Coronavirus infections: health care planning based on Orem's Nursing Theory

to report the experience of professors and students of a graduate course on nursing care in coping with the new coronavirus (COVID-19) based on Self-Care Theory.

Method:

the active methodologies used were a literature search and seminar presentations, with an understanding of Orem's theoretical concepts: health; man; self-care; universal, developmental and health deviation requirements; self-care activities; self-care deficits; the required therapeutic demand; nursing systems. The pandemic was considered a health deviation that requires critical thinking and nursing care planning. Methodological frameworks to classify nursing diagnoses, interventions, and outcomes were used.

Results:

for each health deviation, nursing systems were identified; self-care deficits, diagnoses; actions, interventions; and the form of assessment, outcomes.

Final considerations:

theoretical-practical reflections of the academic context support nursing care planning.

Descriptors:
Nursing Process; Patient Care Planning; Nursing Theory; Nursing Diagnosis; Coronavirus Infections

ND/Self-Care Deficit	NI	NO
Ineffective airway clearance	Medication administration Airway suctioning and management Mechanical ventilation management: invasive	Respiratory status: airway patency Aspiration prevention Mechanical ventilation response
Risk for aspiration	Artificial airway management Vomiting management Chest physiotherapy Neurologic/respiratory/positioning	Nausea & vomiting control Risk detection and control Aspiration prevention Mechanical ventilation response: adult
Dysfunctional ventilatory weaning response	Artificial airway management Airway suctioning/pneumonia prevention Mechanical ventilation management	Gas exchange Mechanical ventilation weaning response Cardiopulmonary status
Impaired spontaneous ventilation Impaired gas exchange	Acid-base management/monitoring Mechanical ventilation management: invasive	Gas exchange Mechanical ventilation and weaning Anxiety level
Impaired bed mobility Impaired physical mobility	Bathing/skin surveillance Body mechanics promotion Self-care assistance Traction/immobilization care Urinary elimination/bowel management Bed rest careMassage	Imobility consequences: physical Fatigue, discomfort and pain/mobility level Tissue perfusion: pulmonary Joint movement
Ineffective health maintenance Ineffective protection	Self-care assistance Medication and pressure management Ventilation assistance Peripheral sensation management Learning facilitation Emergency care Risk identification Coping enhancement Respiratory monitoring Reality orientation	Health promoting and complicance behavior Knowledge: treatment Symptom management Risk detection Knowledge: treatment regimen Symptom management Participation in health care decisions
Ineffective thermoregulation	Bathing Environmental and water management Hyperthermia treatment Vital signs monitoring	Risk control: hyperthermia Thermoregulation
Ineffective peripheral tissue perfusion	Acid-base management Hypervolemia management Hypovolemia management Nutrition management Peripheral sensitivity management Shock management	Circulatory status Tissue integrity: skin & mucous membranes Tissue perfusion: cellular Tissue perfusion: peripheral
Risk for infection	Pressure ulcer prevention Airway management Tube care Tube care: urinary	Imobility consequences: physiological Risk detection and control: infectious process
Risk for impaired skin integrity Risk for pressure ulcer	Circulatory precautions/embolism Hyper/hypoglycemia management Lower extremity monitoring Skin surveillance Immobilization and positioning Vital signs monitoring Fall prevention Nutrition management/planning Bowel constipation/incontinence Infection control Bed rest care Surveillance Immobilization and positioning	Cognition, anxiety and agitation Management/risk detection Infectious process, hyper and hypothermia Respiratory status and vital signs Gastrointestinal, renal, circulatory and cardiopulmonary function Bowel elimination Nutritional status: food and fluid intake Hydration/mobility Acid-base balance
Impaired oral mucous membrane integrity	Water management Oral health maintenance Airway suctioning	Oral hygiene/eye care Risk control: infectious process Hydration
Risk for falls	Area restriction Body mechanics promotion Dementia and pain management	Fall prevention Risk control Agitation and acute confusion level

