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THEORETICAL FOUNDATION (NCMA110) 1988: board certified as a clinical specialist in psychiatric and mental health Coverage: o Eakes, Burke, And Hainsworth...

THEORETICAL FOUNDATION (NCMA110) 1988: board certified as a clinical specialist in psychiatric and mental health Coverage: o Eakes, Burke, And Hainsworth nursing. o Barker 1992: Technical Assistance Workshop and Mentorship for Nurses in o Kolcaba Implementation of the National Plan for Research in Child and Adolescent Mental o Beck Disorders by the National Institutes of Health. o Swanson Reviewed manuscripts for Qualitative Health Research, an Inter-disciplinary o Ruland And Moore Journal, a Sage publication. o Agravante 1999: visiting fellow on a faculty exchange program at the Royal Melbourne o Divinagracia Institute of Technology in Melbourne, Australia. o Locsin Hainsworth’s nursing practice was in public health and psychiatric and mental o Kuan health nursing. o Abaquin 1992: full professor, teaching was psychiatric care in the classroom and clinical. o Laurente “Death and Dying” became an elective in the college’s general studies program. o Non-nursing Theories Interest in chronic illness and its relationship to sorrow began in her practice as a EAKES, BURKE, AND HAINSWORTH facilitator for a support group for women with multiple sclerosis led to “An Theory of Chronic Sorrow Ethnographic Study of Women with Multiple Sclerosis Using a Symbolic Background (Georgene Gaskill Eakes) Interaction Approach.” Born in New Bern, North Carolina. Theory of Chronic Sorrow 1977: BSN Summa Cum Laude from North Carolina Agricultural and Technical Chronic sorrow is the presence of pervasive grief-related feelings that have been State University. found to occur periodically throughout the lives of individuals with chronic health conditions, their family caregivers and the bereaved (Burke, Eakes, & Hainsworth, 1980: M.S.N. at the University of North Carolina at Greensboro 1999, p. 374). 1988: Ed.D. at North Carolina State University. 1980: faculty at the East Carolina University School of Nursing in Greenville, North Theoretical sources Carolina. The concept of chronic sorrow originated with the work of Olshansky. Lazarus and 1970s: Issues related to death, dying, grief, and loss when she sustained life- Folkman’s model of stress and adaptation formed the foundation for their threatening injuries in an automobile crash. This near-death experience heightened conceptualization of how persons cope with chronic sorrow. her awareness of how ill-prepared health care professionals and lay people are to The NCRCS theorists cite Olshansky’s observations of parents with mentally deal with individuals facing their mortality and the general lack of understanding of retarded children that indicated these parents experienced recurrent sadness and grief reactions experienced in response to loss situations. his coining the term chronic sorrow. This original concept was described as “a 1989: Attended a presentation on chronic sorrow by Mary Lermann Burke and broad, simple description of psychological reaction to a tragic situation” immediately made the connection between Burke’s description of chronic sorrow 1980s: other researchers began to examine the experience of parents of children in mothers of children with a myelomeningocele disability and her observations of who were either physically or mentally disabled. This work validated a recurrent sadness and never ending grief the parents experienced. Grief was previously grief reactions among the cancer support group members. The Nursing Consortium conceptualized as a process that resolved over time, and if unresolved, was for Research on Chronic Sorrow (NCRCS) was an outcome of the first meeting abnormal according to Bowlby and Lindemann’s work. Burke, in children with spina 1999: Best of Image award for theory publication presented by the Sigma Theta bifida, defined chronic sorrow as “pervasive sadness that is permanent, Tau International Honor Society of Nursing for her article, “Middle-Range Theory of periodic and progressive in nature” Chronic Sorrow.” The NCRCS group focused on the response to grief and incorporated Lazarus and 1991: North Carolina Nurse Educator of the Year by North Carolina Nurses Folkman’s 1984 work on stress and adaptation as a basis for management Association Professor Emeritus at East Carolina University College of Nursing. methods described in their work. Internal coping strategies include action- Taught undergraduate courses in psychiatric and mental health nursing and oriented, cognitive reappraisal and interpersonal behaviors. Thus, the middle- nursing research, a master’s-level course in nursing education, and an range Theory of Chronic Sorrow extended the theoretical base of chronic sorrow to interdisciplinary graduate course titled “Perspectives on Death/Dying.” not only the experience of chronic sorrow in certain situations but also the coping responses to the phenomenon. Director of Clinical Education at Vidant Medical Center in Greenville, NC Theoretical assertions Background (Mary Lermann Burke) 1. Chronic sorrow is a normal human response related to ongoing disparity created Born in Sandusky, Ohio. by a loss situation. PhD certification from Children’s Medical Center in the District of Columbia. 2. Chronic sorrow is cyclical in nature. BSN Summa Cum Laude from Rhode Island College in Providence 3. Predictable internal and external triggers of heightened grief can be categorized 1982: MS in parent-child nursing from Boston University and Certificate in Parent- and anticipated. Child Nursing and Interdisciplinary Training in Developmental Disabilities 4. Humans have inherent and learned coping strategies that may or may not be 1989: PhD in Family Studies from Boston University effective in regaining normal equilibrium when experiencing chronic sorrow. 5. Health care professionals’ interventions may or may not be effective in assisting 1980: faculty of the Rhode Island College Department of Nursing as clinical the individual to regain normal equilibrium. instructor and she became full-time in 1982, assistant professor in 1987, associate 6. A human who experiences a single or an ongoing loss will perceive a disparity professor in 1991, and professor in 1996. During this period, she taught pediatric between the ideal and reality. nursing in didactic and clinical courses. 7. The disparity between the real and the ideal leads to feelings of pervasive sadness The Concerns of Mothers of Preschool Children with Myelomeningocele: master’s and grief. thesis, identified emotions similar to chronic sorrow. Major Concepts & Definitions Developed the Burke Chronic Sorrow Questionnaire for her doctoral dissertation Chronic sorrow - ongoing disparity resulting from a loss characterized by research, Chronic Sorrow in Mothers of School Age Children with pervasiveness and permanence. Symptoms of grief recur periodically, and these Myelomeningocele. symptoms are potentially progressive. June 1989: dissertation research at the Sigma Theta Tau International Research Loss - occurs as a result of disparity between the “ideal” and real situations or Congress in Taipei, Taiwan, where she interacted with Dr. Eakes of East Carolina experiences. For example, there is a “perfect child” and a child with a chronic University and Dr. Hainsworth of Rhode Island College. Subsequently, this group condition who differs from that ideal. became the NCRCS, joined briefly by Dr. Carolyn Lindgren of Wayne State Trigger events - situations, circumstances, and conditions that highlight the disparity or the recurrent loss and initiate or exacerbate feelings of grief. University. Management methods - means by which individuals deal with chronic sorrow. 1998: development of a middle-range Theory of Chronic Sorrow These may be internal (personal coping strategies) or external (health care 1999: “Middle-Range Theory of Chronic Sorrow” received the Best of Image Award practitioner or other persons’ interventions). in the Theory Category from Sigma Theta Tau International. She collaborated with Ineffective management - results from strategies that increase the individual’s Dr. Eakes in the development of the Burke/Eakes Chronic Sorrow Assessment discomfort or heighten the feelings of chronic sorrow. Tool. Effective management - results from strategies that lead to increased comfort of Board of Trustees: serves on the St. Joseph’s Health Services of Rhode Island the affected individual. Outstanding Alumna Award for Contributions in Nursing Education from the Rhode Island College Department of Nursing and the Alumni Honor Roll Award from Use of empirical evidence Rhode Island College CHRONIC SORROW Background (Margaret A. Hainsworth) NCRCS’s initial conceptual definition of chronic sorrow was derived from interviews Born in Brockville, Ontario, Canada. with mothers of children with spina bifida. Chronic sorrow as a pervasive sadness and found that the experience was permanent, periodic, and potentially 1953: diploma in nursing at Brockville General Hospital in Brockville, Ontario. progressive. 