Notre Dame of Jolo College

Graduate School
Master of Arts in Nursing
Adviser: PROF. ATASHARR SAMAIN PARADJI-HARADJI, RN, MAN, Ph.D
Prepared by: BABY LYKA S. SARIAN, RN

FINAL EXAM

1.1 . What is the relevance and significance of Nightingale’s theory in today’s

modern nursing application especially in the field of Nursing Practice?

The relevance and significance of Nightingale’s theory in today’s modern nursing

application in the field of nursing practice is a holistic process. Effective nursing care
and Florence Nightingale Theory is very appropriate for application to the care of most
patients in the hospital even in home environment, beside the fact that theory is more
than a century old it is still alive, easy to applicate in the fundamental undertak ing
of nursing interventions. Although nursing science is progressively advancing with
higher degree of learning, research and creation of suitable technologies that would
help in improving a patient’s health, nightingale theory is purposeful in the era
globally because her philosophy fits to the basics of nursing and basics remains same.

Harmony with the changing times by the interplay with nature and its preservation
for healthier place to live on. And to signify the importance of conservation of the same
for cleaner future and its glory for the younger generation who will be deprived of the
beauty and abundance of the resources left before its destruction and extinction. Life
then will heal with time and patience for a better tomorrow.

1. 2. What is the relevance and significance of Nightingale’s theory in today’s

modern nursing application especially in the field of Nursing Education?

The relevance and significance of Nightingale's Theory gives emphasis on education

that is geared towards the understanding of global climate change and the advent of
technology. The scientific approach in nursing education should take into consideration
effects of drastic weather that gives various changes to establish principles of nursing
with regards to patient care. Significantly, the changing scope and the nursing scope of
change itself has broadened its borders and interrelated to other disciplines like
behavioral psychology and eco-social philosophy.
2. How can Jean Watson’s Caring Theory be applied in the nursing practice?

It can be applied were charity and heartfelt service is given in abundance without
expecting anything in return. But it is a must to have a promising result regarding the
betterment and sound convalescence of patients. Although it runs contrary to some
ideas that emotion should not be involved in patient care because it could interfere with
the patient wellbeing. Nevertheless the opulence of giving service shall be given
wholeheartedly and cordially.

3. Review your values and beliefs and cite how Watson’s 10 carative factor/caritas
assumptions fit with your own personal philosophy of caring in relation to the
patient, environment, health and nursing.

Continual reviews of the caring behavior of nurses and patient satisfaction help to
improve the quality of nursing. The essence of nursing is caring for others and for
oneself. Watson's 10 carative factors will serve as a guide to the health care professionals
especially for nurses in terms of caring a patient. Nurses should be caring and be able
to establish personal contact, have a communicational approach and good interpersonal
relationships with patients. Interventions should reflect professionalism and care for
individual problems, not only be seen as routine work. Patients appreciate good care;
hence their perception about caring and satisfaction should be taken into consideration.

4. What are the significant applications of Patricia Benner’s Nursing Expertise

Model in the nursing profession?

The important role played by Patricia Benner’s Nursing Expertise Model in the
nursing profession can be employed as a strong basis for developing and improving
nursing career in practice and in clinical issues. Furthermore, another purpose of this
model is to promote deep thinking, determination of nursing knowledge, and creating a
system using which the performance of nurses can be evaluated and incentives can be
applied based on the expertise and experience of them for short this can be used as a
predetermined clinical guideline for conducting all practices associated with nursing
career.

5. As a nurse manager how will you utilize Benner’s model to determine and
address learning needs of your subordinates?

As a nurse manager Benner's theory can utilize as a foundation for assessing the
learning needs your subordinates. In the level of skill acquisition and development
under Benner’s Theory starting from categorizing the skills and knowledge of your
subordinates from there you will know what lacks each of your subordinates.

It is possible to use the novice to expert theory, developed by Benner, to assess

the competency of people in performing special tasks and finding strategies for
improving their performances. Using the Benner's model and familiarity of employees
with the model, your subordinates would be able to evaluate their performance and skill
level and compare them with those of others. The novice to expert theory equips the
managers with a metric to evaluate the performance of themselves and their
subordinates.

