Application of Orem’s theory in caring for end-stage chronic kidney disease patients undergoing kidney transplantation: 2 case studies

Abstract

End-stage Renal Disease (ESRD) has emerged as a critical public health issue at the national level due to the increasing number of patients. Kidney transplantation is the most effective treatment as it enhances patient survival rates and quality of life. However, post-operative nursing care faces challenges such as delayed graft function, fluid and electrolyte imbalances, acute rejection episodes, and infections. Additionally, patients must acquire adequate knowledge and adhere strictly to self-care practices to prevent complications and maintain a good quality of life in the long term.

This study applied Orem's nursing system theory, incorporating three systems: 1) wholly compensatory system, 2) partially compensatory system, and 3) supportive-educative system, to provide nursing care for two patients with ESRD undergoing kidney transplantation. The first case was a male recipient of a kidney from a brain-dead donor. Post-surgery, he experienced delayed graft function, fluid and electrolyte imbalances, and anemia. The second case was a female recipient of a kidney from a living donor. Her new kidney functioned well post-surgery, but she required close monitoring for complications and adjustments in fluid and electrolyte balance. Both patients received comprehensive care during the pre-operative, post-operative, and discharge phases, including self-care skill training. The nursing outcomes showed that the patients were safe and capable of self-care, with discharge times of 21 and 11 days, respectively. The application of Orem's theory enhanced nursing quality by ensuring patient safety, reducing the risk of complications, and effectively promoting self-care capabilities.