1959: diploma in public health nursing. The NCRCS studies addressed the following: 1973: BSN  Individuals with the following: Cancer, Infertility, Multiple sclerosis, Parkinson’s 1974: MS psychiatric and mental health nursing from Boston College disease 1986: PhD in education administration from the University of Connecticut  Spousal caregivers of persons with the following: Chronic mental illness, Multiple sclerosis, Parkinson’s disease TRANSCRIBED BY: EIZEL ABARENTOS | BSN 1 – Y1 – 8  THEORETICAL FOUNDATION (NCMA110)  Parental caregivers of the following: Adult children with chronic mental illness Theoretical sources Triggers Tidal Model draws its core philosophical metaphor from chaos theory, such that Primary events or situations that precipitated the reexperience of initial grief the unpredictable - yet bounded – nature of human behavior and experience is feelings labeled as chronic sorrow triggers. compared to the dynamic flow and power of water and the tides of the sea. For all populations, comparisons with norms and anniversaries were found to Assumption trigger chronic sorrow. Both family caregivers and persons with chronic conditions 1. A belief in the virtue of curiosity : the person is the world authority on their life experienced triggering with management crises. and its problems. By expressing genuine curiosity, the professional can learn One trigger unique for family caregivers was the requirement of unending something of the ‘mystery’ of the person’s story. caregiving. Memories and role change were unique triggers. 2. Recognition of the power of resourcefulness, rather than focusing on Management Strategies problems, deficits or weaknesses Chronic sorrow is not debilitating when individuals effectively manage feelings. 3. Respect for the person's wishes, rather than being paternalistic. The management strategies : internal or external. 4. Acceptance of the paradox of crisis as opportunity Self -care management strategies were designated as internal coping strategies as 5. Acknowledging that all goals must belong to the person action, cognitive, interpersonal, and emotional. 6. The virtue of pursuing elegance—the simplest possible means should be Action coping mechanisms were used across all subjects —individuals with chronic sought conditions and their caregivers. The examples provided are similar to distraction The Ten Commitments methods commonly used to cope with pain. For instance, “keeping busy” and The values of the Tidal Model can be distilled into Ten Commitments. “doing something fun” are examples of action -oriented coping. 1. Value the voice – the person's story is paramount The NCRCS theorists found that cognitive coping was used frequently, and 2. Respect the language – allow people to use their own language examples included “thinking positively,” “making the most of it,” and “not trying to 3. Develop genuine curiosity – show interest in the person's story fight it”. 4. Become the apprentice – learn from the person you are helping Interpersonal coping examples included “going to a psychiatrist,” “joined a support 5. Reveal personal wisdom – people are experts in their own story group,” and “talking to others” 6. Be transparent – both the person and the helper, Professionals are in a Emotional strategy examples included “having a good cry” and expressing privileged position and should model confidence, by at all times being emotions. A management strategy was labeled effective when a subject described transparent and helping to ensure the person understand exactly what is it as helpful in decreasing feelings of re -grief. being done External management as interventions provided by health professionals who assist 7. Use the available toolkit – the person's story contains valuable information affected populations to increase their comfort through roles of empathetic as to what works and what doesn't presence, teacher -expert, and caring and competent professional. 8. Craft the step beyond – the helper and the person work together to Theory of Chronic Sorrow Metaparadigm construct an appreciation of what needs to be done "now" Person 9. Give the gift of time – time is the midwife of change. The question that Humans have an idealized perception of life processes and health. People should be asked is, "How do we use this time?" compare their experiences both with the ideal and with others around them. 10. Know that change is constant – this is a common experience for all people Although each person’s experience with loss is unique, there are common and The Twenty Competencies predictable features of the human loss experience. Competency 1: The practitioner demonstrates a capacity to listen actively to the Health person’s story. There is a normality of functioning. A person’s health depends upon adaptation to Competency 2: The practitioner shows commitment to helping the person record disparities associated with loss. Effective coping results in a normal response to her/his story in her/his own words as an ongoing part of the process of care. life losses. Competency 3: The practitioner helps the person express her/himself at all times Environment in her/his own language. Interactions occur within a social context, which includes family, social, work, and Competency 4: The practitioner helps the person express her/his understanding of health care environments. Individuals respond to their assessment of themselves particular experiences through use of personal stories, anecdotes, similes or in relation to social norms metaphors. Nursing Competency 5: The practitioner shows interest in the person’s story by asking for Diagnosing chronic sorrow and providing interventions are within the scope of clarification of particular points, and asking for further examples or details. nursing practice. Competency 6: The practitioner shows a willingness to help the person in unfolding Nurses can provide anticipatory guidance to individuals at risk. The primary roles the story at the person’s own rate. of nurses include empathetic presence, teacher-expert, and caring and competent Competency 7: The practitioner develops a care plan based, wherever possible, caregiver. on the expressed needs, wants or wishes of the person. PHIL BARKER Competency 8: The practitioner helps the person identify specific problems of Tidal model of mental health nursing living, and what might need to be done to address them. Background Competency 9: The practitioner helps the person develop awareness of what works for or against them, in relation to specific problems of living. There are no absolutes in health care. A patient’s health is fluid, and nurses often Competency 10: The practitioner shows interest in identifying what the person have to adapt to an individual patient’s situation in order to help him or her get thinks specific people can or might be able to do to help them further in dealing with healthy. What works for one patient in his or her illness may not work for another specific problems of living. patient in his or her illness. Competency 11: The practitioner helps the person identify what kind of change Tidal Model helps nurses care for patients in the mental health field by would represent a step in the direction of resolving or moving away from a specific recognizing and working with the inevitability of change in a patient’s life and problem of living. environment. Competency 12: The practitioner helps the person identify what needs to happen He is United Kingdom’s first professor of psychiatric nursing at Newcastle in the immediate future, to help the person to begin to experience this ‘positive step’ University. in the direction of their desired goal. He is currently a psychotherapist and honorary professor at the University of Competency 13: The practitioner helps the person develop their awareness that Dundee in Scotland. dedicated time is being given to addressing their specific needs. Authored more than a dozen books, including the Tidal Model of Mental Health Competency 14: The practitioner acknowledges the value of the time the person Recovery and Reclamation. gives to the process of assessment and care delivery. Honorary doctorate at the Oxford Brookes University in 2001. Competency 15: The practitioner helps the person identify and develop awareness Tidal model of mental health nursing of personal strengths and weaknesses. Introduction: Competency 16: The practitioner helps the person develop self-belief, therefore Tidal model is a mental health recovery model which may be used as the basis promoting their ability to help themselves. for interdisciplinary mental health care. Competency 17: The practitioner helps the person develop awareness of the Developed by phil barker and poppy buchanan-barker of university