6. What is the most significant application of Kari Martinsen’s Theory in your role
as a nurse? Why?

Countless patients complain about the lack of care when consulting their doctors,
facing ignorance, inattentiveness or undignified conduct. The Kari Martisen’s
Philosophy of Caring theory, there is a considerable discrepancy between expectations
and reality in nursing care. Not all doctors or nurses care is a terrific deal. The concept
of care in the field of medicine is disputable. I welcome Kari perspectives on the influence
and importance of ethics in relation to nursing care. As humans, we are social and
dependent on other people. Thus, care is a preconditioned fundamental in human life.
As mankind, we are interconnected; this creates dependency which requires a response
in the form of care. Martinsen understands a state of care as being circumstantial,
emotionally burdened and particularistic in nature. Care is to communicate to the other
in absolute and impulsive way as a reaction to the condition of the other. To accomplish
this, we must identify the patient need in the first place. Noting the necessity for care is
thus the basic element of care as Martinsen implies by arguing that in order to care for
the patient, we must both be able to see and express the patient’s request for assistance
in order to reinforce the patient.

7. How will Imogene King’s Goal Attainment Theory be beneficial in the practice
of clinical nursing?

Individuals decide to pursue a profession in nursing because they want to be

contributory in helping patients get healthy. Some children will utter “mabayah ako
magpaulih, mabayah ako mahinang nurse”. In order to do that, it's necessary to set
health goals with the patient, and then take steps to achieve those goals. Imogene King's
Theory of Goal Attainment focuses on this process to aid nurses in the nurse-patient
relationship, helping their patients meet the goals they set for their health.

Accordingly, nursing practice can occur in acute and chronic care settings, as well
as those appropriate to delivery of care for the maintenance of health. Opportunities for
health promotion exist wherever people are in their communities, regardless of their age
and health state. Participants in nursing are people who can actively participate in
decisions that influence their care, as well as clients who have family members with
whom nurses can make transactions until the clients can participate. King’s conceptual
framework system and Theory of Goal Attainment fits the current trends in nursing
relates the use of minimum data use, common language for nurses and computerized
patient system important in organizing, applying and communicating knowledge.
8. How will the basic tenets of Madeleine Leininger’s Transcultural Nursing theory
best serve you in nursing practice here and abroad?

Nurses are now realizing the importance of transcultural nursing in human care
especially Filipino nurses who are working overseas with today’s heightened public
awareness of health care cost, different cultures and human rights, there is much
greater demand for comprehensive, holistic, and transcultural people care to protect
and provide quality-based care and to prevent legal suits related to improper client care.

Transcultural Nursing theory is rendered best if the basics are mastered and
modifications made to compliment the needed adjustments and moderations of other
cultures. These transformations shall be in consonance and in agreement with the
cultural beliefs and traits so that conflict maybe avoided in the performance of nursing
practices.

9. How will Mercer’s Becoming a Mother Theory be significantly applied in the

field of nursing practice?

Following that theory, Nurse's role is seen as helping women adapt to the
"maternal role". The philosophy of this perspective locates the pregnant woman at the
centre of the process and places nurses in an ideal position to draw upon the concept
of maternal representations in order to support not only a woman's physical transition
to motherhood, but also her psychological transition to motherhood.

Becoming a mother theory signifies much in nursing when put to practice by

those who acquired the basic knowledge of motherhood. Although nature turns
womanhood to motherhood by conception, the application of the knowledge of the
established principles of nursing is fundamental. It complements the natural instincts
of motherhood and the nursing practices applied.

10. How will the Adaptation Model be beneficial to nursing practice?

The benefits of adaptation is the pooling of best practices to be applied for better
nursing practices. It has to adapt to the practicability of principles needed to improve
the acceptance of sound knowledge for nursing practices.

To apply the Roy’s Adaptation Model to nursing practice, the nurse works
collaboratively with the individuals and groups to assess adaptive strengths and to help
deal with issues they encounter in promoting their health. The nurse should promote
the best adaptive strategies in all four adaptive modes. This will promote health as the
integration of adaptation in all four adaptive modes and when the nurse is manipulating
the stimuli and not the patient, the nurse enhances the interaction of the person with
their environment, thereby promoting health.
11. How will the Health Promotion Model be instrumental in improving nursing
practice?

Health promotion can be defined as the process of empowering people to make

healthy lifestyle choices and motivating them to become better self-managers. This will
improve nursing practice through health promotion strategies focusing on patient
education, counseling, and support instruments. Health promotion Model will help
assist nurses in understanding the major determinants of health behaviors as a basis
for behavioral counseling to promote healthy lifestyles. The health promotion model also
notes that each person has unique personal characteristics and experiences that affect
susbsequent actions.

12. Review two definitions of nursing put forth by theorists other than Boykin and
Schoenhofer. Compare Boykin and Schoenhofer’s description of the proper
object of nursing with the others. How are they related?

