Analysis of medical surgical nursing specialist practice in neurological system disorder patients with primary cases of hemorrhagic stroke and non-hemorrhagic stroke using the Dorothea Orem theory model approach
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20252180Keywords:
Hemorrhagic stroke, Non-hemorrhagic stroke, Orem’s theory, Medical-surgical nursing, Self-care, NIHSSAbstract
Background: Hemorrhagic and non-hemorrhagic strokes are among the leading causes of neurological disability worldwide, often resulting in significant self-care deficits. Specialist medical-surgical nurses play a critical role in addressing these needs through structured, theory-guided interventions. Dorothea Orem’s self-care deficit nursing theory (SCDNT) offers a comprehensive framework to guide care for stroke patients experiencing functional dependency.
Methods: This descriptive-analytic study used a retrospective case study approach to examine the application of Orem’s SCDNT in stroke care. The study was conducted at Gatot Subroto Army hospital and the Pusat Otak nasional hospital in Jakarta from October 2022 to May 2023. Data were obtained from three directly managed cases and 40 patient medical record summaries meeting inclusion criteria (hemorrhagic or non-hemorrhagic stroke, ≥6 days hospitalization, complete documentation). Structured reviews of nursing and physician records captured variables such as demographics, risk factors, national institutes of health stroke scale (NIHSS) scores, and nursing diagnoses. Nursing interventions were categorized using Orem’s care systems: wholly compensatory, partially compensatory, and supportive-educative. Descriptive statistics and thematic interpretation were used to analyze patterns and theory-practice alignment. Ethical clearance was not required due to the use of de-identified secondary data, though institutional permission was obtained.
Results: The majority of patients were male (75%) and aged 51-60 years. Hypertension was the most common risk factor (40%). NIHSS scores most frequently ranged from 5-15, indicating moderate stroke severity. The dominant nursing diagnosis was ineffective cerebral perfusion (52.5%). Most patients required wholly or partially compensatory nursing systems based on their level of dependence and clinical status.
Conclusions: Dorothea Orem’s theoretical model effectively supported the delivery of individualized, structured nursing care in stroke patients with neurological deficits. The use of wholly and partially compensatory systems aligned with patients’ functional limitations, enabling nurses to meet care needs, support recovery, and gradually enhance self-care capabilities. These findings underscore the relevance of theory-based practice in specialist nursing and its value in improving outcomes for stroke patients.
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References
enjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics-2019 update: A report from the American Heart Association. Circulation. 2019;139(10):e56-8.
Campbell BCV, Khatri P, Saver JL. Stroke. The Lancet. 2023;401(10387):1204-22. DOI: https://doi.org/10.1016/S0140-6736(23)00862-0
Carter N, Bryant-Lukosius D, DiCenso A, Blythe J, Neville AJ. The use of triangulation in qualitative research. Oncol Nursing Forum. 2014;41(5):545-7. DOI: https://doi.org/10.1188/14.ONF.545-547
Feigin VL, Stark BA, Johnson CO, Roth GA, Bisignano C, Abady GG, et al. Global, regional, and national burden of stroke and its risk factors, 1990- 2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2022;21(9):795-820. DOI: https://doi.org/10.1016/S2215-0366(21)00395-3
Ganti L, Daneshmand A, Patel P, Umar S, Dhand A, Jaffe TA. Intracerebral hemorrhage: A review. Cureus. 2020;12(3):e7481.
Goyal M, Menon BK, van Zwam WH, Dippel DWJ, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: A meta-analysis of individual patient data from five randomised trials. The Lancet. 2020;395(10226):197-206.
Gumbinger C, Reuter B, Stock C, Sauer T, Wiethölter H, Bruder I, et al. Disability and care dependency after acute ischemic stroke: Implications for the use of thrombolysis. J Stroke Cerebrov Dis. 2019; 28(7):1985-92.
Iadecola C, Anrather J. The immunology of stroke: from mechanisms to translation. Nat Med. 2011;17(7):796-808.
Ignatavicius D, Workman L. Medical-surgical nursing: Patient-centered collaborative care. Elsevier Health. 2015.
Jauch EC, Saver JL, Adams Jr HP, Bruno A, Connors JJB, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke. Stroke. 2013;44(3):870-947. DOI: https://doi.org/10.1161/STR.0b013e318284056a
Johnson CO, Nguyen M, Roth GA, Nichols E, Alam T, Abate D, et al. Global, regional, and national burden of stroke, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019. The Lancet Neurol. 2021;20(10):795-820. DOI: https://doi.org/10.1016/S1474-4422(21)00252-0
Kunz WG, Hunink MGM, Sommer WH, Jansen O, Wiest R, Herweh C. NIHSS as a predictor of outcome after stroke: Validation and potential for refining triage. Neurology. 2021;96(1):e29-38.
Langhorne P, Ramachandra S. Stroke Unit Trialists' Collaboration. Organised inpatient (stroke unit) care for stroke: Network meta‐analysis. Cochrane Database System Rev. 2020;4(CD000197). DOI: https://doi.org/10.1002/14651858.CD000197.pub4
Lee BY, Newberg AB. Neuroimaging in traumatic brain imaging. NeuroRx, 2015;12(2):372-83. DOI: https://doi.org/10.1602/neurorx.2.2.372
Li, S., et al. (2017). Nursing care of patients with increased intracranial pressure. J Neurosci Nursing. 2017;49(3):177–83.
LoPresti MA. Intracranial pressure monitoring: An update. Current Neurology and Neuroscience Reports. 2020;20(11):1–8.
Macmillan M, Drummond A. The role of the nurse in the long-term management of stroke patients. Brit J Nursing. 2015;24(20):1012-8.
Iadecola C, Anrather J. The immunology of stroke: From mechanisms to translation. Nature Med. 2011;17(7):796–808. DOI: https://doi.org/10.1038/nm.2399
Orem DE. Nursing: Concepts of practice, 6th ed., Mosby; 2001.
Younas A, Quennell S. Usefulness of nursing theory-guided practice: An integrative review. Scandinavian J Caring Sci. 2019;33(3):540–55.
Teasell RW, Foley NC, Bhogal SK, Speechley MR. An evidence-based review of stroke rehabilitation. Top Stroke Rehabil. 2003;10(1):29-58. DOI: https://doi.org/10.1310/8YNA-1YHK-YMHB-XTE1
Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: A meta-analysis of individual patient data from five randomized trials. The Lancet. 2020;395(10226), 197-206.
Polit DF, Beck CT. Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Wolters Kluwer. 2021.
Yin RK. Case study research and applications: Design and methods (6th ed.). SAGE Publications. 2018.
World Health Organization. Neurological disorders: Public health challenges. World Health Organization. 2006. Available at: https://www.who.int/publications/i/item/978924 1563369. Accessed on 3 March 2025.
Yaghi S, Willey JZ, Cucchiara B, Goldstein JN, Schwamm LH, Bar B, et al. Treatment and outcomes of mild stroke and rapidly improving stroke symptoms. Stroke. 2020;51(3):745-50.
Younas A, Quennell S. Usefulness of nursing theory- guided practice: An integrative review. Scandinavian J Caring Sci. 2019;33(3):540-55. DOI: https://doi.org/10.1111/scs.12670
Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics-2020 update: A report from the American Heart Association. Circulation. 2020;141(9):e139-596.
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