of newcastle, subtlest of changes – in thoughts, feelings or action. uk. Competency 18: The practitioner helps the person develop awareness of how they, Mid-range theory of nursing. others or events have influenced these changes. Main focus: helping individual people, make their own voyage of discovery. Competency 19: The practitioner aims to ensure that the person is aware, at all Definition: times, of the purpose of all processes of care. It is a philosophical approach to the discovery of mental health. Emphasizes Competency 20: The practitioner ensures that the person is provided with copies helping people reclaim the personal story of mental distress, by recovering their of all assessment and care planning documents for their own reference. voice. By using their own language, metaphors and personal stories people begin to express something of the meaning of their lives. This is the first step towards Conclusion helping recover control over their lives". - barker The Tidal Model assumes that nurses should only do what is absolutely necessary It provides a practice framework for the exploration of the patient's need for to meet the person’s needs. nursing and the provision of individually tailored care. This emphasis on ‘doing what needs to be done’ might help avoid fostering Description of the model dependence or otherwise institutionalizing people. In the Tidal Model, the person, the individual is represented, theoretically, by Tidal Model of mental health recovery has been recognized and practiced in several three personal domains: Self, World and Others. different countries. The theory suggests that our mental wellbeing depends on our individual life experience, including our sense of self, perceptions, thoughts and actions TRANSCRIBED BY: EIZEL ABARENTOS | BSN 1 – Y1 – 8  THEORETICAL FOUNDATION (NCMA110) KATHERINE KOLCABA comfort of the patient was small enough to ignore. Comfort of the patient was the nurse’s first and last consideration. A good nurse made patients comfortable, Theory of Comfort and the provision of comfort was a primary determining factor of a nurse’s “In today’s technological world nursing’s historic mission of providing comfort ability and character. to patients and family members is even more important. Comfort is an antidote Harmer stated that nursing care was concerned with providing a “general to the stressors inherent in health care situations today, and when comfort is atmosphere of comfort,” and that personal care of patients included attention enhanced, patients and families are strengthened for the tasks ahead. In to “happiness, comfort, and ease, physical and mental,” in addition to “rest addition, nurses feel more satisfied with the care they are giving.” -K. Kolcaba and sleep, nutrition, cleanliness, and elimination”. (personal communication, March 7, 2008) Goodnow wrote, “A nurse is judged always by her ability to make her patient Background comfortable. Comfort is both physical and mental, and a nurse’s responsibility does 1944: born in Cleveland, Ohio not end with physical care” in a chapter in her book, The Technique of Nursing, to 1965: Nursing diploma from St. Luke’s Hospital School of Nursing the patient’s comfort. Emotional comfort was called mental comfort and was 1987: graduated from the Frances Payne Bolton School of Nursing at Case achieved mostly by providing physical comfort and modifying the environment for Western Reserve University patients. 1997: Ph.D. in Nursing and received a Certificate of Authority as a Clinical Nursing Relief - synthesized from the work of Orlando who posited that nurses relieved the Specialist. needs expressed by patients. Her education specialized in Gerontology, End of Life and Long-Term Care Ease - synthesized from the work of Henderson who described 13 basic functions Interventions, Comfort Studies, Instrument Development, Nursing Theory, and of human beings to be maintained during care. Nursing Research. Transcendence - derived from Paterson and Zderad, who proposed that patients Associate Professor of nursing at the University of Akron College of Nursing. rise above their difficulties with the help of nurses. Focused on volunteering with the American Nurses Association and the Honor Theoretical assertions Society of Nursing, Sigma Theta Tau. The Theory of Comfort contains three parts (assertions) to be tested separately or Her publications include Comfort Theory and Practice: A Vision for Holistic Health as a whole. Care and Research.  Part I states that comforting interventions, when effective, result in increased Major Concepts & Definitions comfort for recipients (patients and families), compared to a pre-intervention baseline. Care providers may also be considered recipients if the institution Those receiving comfort measures are referred to as recipients, patients, makes a commitment to the comfort of their work setting. Comfort interventions students, prisoners, workers, older adults, communities, and institutions in address basic human needs, such as rest, homeostasis, therapeutic Kolcaba’s theory. communication, and treatment as holistic beings. These comfort interventions are usually non-technical and complement delivery of technical care. Health care needs - needs for comfort arising from stressful health care situations  Part II states that increased comfort of recipients of care results in increased that cannot be met by recipients’ traditional support systems. These needs may be engagement in health seeking behaviors (HSBs) that are negotiated with the physical, psychospiritual, sociocultural, and environmental. The needs become recipients. apparent through monitoring, verbal or nonverbal reports, pathophysiological  Part III states that increased engagement in HSBs results in increased quality parameters, education and support, and financial counseling and intervention. of care, benefiting the institution and its ability to gather evidence for best Comfort interventions - nursing actions designed to address specific comfort practices and best policies. needs of recipients, including physiological, social, cultural, financial, Assumptions psychological, spiritual, environmental, and physical interventions. 1. Human beings have holistic responses to complex stimuli. Intervening variables - interacting forces that influence recipients’ perceptions of 2. Comfort is a desirable holistic outcome that is germane to the discipline of total comfort. They consist of past experiences, age, attitude, emotional state, nursing. support system, prognosis, finances, education, cultural background, and the 3. Comfort is a basic human need which persons strive to meet or have met. It is totality of elements in the recipients’ experience. an active endeavor. Comfort - state experienced by recipients of comfort interventions. It is the 4. Enhanced comfort strengthens patients to engage in health-seeking behaviors immediate and holistic experience of being strengthened when needs are (HSBs) of their choice. addressed for three types of comfort (relief, ease, and transcendence) in four 5. Patients who are empowered to actively engage in HSBs are satisfied with their contexts (physical, psychospiritual, sociocultural, and environmental). Types and health care. contexts are defined in Figure 33-1. 6. Institutional integrity is based on a value system oriented to the recipients of Health-seeking behaviors - A broad category of outcomes related to the pursuit care. Of equal importance is an orientation to a health promoting, holistic setting of health as defined by recipient(s) in consultation with the nurse Health-Seeking for families and providers of care. Behaviors (HSBs) was synthesized by Schlotfeldt and proposed to be internal, Theory of Comfort Metaparadigm external, or a peaceful death. Person Institutional integrity - Corporations, communities, schools, hospitals, regions, states, and countries that possess qualities of being complete, whole, sound, Recipients of care may be individuals, families, institutions, or communities in need upright, appealing, ethical, and sincere. When an institution displays this type of of health care. Nurses may be recipients of enhanced work-place comfort when integrity, it produces evidence for best practices and best policies. initiatives to improve working conditions are undertaken, such as those to gain Best practices - Use health care interventions based on evidence to produce best Magnet Status. possible patient and family outcome. Health Best policies - Institutional or regional policies ranging from protocols for optimal functioning of a patient, family, health care provider, or community as procedures and medical conditions to access and delivery of health care. Figure defined by the patient or group. 