Patients' expectations of independence-dependence in self-care for the first week after discharge : Orem's self care theory applied to adult medical-surgical patients in one hospital in the Philippines

Abstract

Hospitals have an important role in health education for clients. Through discharged planning, a client's need for informed self-care can be met. The purpose of study was to define self-care deficits at discharge as perceived by adult medical-surgical hospitalized patients. The problem addressed in this study was, What activities in discharge planning will best meet the needs of hospitalized adult patients for care at home? Data were gathered at a private church-related hospital in North Philippines. The information obtained was intended to be of value in developing criteria to select patients who need discharge planning. Orem's self-care theory was used to guide this study. This survey study described and compared various subject variables with the patient's assessment of needs for help within the first week of discharge. The tool developed for this study contained 52 items, adapted from a prior tool and organized into 10 subscales based on Orem's self-care theory. Subjects rated each item on a 5-point scale ranging from independence in doing by self (1) to dependence on a health care professional (5). A nonprobability sample of 50 subjects participated in this study. The four major research hypothesis postulated a difference in self-care requirements depending on personal and illness variables, differences in subscales, and in areas of self-care: universal, developmental, and health deviation. ANOVA and t test were used to test for significance. Major conclusions from this study are that older, male, married, and long-term chronic patients have higher dependency needs than do younger, female, or single patients. Patients with less than a high school educational level are more dependent in health deviation self-care area needs than persons with more education. Patients in hospital longer have increased need for discharge planning. Recommendations included repeating the study with a larger sample and in different cultures and settings. Recommendations for nursing administrators included encouraging nurses to emphasize patient teaching or education to enhance quality of nursing care. The card sort used for defining expected self-care needs after discharge could be used as an assessment for discharge protocol.