Nursing Theorist - Case Study Example

Nursing Theorist Scenario A 74 year old alert and oriented, widowed man is discharged from the hospital after his fifth year for heart failure. He lives alone, although he has children in a neighboring state. He has stasis ulcers on both legs and has significant hearing loss. In the past, he has refused home care services. He agreed to have a nurse to come with him because it was the only way they would discharge him. You are the home care nurse. Application of Self-Care Theory by Orem: The objective of this theory is to bring health care services in human action and denote that individuals can benefit from nursing when they are experiencing conditions that will limit their actions in everyday life. In performing the theory, a client is thought on how to take care of himself, hence the name “self-care.” However, the nurse must apply caring services whenever the person feels a distinctive inability on some part of learning self-care (Jose, 2007). Furthermore, Orem’s theory consists of three interrelated principles. The first principle is the self-care theory. In this method, the theory has application on employing the learned, real judgments in sustaining life, health and continuing personal development and well-being. The human adaptation with the environment enables him to correspond to what the self-requirements for functional and developmental regulations (Orem 2001, as cited in Tomey & Alligood, 2006, p. 269). Overall the process occurs in assessing the person’s physical functions and developmental functions, then, distinguishing these requisites and applying the necessary action for it to satisfy the patient’s regulatory functions, and finally, the adaptation of the person to these skills independently. A harmonious relationship between a nurse and client will somehow improve the patient’s stress management and sets examples to relatives that in turn will provide health care to the patient. In this patient’s situation, his nearest relative is in another state, which means it will be harder to implicate such examples to them. Hence, a manageable self-care is more appropriate. Furthermore, the related concepts to managing self-care is important such as self-care, self-agency, therapeutic self-care demand and self-care deficit that will utilize the utmost advantage available to the client. Utilizing Orem’s theory in this concept will cooperate with other theories corresponding to health promotion and family systems to guide the overall health assessment, selection of appropriate health outcomes and administering nursing interference. Added interventions include the NANDA, Nursing Intervention Classifications, and Nursing Outcomes Association, which will facilitate the compatibility of health care documentation to the patient (Kumar, 2007). Because the Orem’s theory requires family intervention, it is also necessary to contact his children for them to come home or take their father to their homes for further care management. However, self-care is the patient’s contribution to his overall existence. In other words, it is a human regulatory function designed to examine and take care of the health, functioning, and development of a person. Furthermore, to maintain the patient’s good health it will be better to monitor his heart conditions everyday such as blood pressure examination and daily treatment of his stasis ulcers. Because he experiences hear loss, it would be appropriate to have more patience in teaching self-care. As a nurse, you must provide courage and esteem for your patient to control the course of the disease because without such values, the impact on self-care is negative. To manifest total control on the patient’s health, it would be advisable to perform the therapeutic self-care demands. This is to sustain life, health, and well-being. Considering heart failure as a chronic disease, it is necessary to employ the observation on universal therapeutic self-care demands (water and food), developmental self-care demands (death of a loved one), and health deviation therapeutic self-care demands. Hence, the overall objective of the therapeutic self-care demand is to prevent further complications coming from the effects of existing deviations in health (Kumar, 2007). Application of Peplau’s Theory Another theory developed in 1952 that corresponds with nurse-client relationship is Peplau’s Nursing Model. She emphasizes those interpersonal relationships in a manner affected by interpersonal experience of the patients obtain from their own perceptions and beliefs and the awareness of nurses concerning their own values, judgment and theoretical orientation (Bernabeu, 2007, p. 1). The Four Concepts of Peplau (Figure 1): HILDEGARDE PEPLAU Person: As a human being who is understood as a living organism in a situation of unstable equilibrium. Health: Symbolic term which implies an advance of the personality and other human processes favoring a personal, and social, creative, constructive and productive life. Environment: Refers to it as the forces existing outside of the organism, taking into account culture and interpersonal processes. Nursing: This is described as a significant interpersonal and therapeutic process which acts with other human processes which make the health of people possible. (Bernabeu, 2007, p. 1) The response readily comes from a nurse with sufficient knowledge down to a patient having a specific need. Peplau stresses her description of the theory as “the vehicle through which the patients are able to clarify and reconstruct their feelings, thoughts and ideas” (Bernabeu, 2007, p. 2). The end of therapeutic relationship is in motion whenever the knowledge of both patient and nurse coincide. The model instituted by Peplau exhibits the four-phase relationship concerning personal interactions. These phases may encourage a nurse to attain specific roles such as a teacher, person with resources, advisor, substitute, leader, educator, and expert technician, which enhance the self-esteem and supplication of elements fundamental for an independent patient. The first phase is the Orientation. In this phase, the nurse must help the patient recognize his/her situation such being in the hospital after operation or being a home nurse for recovery. Applied in the situation, the patient has you as the home nurse, therefore, it is the home nurse’s emphasis to give focus on the patient’s situation, new people and the state of health (Bernabeu, 2007, p. 2.) It is necessary to ask the patient of his basic information like names, the procedures he will encounter and the repetition of actions. The interrogation that will happen between the nurse and the patient in this phase will enable to clarify the expectations coming from both sides. Generally, this phase will determine the characteristics, objectives and objective of the relationship (Bernabeu, 2007, p. 2). Second is the phase of identification. In this stage, the appearance of global evaluation takes place, which will distinguish what is happening and what is the appropriate action to such situation. Patients should have a clarification of what is really occurring. In other words, the patient should trust