33-2 depicts the relationship of these last three concepts. Environment Use of empirical evidence any aspect of patient, family, or institutional settings that can be manipulated by The seeds of modern inquiry about the outcome of comfort were sown in the late nurse(s), loved one(s), or the institution to enhance comfort 1980s, marking a period of collective, but separate, awareness about the concept Nursing of holistic comfort. Hamilton concluded that comfort is multi-dimensional, meaning intentional assessment of comfort needs, the design of comfort interventions to different things to different people from the patient’s perspective. address those needs, and reassessment of comfort levels after implementation After Kolcaba developed her theory, she tested it using an experimental design in compared with a baseline. Assessment and reassessment may be intuitive or her dissertation associated with a diagnosis of early breast cancer with the holistic subjective or both, such as when a nurse asks if the patient is comfortable, or intervention was guided imagery in meeting the patient’s their comfort needs. objective, such as in observations of wound healing, changes in laboratory values, The following interventions have been tested: or changes in behavior.  Types of immobilization for persons after coronary angiography CHERYL TATANO BECK  Cognitive strategies for persons with urinary frequency and incontinence Postpartum Depression Theory  Reducing stress in college students “The birth of a baby is an occasion for joy—or so the saying goes … But for  Hand massage for hospice patients and residents in long-term care some women, joy is not an option.” (Beck, 2006b, p. 40) Four major theoretical propositions about the nature of holistic comfort : 1. Comfort is generally state specific. Background 2. The outcome of comfort is sensitive to changes over time. 1970: BSN: 1st clinical rotation: obstetrical nursing - lifelong specialty, a 3. Any consistently applied holistic nursing intervention with an established history registered nurse at the Yale New Haven Hospital on the postpartum and normal for effectiveness enhances comfort over time. newborn nursery unit. 4. Total comfort is greater than the sum of its parts 1972: MS in maternal-newborn nursing and a certificate in nurse midwifery at Theoretical sources Yale University Kolcaba began her theoretical work as she diagrammed her nursing practice early 1973: instructor and consultant, in her doctoral studies. It began with an extensive review of the literature about 1999: “Distinguished Researcher of the Year” comfort from the disciplines of nursing, medicine, psychology, psychiatry, 1993: fellow in the American Academy of Nursing ergonomics, and English. She learned that the original definition of comfort was “to Nursing Journals strengthen greatly” and provided a wonderful rationale for nurses to comfort o Advances in Nursing Science patients since the patients would do better and the nurses would feel more satisfied. o Nursing Research 1900-1929: Comfort was the central goal of nursing and medicine because, o the Journal of Nursing Education through comfort, recovery was achieved. The nurse was duty bound to attend to Executive board for the Marce Society and advisory committee of the Donaghue details influencing patient comfort. Aikens proposed that nothing concerning the Medical Research Foundation in Connecticut. TRANSCRIBED BY: EIZEL ABARENTOS | BSN 1 – Y1 – 8  THEORETICAL FOUNDATION (NCMA110) Polit and Hungler research text, a fixture in countless graduate nursing programs life events are combined to determine the amount of life stress a woman is which she became coauthor of Polit’s seventh edition. experiencing. Stressful life events can be either negative or positive and can 1980: Obstetrical nursing: women in labor, examining their responses to fetal include experiences such as the following: monitoring eventually became the postpartum period and specific studies of Marital changes (e.g., divorce, remarriage) postpartum mood disorders. Occupational changes (e.g., job change) 1993: Postpartum depression Crises (e.g., accidents, burglaries, financial crises, illness requiring 2002c; Beck & Gable, 2000: the Postpartum Depression Screening Scale (PDSS) hospitalization) (Effect size = Medium) 1998, 2001, 2002b: the Postpartum Depression Predictors Inventory (PDPI) Social Support Theoretical and Philosophical Sources Instrumental support (babysitting, help with household chores) and “Caring is the essence of nursing.” Jean Watson’s caring theory endorses emotional support. Structural features of a woman’s social network (husband caring as central to nursing, and quantitative methodologies may not reflect or mate, family, and friends) include proximity of its members, frequency of adequately the ideal of transpersonal caring. contact, and number of confidants with whom the woman can share personal Advanced nursing as a caring profession is desirable and achievable in practice, matters. research, and education. Lack of social support is when a woman perceives she is not receiving the Phenomenology was used in the first major study of how women experienced amount of instrumental or emotional support she expects. (Effect size = postpartum depression, using Colaizzi’s (1978) approach. Medium) Grounded theory as influenced by the theoretical and philosophical ideas of Prenatal Anxiety: occurs during any trimester or throughout the pregnancy. Glaser, Strauss, and Hutchinson. Anxiety refers to feelings of uneasiness or apprehension concerning a vague, With feminist theory, there is explicit valuing of the importance of understanding nonspecific threat. (Effect size = Medium) pregnancy, birth, and motherhood through “the eyes of women”. Marital Satisfaction: degree of satisfaction with a marital relationship is Childbirth occurs in many simultaneous contexts (medical, social, economic), and assessed and includes how happy or satisfied the woman is with certain aspects that mothers’ reactions to childbirth and motherhood are shaped by their of her marriage, such as communication, affection, similarity of values (e.g., responses to these contexts. finances, childcare), mutual activity and decision making, and global wellbeing. Sichel and Driscoll’s model to “suggest that a woman’s genetic makeup, (Effect size = Medium) hormonal and reproductive history, and life experiences all combine to predict her History of Depression: a report of having had a bout of depression before this risk of ‘an earthquake’ which occurs when her brain cannot stabilize, and mood pregnancy. (Effect size = Medium) problems erupt”. Infant Temperament: the infant’s disposition and personality. Difficult Robert Gable as important source in her work developing a wealth of temperament describes an infant who is irritable, fussy, unpredictable, and knowledge about postpartum depression, the next logical steps for Beck difficult to console. (Effect size = Medium) became developing instruments that could predict and screen for postpartum Maternity Blues: a non-pathological condition after giving birth. Prolonged depression. He assisted Beck with theoretical operationalization of her theory for episodes of maternity blues (lasting more than 10 days) may predict postpartum practical use. depression. (Effect size = Small to medium) Major Concepts & Definitions Self-Esteem: a woman’s global feelings of self-worth and self-acceptance. It is Postpartum Mood Disorders her confidence and satisfaction in self. Low self-esteem reflects a negative self- Postpartum depression and maternity blues have become better delineated evaluation and feelings about oneself or one’s capabilities. (Effect size = Medium) over time, as has the understanding of postpartum psychosis. Two other Socioeconomic Status: a person’s rank or status in society involving a perinatal mood disorders, postpartum obsessive-compulsive disorder and combination of social and economic factors such as income, education, and postpartum-onset panic disorder, have been identified. occupation. (Effect size = Small) Postpartum Depression: a non-psychotic major depressive disorder with Marital Status: a woman’s standing in regard to marriage; denotes whether a distinguishing diagnostic criteria that often begins as early as 4 weeks after woman is single, married or cohabiting, divorced, widowed, separated, or birth. It may also occur anytime within the first year after childbirth. Postpartum partnered. (Effect size = Small) depression is not self-limiting and is more difficult to treat than simple Unplanned or Unwanted Pregnancy: a pregnancy that was not planned or depression. Prevalence rates are 13% to 25%, with more women affected who wanted. It is the issue of pregnancies that remain unwanted after initial are poor, live in the inner city, or are adolescents. Approximately 50% of all ambivalence. (Effect size = Small) women suffering from postpartum depression have episodes lasting 6 months Postpartum Depression Theory Metaparadigm or longer. Person Maternity Blues: postpartum blues and baby blues, it is a relatively transient described in terms of