Guest Contributor: Justin McFail, MSN, RN

A few years ago, I wrote a piece conceptualizing self-care as a cup we’re constantly pouring from in order to take care of others. I think the metaphor rings true still today. More recently, I discovered a fellow contributor, Meghann Buyco, found inspiration in my piece taking the discussion further, linking the concept of self-care, disability, and adaptation – focusing of Roy’s Adaptation Model.

This led me to reflect on Roy’s model and how we must understand the language of our needs in order to adapt. I also spent some time reflecting on Orem’s Self-Care Framework and how she conceptualized the requisites of self-care. To me, both models lay the foundation of how a nurse should operationalize their own needs.

Now, with flattery and gusto aside, I have some critiques. While both Roy and Orem’s works were monumental in the way we theorize and articulate these concepts within the hallowed halls of academia…they are…just that…Academic. Both concepts lack some tangibility for the novice nurse to understand. Flowcharts with boxes and arrows, grandiose words like “stimuli,” “compensatory,” and “Heath-Deviation Self-Care Requisite” – these are all well and good, but lofty aspirations of this cloister of erudition we call academia. Normal people don’t use these words…Certainly, I do…but I’m not normal. I write nursing theory blog posts for fun, and you read them. We’re the minority in this situation. The rest of the word struggles to integrate these concepts into their lives.

Thus, I argue, we need to adapt better adaptation, and while we’re at it, self-care. I would like to introduce to the Nursology community – Spoon Theory. This is not a theory of my own creation but conceptualized many years ago by Christine Miserandino to explain her chronic illness to a friend. Many within the chronically ill and disabled communities have latched onto it as a way to translate their limitations for others.

The cornerstone of Spoon Theory is that we start a day with a certain number of spoons, it varies day by day, and person to person. Some people have an entire drawer at their disposal, while others are clinging to a few. Everything we do in life takes a spoon – walking, eating, general existence – the basics of life and self-care as well as those adult functions we all need to complete – work, bills, childcare – those all take spoons from our spoon bank…our cutlery drawer if you will.

For those with normal functioning bodies and minds, most don’t consider how exercising, showering, and even eating uses their spoons. They have enough to spare. Those with chronic illness, disability, neurodivergence, or what-have-you, likely have learned overtime that they need to be cautious about how, when, and where they spend their spoons. Even if they don’t use the term “spoons.” Run out spoons before the end of the day, and you will have to make some tough choices later.

This is the praxis of Roy and Orem’s models. We must determine our needs. Our “requisites” as Orem refers to them. For normal people, they spend spoons and go about their day. But for others, they must adapt. The grocery store may too be overwhelming for someone with autism, so they use a delivery app to conserve their spoons. This is management of stimuli while understanding physiological needs. Adaptation to meet self-care requisites.

To further expand on this theory, in Miserandino’s original work, she alludes to the idea that spoons cannot be recovered. Once spent they are spent. This is likely true for chronic illness. I don’t know. I don’t have an autoimmune disorder like lupus. I do have a host of bits and bobbles in my brain that the common medical establishment might call “mental health” “disorders.” Although, I do take issue with pathologizing of my neurofunction and the word “disorder” – that’s a rant for another time. Regardless, my stance is for some of us, some of the time, may be able to recover spoons. Self-care tasks like eating, sleeping, or mindfulness can help us find a spoon that fell under the dusty couch some time ago. In many cases, putting a spoon towards a self-care task can result in a net spoon benefit. Maybe not today, but perhaps tomorrow or throughout the next week.

Now this is all well and good, but in reality, I’m just some person waxing and waning semi-poetically in the lofty confines of this pseudo-academic setting. My words are useless without application.

Thus, I’ve started using Spoon Theory to conceptualize parts of my life. I try to prioritize tasks by how many “spoons” they might take to complete. I have a bit of insomnia. It’s a curse amongst people who think too much and those that have worked night shift for too many years (anyone feel called out yet?). There are days where my spoons are limited to a point where I have to choose between eating and a mundane task. I’ve tried to fight it, but you can’t push against the wind. Overtime, I’ve learned to adapt, and prioritize my physiological needs. If I don’t eat, I won’t have more spoons tomorrow. I’ll likely have less. And even worse…I may run out before my day is done.

This language has caught on with my soon-to-be wife. There are days where I look at my other half and simply say “I don’t have the spoons for that today.” Without another word she understands, what I have left is going towards keep me alive. The rest can wait. The dishes will be there tomorrow. They may grow other things, but they’re not growing legs and walking away.

I’m not the only one trying to apply Spoon Theory to the world around them. Some have used it as a tool to promote self-regulation in autistic children. Others have built upon it as framework understand burnout, marginalization, and mental illness. These are all reimaginations that give a physical representation to concepts that we are unable to reach out and touch.

Roy and Orem’s theories were seminal works for their time, but my students can’t hold the pieces of a hallowed musty tome in their hands. Well…they can…but those are just pieces of paper without much significance. They’re not “tangible.” Just like chronic illness, disability, mental health, and burnout aren’t tangible.
But spoons can be…

Everyone knows the weight of a spoon in their hand. We can hold a pile of spoons in our grasp, and as we place them on the table, we begin to understand what it’s like to run out of spoons at the end of the day.

Someday, I’ll revisit the cutlery drawer, and we’ll talk about forks and knives. But that’s not for today. I don’t have spoons for it right now. But with some rest, proper self-care, and a bit more rumination, I’ll likely have more to say.

As a final remark, I’ll ask you this – How many spoons do you have today? What are you spending them on?

About Justin McFail

Justin graduated in Spring 2022 with a Master of Science in Nursing – Nursing Education from Millersville University. A registered nurse since 2015, Justin has worked in various specialties including medical-surgical and intensive care areas. In 2020, Justin volunteered as part of the Special Pathogens team in his home ICU. Currently, he still works in the Surgical ICU, which thankfully, has seen less COVID-19 patients. He is also an adjunct instructor and wearer of many hats for Millersville University. As an educator, Justin strives to bring creative models of education to the classroom…and on occasion shouting about cutlery to his colleagues during meetings.