ND/Self-Care Deficit	NI	NO
Ineffective health maintenance Decisional conflict	Self-care assistance Self-responsibility facilitation Risk identification Culture brokerage Self-awareness/coping enhancement Behavior modification Health system guidance	Health promoting behavior Knowledge: health promotion and resources Risk detection Participation in health care decisions
Impaired gas exchange	Acid-base/vital signs monitoring Mechanical ventilation management: noninvasive Anxiety reduction	Respiratory status: gas exchange and ventilation
Ineffective breathing pattern	Mechanical ventilation management: noninvasive and weaning Vital signs monitoring Oxygen therapy Anxiety reduction	Respiratory status: airway patency, gas exchange and ventilation Anxiety level
Impaired spontaneous ventilation	Emotional support Airway/acid-base management Mechanical ventilation management: noninvasive/oxygen therapy Vital signs monitoring	Respiratory status: gas exchange Respiratory status: ventilation
Readiness for enhanced self-care	Self-modification and self-care assistance Mutual goal setting Self-responsibility facilitation	Self-care: hygiene compliance behavior
Relocation stress syndrome	Emotional support/counseling Anger control assistance Active listening Mutual goal setting Self-responsibility facilitation	Personal autonomy Coping Loneliness severity Anxiety level Fear level
Anxiety	Antecipatory guidance/counseling Relocation stress reduction Increased safety/emotional support	Anxiety self-control Coping
Fear	Counseling Emotional and decision-making support Support system enhancement Anxiety reduction/presence/calming technique	Fear self-control Fatigue level Fear level
Ineffective thermoregulation	Bathing/hygiene Environmental management/water management Hyperthermia treatment/vital signs monitoring	Risk control: hyperthermia Thermoregulation
Social isolation	Counseling/emotional support Self-awareness enhancement Relocation stress reduction	Social support

ND/Self-Care Deficit	NI/Activities	NO
Feeding self-care deficit	Nutrition management Nutrition monitoring • Discuss supportive habits for purchasing food and isolation restrictions; • Determine food consumption habits; • Facilitate the identification of eating behaviors to be changed.	Self-care: food and activities of daily living Nutritional status
Decreased diversional activity engagement	Activity therapy Recreation therapy • Promote occupational therapy or art therapy activities; • Set goals for performing exercises and recreational activities; • Encourage activities with music therapy.	Social involvement motivation Leisure and play participation Personal well-being Health promoting behavior
Risk for loneliness	Coping enhancement Emotional support Counseling Family integrity promotion Support system enhancement • Develop social skills of distance interaction using the internet; • Promote stress reduction through change.	Social support Family well-being Social interaction skills
Impaired social interaction	Self-awareness enhancement Support group Communication enhancement • Encourage resilience promotion; • Promote remembrance therapy and improve family support, animal therapy, and recreational therapy.	Family well-being Social involvement Social interaction skills Leisure and play participation
Risk for contamination	Infection control Environmental management: community and safety Health policy monitoring • Use masks.	Safe home Self-care: hygiene Personal safety behavior Community risk control: infectious diseases
Anxiety	Anxiety reduction Coping enhancement Relaxation therapy • Use a calm and reassuring approach; • Listen carefully; • Promote anxiety reduction measures.	Anxiety self-control Coping Acceptance: health status Social interaction skills
Risk for spiritual distress	Community disaster preparedness Antecipatory guidance Conflict mediation Coping enhancement Emotional support Environmental management: comfort Relocation stress reduction Resiliency promotion	Psychosocial adjustment: life change Personal well-being Management and risk detection CopingHope Spiritual health
Risk for infection	Infection protection Infection control • Protect against infection and guidance to avoid physical contact and visits; • When leaving and returning, take the necessary hygiene precautions: wear a mask; do not touch the hand on the face, mouth, eyes and nose; make use of respiratory etiquette; wash the hands with soap and water frequently; • Use 70% gel alcohol, when hand washing is impossible. Surveillance Risk identification	Self-care: hygiene Immunization behavior Community risk control: infectious diseases Risk detection
Deficient knowledge	Counseling Health screening Health education Teaching: disease process • Guide clients on necessary inputs, hygiene techniques, mechanisms for maintaining home isolation and providing support regarding changes in their standard of living with better acceptance and promotion of well-being; • Bring clients to know the aspects of the spread of the disease and take actions to reduce the potential risk for infection.	Knowledge: health behavior Knowledge: disease process/health promotion Information processing Client satisfaction: teaching

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[1] Corresponding author: Tayomara Ferreira Nascimento E-mail: tayomara.ferreira@unesp.br