wholeness with biological, sociological, and psychological and self-limited period of melancholy and mood swings during the early components. A strong commitment to the idea that persons or personhood is postpartum period. Maternity blues affects up to 75% of all women in all understood within the context of family and community. cultures. Health Postpartum Psychosis: a psychotic disorder characterized by hallucinations, not defined explicitly but include traditional ideas of physical and mental health. delusions, agitation, and inability to sleep, along with bizarre and irrational Health is the consequence of women’s responses to the contexts of their lives and their environments. Contexts of health are vital to understanding any singular issue behavior. Although postpartum psychosis is relatively rare (1 to 2 women per of health 1000 births), it represents a true psychiatric emergency because both mother Environment and baby (and perhaps other children) are in grave danger of harm. Although include individual factors as well as the world outside of each person. Outside postpartum psychosis often begins to appear during the first week postpartum, environment includes events, situations, culture, physicality ecosystems, and it is frequently not detected until serious harm has occurred. sociopolitical systems. Women in the childbearing period receive care within a Postpartum Obsessive-Compulsive Disorder: symptoms include repetitive, health care environment structured in the medical model and permeated with intrusive thoughts of harming the baby, a fear of being left alone with the infant, patriarchal ideology and hypervigilance in protecting the infant. Nursing Postpartum-Onset Panic Disorder: identified recently and without reported a caring profession with caring obligations to persons we care for, students, and prevalence rates. It is characterized by acute onset of anxiety, fear, rapid each other. Interpersonal interactions between nurses and those for whom we care breathing, heart palpitations, and a sense of impending doom. are the primary ways nursing accomplishes goals of health and wholeness. Loss of Control: a process women go through with postpartum depression. It KRISTEN SWANSON was experienced in all areas of women’s lives, although the particulars of the Theory of Caring circumstances may be different. The concept fit with extant literature and left “Caring is a nurturing way of relating to a valued other toward whom one feels a women with feelings of “teetering on the edge.” The process identified consisted personal sense of commitment and responsibility.” (Swanson, 1991, p. 162) of the following four stages: a. Encountering terror: consisted of horrifying anxiety attacks, enveloping Background fogginess, and relentless obsessive thinking Born on January 13, 1953, in Providence, Rhode Island. b. Dying of self: consisted of alarming unrealness, contemplating and attempting 1975: BSN Magna cum laude from the University of Rhode Island College of self-destruction, isolating oneself Nursing c. Struggling to survive: consisted of battling the system, seeking solace at 1978: MSN in Adult Health and Illness Nursing Program at the University of support groups, and praying for relief Pennsylvania in Philadelphia. d. Regaining control: consisted of unpredictable transitioning, guarded recovery, PhD in nursing program at the University of Colorado in Denver, Colorado and mourning lost time. Psychosocial nursing with an emphasis on exploring the concepts of loss, stress, Prenatal Depression: during any or all of the trimesters of pregnancy has been coping, interpersonal relationships, person and personhood, environments, and found to be the strongest predictor of postpartum depression. (Effect size = caring. Medium) Caring and miscarriage became the focus of her doctoral dissertation and, Child Care Stress: infant health problems and difficulty in infant care pertaining subsequently, her program of research. to feeding and sleeping. (Effect size = Medium) Careers: Life Stress: an index of stressful life events during pregnancy and postpartum. o RN at the University of Massachusetts Medical Center in Worcester. The number of life experiences and the amount of stress created by each of the TRANSCRIBED BY: EIZEL ABARENTOS | BSN 1 – Y1 – 8  THEORETICAL FOUNDATION (NCMA110) o Clinical instructor of medical-surgical nursing at the University of Pennsylvania caring, they also need to think of self and other nurses and their care as that cared- School of Nursing for other. o Faculty at University of Washington School of Nursing RULAND AND MOORE o Professor and chairperson of the Department of Family Child Nursing. Peaceful End-Of-Life Theory o Conducts research funded by the National Institutes of Health and National Institutes of Nursing Research “Standards of care offer a promising approach for the development of middle- o Consultant at national and international levels range prescriptive theories because of their empirical base in clinical practice Awarded National Research Service postdoctoral fellowship from the National and their focus on linkages between interventions and outcomes” (Ruland & Center for Nursing Research Moore, 1998, p. 169) 1991: Swanson was inducted as a fellow in the American Academy of Nursing Background (Cornelia M. Ruland) 2002: Distinguished Alumnus Award from the University of Rhode Island 1998: PhD from Case Western Reserve University in Cleveland, Ohio. Theoretical Sources Director of the Center for Shared Decision Making and Nursing Research at Rikshospitalet University Hospital in Oslo, Norway Watching patients move into a space of total dependency and come out the Adjunct faculty: Department of Biomedical Informatics at Columbia University in other side restored was like witnessing miracles unfold. Sitting with spouses in New York. the waiting room while they entrusted the heart (and lives) of their partner to Ruland has established a research program on improving shared decision making the surgical team was awe inspiring. It was encouraging to observe the inner and patient-provider partnerships in health care, and the development, reserves family members could call upon in order to hand over that which they implementation, and evaluation of information systems to support it. could not control. It warmed my heart to be so privileged as to be invited into She focuses on aspects of and tools for shared decision making in the spaces that patients and families created in order to endure their clinically challenging situations: transitions through illness, recovery, and, in some instances, death (Swanson, 1. for patients confronted with difficult treatment or screening decisions for which 2001, p. 412). they need help to understand the potential benefits and harms of alternative options and to elicit their values and preferences Dr. Jacqueline Fawcett’s course on the conceptual basis of nursing practice preference-adjusted management of chronic or serious long-term illness over as a master’s-prepared nurse not only made her better understand the time. differences between the goals of nursing and other health disciplines, but also made her realize that caring for others as they go through life transitions of Background (Shirley M. Moore) health, illness, healing, and dying was congruent with her personal values. Associate Dean for Research and Professor, School of Nursing, Case Western Dr. Jean Watson as a mentor during doctoral studies. She attributes the Reserve University. emphasis on exploring the concept of caring in her doctoral dissertation to 1969: diploma in nursing from the Youngstown Hospital Association School of Dr. Watson’s influence. Neither Swanson nor Watson has ever seen Swanson’s Nursing program of research as application of Watson’s Theory of Human Caring. 