Application of Nursing Theory into Practice: Dorothea Orem’s Self-Care Deficit Nursing Theory in a Critically Ill Patient

Abstract

Background: Critically ill patients often experience impaired self-care due to respiratory compromise, immobility, weakness, invasive devices, and healthcare dependence. Orem’s Self-Care Deficit Nursing Theory guides assessment of self-care needs and appropriate nursing interventions.

Methods: This case report describes a 28-year-old man admitted to an intensive care unit after a severe road traffic accident with polytrauma (including a blunt chest trauma with pulmonary contusions, left femur fracture, and abdominal wall contusions) and acute respiratory failure. He required invasive mechanical ventilation for 20 days. One day following successful extubation (ICU Day 21), he developed post-extubation hypoxemia with an SpO2 dropping to 80% on room air. High-flow nasal oxygen (HFNO) therapy was immediately initiated at a flow rate of 50 L/min and an FiO2 of 0.50, successfully restoring SpO2 to 95%–97%. He had marked generalized weakness, was lethargic, anxious, and irritable, had an ineffective cough with retained secretions requiring suctioning, and relied on enteral nutrition via a nasogastric tube and a Foley catheter for urine-output monitoring. He was completely dependent for hygiene, oral care, repositioning, and mobility.

Results: Orem’s theoretical concepts were applied to categorize self-care deficits and map nursing activities explicitly across Wholly Compensatory, Partly Compensatory, and Supportive-Educative nursing systems. Care transitioned dynamically from nurse-administered compensatory measures toward patient-partnered activities as functional participation improved.

Conclusion: Orem’s theory served as an effective conceptual framework for organizing clinical reasoning and structuring individualized care during recovery from prolonged mechanical ventilation. This report illustrates theoretical organization of care rather than a demonstrated causal effect on clinical recovery.