms, using an inhaler with a spacer correctly, taking controller medication daily and avoiding triggers. The child's self-care agency grew with age; a seven-year-old needs a parent to manage controller medication, while a ten-year-old can carry a rescue inhaler. The school nurse's work fit the supportive-educative system: teaching inhaler technique, reviewing the asthma action plan with families and helping children learn to recognize early symptoms. The theory gave me a clear structure and a clear role for nursing.

What the Theory Trained Me to See

Attention trained by a framework has costs as well as benefits, and this reflection is about the costs. Orem's theory trained me to look at capacity: the child's and the parent's knowledge, skill and motivation to meet the demands of asthma. When a child's asthma was poorly controlled, the theory directed me to ask what the child or parent did not know or could not do. I found real deficits. Many children used their inhalers incorrectly, and some parents did not understand the difference between controller and rescue medication. Teaching those skills was worthwhile, and I would do it again.

What It Kept Out of View

What the theory did not train me to see was everything around the child that no amount of self-care agency could change. I noticed it first in one family. A mother whose son had three emergency visits in one winter knew the action plan well and could demonstrate perfect inhaler technique. Her son's asthma was poorly controlled because their apartment had mold in the bathroom and cockroaches in the kitchen, and the landlord had ignored her complaints for months. In Orem's terms, I could describe the triggers as part of the self-care demand and the mother's inability to remove them as a limit on her dependent-care agency. But that framing placed the problem inside the family, as a deficit, when the problem was the building.

Once I saw that, I saw it elsewhere. Research on housing and asthma has shown that home triggers, including pests, mold and moisture, contribute to poor asthma control, and that interventions to improve the home environment can improve control (Krieger, 2010). A scoping review of structural and social determinants of asthma describes the role of housing, neighborhood conditions, air pollution, poverty and access to care in asthma outcomes (Sullivan & Thakur, 2020). The school sits near a highway interchange, and several children live in buildings along it. Some families had gaps in insurance coverage that interrupted controller medication. None of these were deficits in self-care agency. They were conditions that made the self-care demand impossible to meet, however capable the family was.

The theory did not forbid seeing these things; its concept of basic conditioning factors includes environmental and health system factors. But it placed them in the background, as factors that condition agency, while it placed the family's actions in the foreground. My attention followed the foreground.

What I Would Do Differently

If I began the project again, I would keep Orem's theory for what it does well, organizing the teaching and support that children and families need, and pair it with a framework that puts structural conditions in the foreground. I would also change my assessment. The clinic's intake asks about symptoms, medications and inhaler technique. I would add questions about housing conditions, pests and mold, and insurance continuity, and I would build a referral pathway to community health workers and legal aid for housing complaints. The project's outcome measures would include not only inhaler technique and school days missed but also whether home triggers were addressed.

I would also change the language in my notes. I had been writing that a family had a knowledge deficit or a dependent-care deficit. For some families, that was accurate. For others, it attributed to the family a problem that belonged to a landlord, a highway or an insurance system.

How the Change Would Show in the Project

A committee reading my proposal before and after this reflection would see three differences. The problem statement would no longer describe poorly controlled asthma as a result of gaps in family knowledge alone; it would name home triggers, outdoor air and interrupted coverage as conditions that limit what any family can do. The intervention would still include teaching, but it would add a housing and coverage screen with referrals, so that the school nurse's work reached beyond the supportive-educative system. And the evaluation would separate children whose families gained skills from children whose homes changed, since the two groups might improve for different reasons. None of these changes abandons Orem's theory. They place it inside a larger picture that the theory, used alone, had let me leave blank.

What This Taught Me About Theory

The larger lesson is that choosing a framework is also choosing what to leave in the background. Before this course, I thought of a theory as a lens that makes things clearer. I now think of it as a lens that makes some things clearer by making others harder to see. That is not a reason to avoid theory, since without Orem's structure my teaching would have been less organized and less effective. It is a reason to ask, at the start of any project, what the chosen framework will make easy to overlook, and to decide deliberately how to keep those things in view.

References

Krieger, J. (2010). Home is where the triggers are: Increasing asthma control by improving the home environment. Pediatric Allergy, Immunology, and Pulmonology, 23(2), 139-145. https://doi.org/10.1089/ped.2010.0022

Orem, D. E. (2001). Nursing: Concepts of practice (6th ed.). Mosby.

Sullivan, K., & Thakur, N. (2020). Structural and social determinants of health in asthma in developed economies: A scoping review of literature published between 2014 and 2019. Current Allergy and Asthma Reports, 20(2), Article 5. https://doi.org/10.1007/s11882-020-0899-6