1974: BSN from Kent State University (1974). Dr. Kathryn E. Barnard for encouraging her to make the transition from the 1990: MS in psychiatric and mental health nursing interpretive to contemporary empiricist paradigm, to transfer what she learned 1993: Ph.D. in nursing science at Case Western Reserve University and postulated about caring through several phenomenological investigations to She has taught nursing theory and nursing science and conducts a program of guide intervention research and, hopefully, clinical practice with women who have research and theory development that addresses recovery after cardiac events. miscarried. Moore encouraged by Joyce J. Fitzpatrick, Jean Johnson, and Elizabeth Lenz to Major Concepts & Definitions not only use theory but to develop it as well. The Rosemary Ellis Theory Conference offered an opportunity to explore theory Caring - nurturing way of relating to a valued other toward whom one feels a as a practical tool for practitioners, researchers, and teachers. Influenced by personal sense of commitment and responsibility. these experiences. Knowing - striving to understand the meaning of an event in the life of the other, Moore considers theory construction an essential skill for doctoral students. avoiding assumptions, focusing on the person cared for, seeking cues, assessing meticulously, and engaging both the one caring and the one cared for in the Theoretical Sources process of knowing. The Peaceful End-of-Life Theory is based primarily on Donabedian’s model of Being with - being emotionally present to the other. It includes being there in structure, process, and outcomes, which in part was developed from general person, conveying availability, and sharing feelings without burdening the one system theory. cared for. In the Peaceful End-of-Life Theory, the structure-setting is the family system Doing for - to do for others what one would do for self if at all possible, including (terminally ill patient and all significant others) that is receiving care from anticipating needs, comforting, performing skillfully and competently, and professionals on an acute care hospital unit, and process is defined as those actions (nursing interventions) designed to promote the positive outcomes of the protecting the one cared for while preserving his or her dignity. following: (1) being free from pain, (2) experiencing comfort, (3) experiencing Enabling - facilitating the other’s passage through life transitions and unfamiliar dignity and respect, (4) being at peace, and (5) experiencing a closeness to events by focusing on the event, informing, explaining, supporting, validating significant others and those who care. feelings, generating alternatives, thinking things through, and giving feedback. Preference theory which has been used by philosophers to explain and define Maintaining belief - sustaining faith in the other’s capacity to get through an event quality of life, a concept that is significant in end-of-life research and practice. Good or transition and face a future with meaning, believing in other’s capacity and Life as getting what one wants, an approach that seems particularly appropriate in holding him or her in high esteem, maintaining a hope-filled attitude, offering end-of-life care. It can be applied to both sentient persons and incapacitated realistic optimism, helping to find meaning, and standing by the one cared for no persons who have previously provided documentation related to end-of-life matter what the situation. decision making. Quality of life is defined and evaluated as a manifestation of Major Assumptions satisfaction through empirical assessment of such outcomes as symptom relief and Nursing as informed caring for the well-being of others. Nursing discipline is satisfaction with interpersonal relationships. informed by empirical knowledge from nursing and other related disciplines, as well This theory was derived in a doctoral theory course in which Ruland was a student as “ethical, personal and aesthetic knowledge derived from the humanities, clinical and Moore was faculty. Middle-range theories were just emerging, and there were experience, and personal and societal values and expectations.” few good definitions or examples. The class was challenged to think about the future use and development of middle range theory for nursing science and Person as “unique beings who are in the midst of becoming and whose wholeness practice. The students discussed knowledge sources from which they could derive is made manifest in thoughts, feelings, and behaviors.” Life experiences of each middle range theory, such as empirical knowledge, clinical practice knowledge, and individual are influenced by a complex interplay of “a genetic heritage, spiritual synthesized knowledge. Each student was asked to derive a middle range theory endowment and the capacity to exercise free will.” Persons both shape and are from a knowledge source of choice. Ruland had just completed a major project to shaped by the environment in which they live. develop a clinical practice standard for peaceful end of life with a group of cancer Persons as dynamic, growing, self-reflecting, yearning to be connected with others, nurses in Norway. The standard was synthesized into the theory of peaceful end of and spiritual beings. She suggests the following: “spiritual endowment connects life by Ruland and later was refined with Moore’s assistance. This is an example of each being to an eternal and universal source of goodness, mystery, life, creativity, middle range theory developed by doctoral nursing students as they study and serenity. The spiritual endowment may be a soul, higher power/Holy Spirit, knowledge development methods. This theory is also an example of middle range positive energy, or, simply grace. Free will equates with choice and the capacity to theory development using a standard of practice as a source. decide how to act when confronted with a range of possibilities.” Limitations set by Major Concepts & Definitions race, class, gender, or access to care might prevent individuals from exercising Not being in pain free will. Acknowledging free will mandates the nursing discipline to honor Being free of the suffering or symptom distress is the central part of many individuality and to consider a whole range of possibilities that are acceptable or patients’ end-of-life experience. Pain is considered an unpleasant sensory or desirable for those whom nurses attend. emotional experience associated with actual or potential tissue damage. The other, whose personhood nursing discipline serves, refers to families, groups, Experience of comfort and societies. Understanding of personhood, nurses are mandated to take on Comfort is defined inclusively, using Kolcaba’s work as “relief from discomfort, leadership roles in fighting for human rights, equal access to health care, and other the state of ease and peaceful contentment, and whatever makes life easy or humanitarian causes. When nurses think about the other to whom they direct their pleasurable.” Experience of dignity and respect TRANSCRIBED BY: EIZEL ABARENTOS | BSN 1 – Y1 – 8  THEORETICAL FOUNDATION (NCMA110) Each terminally ill patient is “respected and valued as a human being.” This f. Source of Development – Derived from practice or deduced from middle range concept incorporates the idea of personal worth, as expressed by the ethical theory or grand theory. principle of autonomy or respect for persons, which states that individuals should What prompted Sister Carolina Agravante to do the theory? be treated as autonomous agents, and persons with diminished autonomy are The present day demands in the nursing profession challenge nursing educators entitled to protection. to revisit their basic responsibility of educating professional nurses who are Being at peace responsive to technological, educational and social changes happening in the Peace is a “feeling of calmness, harmony, and contentment, (free of) anxiety, Philippines society today. restlessness, worries, and fear.” A peaceful state includes physical, Nursing education is faced with a new concern that is globalization of nursing psychological, and spiritual dimensions. services for the international market. Therefore, a need to develop globalization of Closeness to significant others care with focus on developing caring nurses. Closeness is “the feeling of connectedness to other human beings who care.” It Nurses need competent leaders with a dream of what nursing can be, whose basic involves a physical or emotional nearness that is expressed through warm, stand is caring and service who are competent in nursing, assertive of their own intimate relationships. rights with the help profession. The formation of new nursing leaders is urgently needed; leaders with new vision Major assumptions who will venture new traits and who have gone through new formation in order to The metaparadigm concepts explicitly addressed were nursing and person. The serve the society as professional nurse. theory addresses the nursing phenomena of complex, holistic care to support Main Propositions persons’ peaceful end of life. CASAGRA transformative leadership is a psycho-spiritual model, was an effective Two assumptions of Ruland and Moore’s theory are identified as follows: means for faculty to become better teachers and servant leaders. a. The occurrences and feelings at the end-of-life experience are personal and Care complex is a structure in the personality of the caregiver that is significantly individualized. related to the leadership behavior. b. Nursing care is crucial for creating a peaceful end-of-life experience. Nurses The CASAGRA servant-leadership formula is an effective modality in enhancing assess and interpret cues that reflect the person’s end-of-life experience and the nursing faculty’s servant-leadership behavior. intervene appropriately to attain or maintain a peaceful experience, even when Vitality of Care Complex of the nursing faculty is directly related to leadership the dying person cannot