the nurse in objectives that will help him administer the cure, things done on professional grounds and the fulfillment of each objective. In addition, a nurse should openly discuss her approach, augmenting the identification, and the ability of the patient to cooperate with problem solving. In this phase: the relationship may occur as implications on the productive lines, somewhat the patient may appear passive when identifying with the nurse. Both situations should have the nurse’s awareness of change in the behavior patterns of the patient that will distinguish what the patient thinks or feels about the situation (Bernabeu, 2007, p. 3). Third is the exploitation phase wherein the patient identifies of himself as the informed patient concerning the situation. In this stage, the patient being familiar with the treatment process will make sufficient actions to use the resources available. In the case of the patient in scenario 1, he will identify with the environment and somehow make use of the teaching skill of his home nurse. He may ask questions relevant to the health care situation or discuss things that will evaluate the fulfillment of the short and long-term health objectives. In this phase, the most important advancement is the patient’s partial control of the situation. He may see such as a productive situation in that the planning and execution of care is now a cooperative process. In addition, this phase may appear as a work phase because both the nurse and the patient will begin acting as adults incorporating to each others independence and interdependence. Nurses who see changes in their patient will be able to adapt into the force of independence. The last phase is the solution. According to Peplau, this stage is the “process of gaining freedom” in which the patient starts to leave the hospital or gain life at home care. The social relationships of nurse and client are only on temporary basis. In context, there is termination after the fulfillment of goals and achieving objectives. In addition, the termination should have planning that prepares the patient for the termination. Immediate termination may cause negative results to the patient; hence, objectives should be on a platform of achievement and possibility because unfulfilled objectives may interrupt the termination (Bernabeu, 2007, p. 3). Scenario #2. A 54-year-old woman is admitted to the oncology unit. She has metastatic ovarian cancer. She has significant ascites, a pain score of 1to10 and difficulty breathing and speaking but she is awake and alert. Her husband and three teenage children are at her bedside at all times. They talk to her about all the places they will go and all the things they will do as a family when she “beats this thing." Application of Jean Watson’s Transpersonal Caring The basis of this theory is very broad. Caring for human beings may exhibit different choices and different perspectives. According to Watson, her theory for human caring exceeds what they call as subjective inner healing processes. She preserves the identity of nursing as curing with caring and caring without curing. The primary mission of nursing does not only isolate it from biological aspects rather it concludes the embodiment of a person, beyond ego-self to the spiritual healing. Nursing occurs in the ten carative factors included within the transpersonal caring. Hence, the meaning of nursing goes back to the notion of “science and art” (George, 2007). The transpersonal relation comes from the caring consciousness and intentionality where she enters the person’s spiritual realm and ignites it with the real world. As Watson places it, Transpersonal caring calls for an authenticity of being and becoming, an ability to be present to self and other in a reflective frame; the transpersonal nurse has the ability to center consciousness and intentionality on caring, healing, and wholeness, rather than on disease, illness and pathology. (Watson’s Caring Theory, 2000). The Ten Carative Factors (Watson’s Caring Theory, 2000), but at some point these carative factors changed into clinical caritas which are in blue.  Formation of a Humanistic-altruistic system of values; *Practice of loving kindness and equanimity with context of caring consciousness.  Instillation of faith-hope; *Being authentically present, and enabling and sustaining the deep belief system and subjective life world system and one being cared for.  Cultivation of sensitivity to ones self and to others; *Cultivation of one self beyond the self ego, going to the spiritual field.  Development of a helping-trusting, human caring relationship; *Building the help-trust and original caring relationship.  Promotion and acceptance of the expression of positive and negative feelings; *Being present to and supportive of the expression of positive and negative feelings as a connection with deeper spirit of self and one being cared for.  Systematic use of a creative problem-solving caring process; *Engaging in activities that are part of the self-caring healing process.  Promotion of transpersonal teaching-learning; *Provides the original transpersonal caring that genuinely attends to the unity of being and meaning.  Provision for a supportive, protective, and/or corrective mental, physical, societal, and spiritual environment; *Making healing environments available in all aspects.  Assistance with gratification of human needs; *Administering the human care essentials such as spiritual and basic needs.  Allowance for existential-phenomenological-spiritual forces. *Opening one self to the spiritual dimensions. (Braud & Anderson,, 1998). In applying the contents of the theory to the scenario, the nurse must give love, caregiving and support to her patient. The nurse must be able to subject herself entirely to her patients caring aspect. To do this, encouraging bonds among the family members is a good things another is to make a closer attempt to change the spiritual ethics of a person, especially a patient. Cancer is a disease that is still incurable; applying the wholeness method of caring and curing to the patient will help her manifest a good outlook and better response to treatment. Moreover, the patient must be able to feel support from other people especially of health care professionals. In therapeutic care, it is best to prevent complications to occur, give a diet that will help ease the side effects of chemotherapy and last is to make available remedies when needed. BIBLIOGRAPHY Jose, S. Nursing Practice – Framework: Scope and Trends. 25 October 2007 12 December 2007 . Tomey, A. M., & Alligood, M. R. (2006). Nursing theorists and their work. (6th edition). St. Louis, MO: Mosby. Kumar, C. Application of Orems Self-Care Deficit Theory and Standardized Nursing Languages in a Case Study of a Woman with Diabetes. July 2007 13 December 2007 . Bernabeu, M.D. APPLICATION OF THE HILDERGARDE PEPLAU NURSING MODEL. 13 December 2007 George, J. Nursing Theories: The Base for Professional Nursing. Pearson Education [Online] . Watson’s Caring Theory. 2000 13 December 2007 Braud, W. and Anderson, R. Transpersonal research methods for the social sciences. 1998 Thousand Oaks, CA: Sage Publications Read More