communicate verbally. behavior. Two additional assumptions are implicit: The model is a Three-Fold Transformation Leadership Concept rolled into one, comprising of a. Family, a term that includes all significant others, is an important part of end-of- the following elements: life care. 1. Servant-Leader Spirituality b. The goal of end-of-life care is not to optimize care, in the sense that it must be 2. Self-Mastery expressed in a vibrant care complex the best, most technologically advanced treatment, a type of care that frequently 3. Special Expertise level in the nursing field one is engaged in. results in overtreatment. Rather, the goal in end-of-life care is to maximize Servant-leadership behavior treatment, that is, the best possible care will be provided through the judicious Perceived behavior of nursing faculty manifested through the ability to model the use of technology and comfort measures, in order to enhance quality of life and servant leadership qualities to students, ability to bring out the best in students, achieve a peaceful death. competence in nursing skills, commitment to the nursing profession, and sense of Sister CArolina S. AGRAvante, SPC, RN, PhD collegiality with the school, other health professionals, and local community. Transformative Leadership Theory Self-Mastery “Focus on the type of leadership in nursing that can challenge the values of the Is expressed in vibrant care complex Care complex in the personality of the nursing changing world...” faculty is highly correlated to their leadership behavior. Background The care complex is necessary given as a stimulant in the performance of the Educational Background leadership activities. o 1964 A person with dynamic care complex is the cornerstone of nursing leadership.  BSN Degree at St Paul University Manila as magna cum laude Special expertise o 1964 is the level of competence in the particular nursing area that the professional nurse  Passed the NLE as a board topnotcher is engaged in. o 1967-1969 Expertise is the practice of caring and proactive in face of challenges for the  Master’s Degree in Nursing Education at Catholic University of America as a profession go hand-in-hand. full-fledged scholar. Education and practice bring this about. o 2002 Applicability  Doctoral Degree in Nursing at University of the Philippines Manila The servant-leader formula can be a useful tool to charge nurses as this will enable  CASAGRA Transformative Leadership Theory was published them to become leaders and educators while following the footsteps of our Lord, Professional Experience Jesus Christ. o President of St. Paul University - Iloilo, where she taught research subjects In the academe, knowing one's strengths and weak points can help in becoming a among senior students better individual and professional resulting to an effective teaching on students and o Former president of the Association of Deans of the Philippines Colleges of staff. Nursing (ADPCN) The effect of the CASAGRA leadership model using the servant leader model on o Philippine Accreditation Association of Schools, Colleges and Universities the leadership behavior in the nursing facility is an effective formula in organizing (PAASCU) Accreditors one direction in achieving organizational goals. o Representative in the International Nursing Congress that was held in Brunei in Summary 1996 The Transformational Leadership o Part of a delegation that participated in the International Council of Nursing in Make change happen in Vancouver, Canada o Self o President of St. Paul College - Ilocos Sur - Vice-President for Academics o Others Program chair of the school's Department of Nursing. o Groups The CASAGRA Transformative Leadership Theory o Organizations Focused primarily on the educational and psychospiritual aspect of nursing. Charisma is a special leadership style associated with transformational Sr. Agravante emphasized the need for nursing faculty specially trained to develop leadership, extremely powerful, extremely hard to teach holistic nurses who will become leaders in health service. CARMELITA DIVINAGRACIA The CASAGRA Transformative Leadership Model: Servant–Leader Formula & the Theory of Composure Behavior Nursing Faculty’s Transformative Leadership Behavior. Background It is psycho-spiritual model coined after the name of the investigator. This consists of the three S namely: Master in Nursing at UP in 1975 1. Servant-leader spirituality Doctoral Degree in Nursing at UP in 2001 2. Self-mastery Dean - College of Nursing [president] U.E.R.M Memorial medical center / ADPCN 3. Special expertise Aurora Blvd, Quezon City, Philippines. The CASAGRA Transformative Leadership Theory is classified as a Practice Recipient of the Anastacia Giron Tupas Award given by the Philippine Nursing Theory. Association (PNA) in 2008. a. Complexity / Abstractness, Scope - Focuses on a narrow view of reality, Member of CHED ‘s Technical committee on Nursing Education simple and straightforward Has been lauded for developing the art and competency of teaching nursing. b. Specificity - Linked to a special populations or an identified field of practice Has been a clinic nurse, staff nurse, head nurse, instructor, assistant dean and c. Characteristic of Scope – Single, concrete concept that is operationalized dean – Expert in Research and Education. d. Characteristic of Proposition – Propositions defined; Has lectured and written about her work as a nurse and has use her hands-on e. Testability – Goals or outcomes defined and testable; experience to develop better ways to teach nursing. TRANSCRIBED BY: EIZEL ABARENTOS | BSN 1 – Y1 – 8  THEORETICAL FOUNDATION (NCMA110) Her love for nursing and her dedication to carve out learning tools for nursing 2.Physiologic Wellness Outcome: This refers to the perceived wellness of students has been a commendable and rare field of discipline. selected orthopedic patients after receiving nursing care in terms of vital signs, Theory of Composure Behaviors bone pain sensation, and complete blood count. o These patient wellness outcomes reflect their needs as their illness turn to recovery A condition of being in a state of well-being, a coordinated and integrated living and rehabilitation. These needs must be met through high quality nursing care, pattern that involves the dimension of wellness. none other than through COMPOSURE behaviors. Dr. Carmelita C. Divinagracia conducted a study to determine the effects of o COMPOSURE behaviors have been inspired to the principle of holistic care COMPOSURE behaviours of the advanced practitioner on the recovery of selected wherein a patient wellness outcome can be achieved through series of quality patients at the Philippine Heart Center. attributes of nurses, which caters to every aspect of patient wellness, may it be Behaviours include: competence, presence and prayer, open-mindedness, biobehavioral or physiologic wellness outcome stimulation, understanding, respect and relaxation, and empathy. Composure Behaviors Divinagracia (2001) as cited by Leocadio (2009), conceptualized forty statements COMpetence that represented the dimensions of wellness which include the physical, emotional, o An in-depth knowledge and clinical expertise demonstrated in caring for patients. – intellectual, and spiritual domain. This is also stands for consistency and congruency of words and deeds of the Physical domain involves muscle strength, mobility, posture, gait exercise, and nurse. activity tolerance and cardio-respiratory endurance. Presence and Prayer Emotional domain includes awareness, orientation, understanding of own and o A form of nursing measure which means being with another person during times of other personal feelings and ability to control and cope with emotions. need. Intellectual domain refers knowledge and perception of a healthy self and ability to o This includes therapeutic communication, active listening, and touch. recognize the presence of risk factors and preventive measures and spiritual o It is also a form of nursing measure which is demonstrated through reciting a prayer domain is defined as development of inner self or one’s soul through a relationship with the patient and concretized through the nurse’s personal relationship and faith with God and others. in God. The most basic form of holistic communication is "Active listening". Active listening Open-mindedness is a specific way of hearing what a person says and feels and reflecting that o A form of nursing measure which means being receptive to new ideas or to reason. information back to the speaker. Its goal is to listen to the whole person and provide o It conveys a manner of considering patient’s preferences and opinions related to her with empathic understanding. It is the skill of paying gentle, compassionate his current health condition and practices and demonstrate the flexibility of the attention to what has been said or implied. When you listen in this way to patients, nurse to accommodate patient’s views. you just try to reflect the other person's feelings and deeper meanings, which helps Stimulation them feel heard and understood. You don't analyze, interpret, judge, or give advice. o A form of nursing measure demonstrated by means of providing encouragement When patients are listened to in this way, they are less anxious, complain less that conveys hope and strength, guidance in the form of giving explanation and about their caregivers, and are more likely to comply with their treatment plan. supervision when doing certain procedures to patient, use of complimentary words A cardiac patient might be angry and complaining. As the nurse, you may try to or praise and smile whenever appropriate. avoid his room, and, when you have to be there, move in and out as quickly as o Appreciation of what patient can do is reinforced through positive encouraging possible. remarks and this is done with kind and approving behavioural approach. Avoidance is one solution, but there might be a different approach. Understanding Active listening helps patients clarify and articulate their inner process. For a o According to her, it conveys interest and acceptance not only of patient’s condition patient, being carefully listened to can be a moving and profound experience, one but also his entire being. that transforms the relationship between patient and nurse. o This is manifested through concerned and affable facial approach; this is a way of Active listening is particularly relevant in a hospital setting, where patients often making the patient feel important and unique. report 132 that they feel isolated and invisible. It can make a difference in rebuilding Respect a patient's sense of self. It can also be rewarding for the nurse. o Acknowledging the 31 patient’s presence. A positive total outlook on life is essential to wellness and each of the wellness o Use of preferred naming in addressing the patient, po and opo, is a sign of positive dimensions. regard. It is also shown through respectful nods and recognition of the patient as A “well” person is satisfied in his/her work, is spiritually fulfilled, enjoys leisure time, someone important. is physically fit, is socially involved, and has a positive emotional-mental outlook. Relaxation This person is happy and fulfilled. Many experts believe that a positive total outlook o Entails a form of exercise that involves alternate tension and relaxation of selected is a key to wellness group of muscles. The way one perceives each of the dimensions of wellness affects total outlook. Empathy Researchers use the term self-perceptions to describe these feelings. Many o Senses accurately other person’s inner experience. – The empathic nurse researchers believe that self-perceptions about wellness are more important than perceives the current positive thought and feelings and communicates by putting actual ability. For example, a person who has an important job may find les himself in the patient’s place. meaning and job satisfaction than another person with a much less important job. o Through the COMPOSURE behaviours of the nurse, holism is guaranteed to the Apparently, one of the important factors for a person who has achieved high level patient. wellness and a positive life’s outlook is the ability to reward himself/herself. Some people, however, seem unable to give themselves credit for their life’s experiences. Divinagracia (2001) stated that nursing is a profession that surpasses time and The development of a system that allows a person to positively perceive the self is aspects of the individual as one of its clients. From the time the nurse admits a important. Of course, the adoption of positive perceive lifestyles that encourage patient to the time of his discharge, the nurse’s presence becomes a meaningful improved self-perception is also important occasion for the two parties to develop mutual trust, acceptance, and eventually Emotional Wellness satisfying relationships. o a person’s ability to cope with daily circumstances and to deal with personal This framework represents the orthopedic patients, COMPOSURE behaviors of feelings in a positive, optimistic, and constructive manner. novice nurses, and the patient wellness outcome such as physiologic and o A person with emotional wellness is generally characterized as happy, as opposed biobehavioral. The innermost part of the oval is the orthopedic patients. Being the to depressed. recipient of care, they are being influenced by many factors and one of those are o A person with intellectual health is free from illnesses that invade the brain and the behaviors of nurses in implementing quality nursing care. As the COMPOSURE other systems that allow learning. A person with intellectual health also possesses behaviors of novice nurses' envelopes, the orthopedic patients as shown above, intellectual wellness. the researcher believe that there will be an essential improvement in the patient Intellectual Wellness wellness outcome, may it be on physiologic and/or biobehavioral wellness o a person’s ability to learn and to use information to enhance the quality of daily outcome. living and optimal functioning. o A person with intellectual wellness is generally characterized as informed, as Patient Wellness Outcome opposed to ignorant. o This refers to the perceived wellness of selected orthopedic patients after receiving o A person with intellectual health is free from illnesses that invade the brain and nursing care in terms of physiologic and biobehavioral. other systems that allow learning. o Many illnesses are curable and may have only a temporary effect on health. Others, o A person with intellectual health also possesses intellectual wellness. such as diabetes, are not curable but can be managed with proper eating, physical Physical Wellness activity, and sound medical supervision. It should be noted that those possessing o a person’s ability to function effectively in meeting the demands of the day’s work manageable conditions may be more at risk for other health problems, so proper and to use free time effectively. Physical wellness includes good physical fitness management is essential. For example, unmanaged diabetes is associated with and the possession of useful motor skills. high risk for heart disease and other health problems. o A person with physical wellness is generally characterized as fit versus unfit. o Two patient wellness outcomes which have been categorized as: o A person with physical health is free from illnesses that affect the physiological 1. Biobehavioral Wellness Outcome: This refers to the perceived wellness of systems of the body such as the heart, the nervous system, and the like. selected orthopedic patients after receiving nursing care in terms physical, o A person with physical health possesses an adequate level of physical fitness and intellectual, emotional, and spiritual. physical wellness TRANSCRIBED BY: EIZEL ABARENTOS | BSN 1 – Y1 – 8  THEORETICAL FOUNDATION (NCMA110) Spiritual Wellness o Knowing persons is a process of nursing that allows for continuous appreciation o a person’s ability to establish a values system and act on the system of beliefs, as of persons moment to moment (Locsin, 2005). well as to establish and carry out meaningful and constructive lifetime goals. It is o Technology is used to know wholeness of persons moment to moment (Locsin, often based on a belief in a force greater than the individual that helps one 2004). contribute to an improved quality of life for all people. o Nursing is a discipline and a professional practice (Boykin & Schoenhofer, 2001). o A 138 person with spiritual wellness is generally characterized as fulfilled as Dimensions of Technological Value in the Theory opposed to unfulfilled. Technology as completing human beings o Spiritual health is the one component of health that is totally comprised of the to reformulate the ideal human being such as in replacement parts, both wellness dimension; for this reason, spiritual health is considered to be mechanical (prostheses) or organic (transplantation of organs.) synonymous with spiritual wellness. Technology as machine technologies Optimal Health e.g. computers and gadgets enhancing nursing activities to provide quality patient o includes many areas, thus the term holistic (total) is appropriate. In fact, the word care such as Penelope or Da Vinci in the Operating Theatres; health originates from a root word meaning “wholeness”. Technologies that mimic human beings and human activities o The holistic nurse is an embodiment of the care she renders. The nurse creates meet the demands of nursing care practices, e.g. cyborgs (cybernetic organisms) the calm environment in any setting that facilitates treatment, healing and recovery or anthropomorphic machines and robots such as ‘nursebots’ (Locsin & Barnard, from any pain or discomfort. 2007). ROZZANO LOCSIN Technologi