13. What is the most significant application of Kolcaba’s Theory of Comfort in

your role as a nurse in the care of a post-operative client? Why?

Providing comfort is a positive outcome that is linked to addressing the patient's

health seeking behaviors during the interpersonal relationship between patient-nurse
(Kolcaba, 2001). Patient comfort is a desired outcome in the peri-operative setting. When
choosing a middle range theory that focused on patient problems in this setting, I
wanted to choose one that would guide nursing practice towards positive patient
outcomes. With this in mind, I chose Comfort Theory by Katherine Kolcaba, which
supports the main concept of providing patient comfort through holistic care that
strengthens patients to engage in behaviors that promote a state of well-being. This
theory provides a useful framework to enhance patient comfort by helping to guide
holistic nursing interventions KOLCABA'S COMFORT THEORY AND PATIENT
CENTERED CARE 11 for not only physical discomfort, but psychological or emotional
discomfort as well. In fact, explains that patients strive to have their comfort needs met,
and the comfort theoretical framework can assist nurses with their assessments of
various comfort needs within the "context in which comfort occurs" (p. 89). Patients may
be strengthened by having their human needs for "relief, ease, and transcendence" met
in the areas of their "physical, psycho spiritual, environmental and sociocultural milieu

Application of Comfort Theory to Practice Utilizing Kolcaba's middle range theory of

comfort can be easily adapted in the perioperative setting and is useful in addressing
the patients' various comfort needs. I found it practical as a framework for providing
holistic interventions while addressing the patient's anxiety. Pre-operative anxiety is a
common discomfort and can have negative effect on the patient's ability to cope in their
situation. Providing comfort through compassionate care will help to alleviate the
negative symptoms experienced by the patient relevant to her fear of her post-operative
diagnosis and pain. When comparing the outcomes from my case study to the comfort
theoretical framework I can see similarities as well as insights that I have gained. Along
with the concepts and interventions that I have identified, Kolcaba's framework shows
how certain aspects of comfort are inter-related within the context of a patient's "holistic
experience". The comfort theory framework clearly explicates how to assess the patient
within their unique situation and environment, thus enabling the nurse to choose
comforting interventions resulting in positive patient outcomes. In addition to comfort,
this theory enlightened me to the fact that an increase in positive patient outcomes also
results in nurse satisfaction, decreased hospital length of stay, and decreased re-
admissions leading to positive institutional outcomes. Using a theory specific to the
practice setting can help to provide a positive change in the way that nurses provide
holistic patient care based on the patient's individualized physical and emotional needs.

Postoperative behavioural changes including separation anxiety, sleep disturbances,

aggression towards authority, temper tantrums, and eating problems. Nurses use
various kinds of strategies in reducing discomfort in children did survey on use of non-
pharmacological methods in relieving children's (8-12-year) postoperative pain on
hospital nurses in Finland. The study showed that emotional support, creating a
comfortable environment and assisting with day by day activities were accounted for to
be utilized routinely, though the cognitive-behavioural and physical techniques
incorporated some less much of the time utilized and less surely understood strategies.
Stephens, Barkey, Hall 5 listed several interventions to comfort children and families
during stressful procedures are categorized under social and psycho spiritual comfort ,
environmental comfort and physical comfort .Hawley MP 6 described nurses' comforting
strategies under the accompanying classes: Immediate and competent
technical/physical care, attending to physical discomforts positive talk, vigilance,
including and attending to family. Focusing on comfort from a patient perspective offers
practice insights that challenge organizational and cultural norms and suggest
additional ways of working to address these issues.

14. How will Reed’s Self-Transcendence Theory be beneficial in your function

as a nurse in the management of a stage 4 cancer client, who is in chronic,
severe pain?

The ability of human beings to find meaning by being directed toward something, or
someone, other than themselves is termed "self-transcendence." Previous research
indicated that the ability of nurses to self-transcend and thus derive positive meaning
from patient-caring experiences increased work commitment and fostered work
engagement. However, the relationship between self-transcendence and work
engagement had not been investigated. The purpose of this study was to explore the
levels and relationships of self-transcendence and work engagement in acute care staff
registered nurses. This was a descriptive correlational study using Reed's theory of self-
transcendence. The Self-transcendence Scale, the Utrecht Work Engagement Scale, and
a demographic questionnaire were completed by a convenience sample of 84 ACSRNs
who attended an annual acute care nursing conference in northern Illinois. ACSRNs
level of self-transcendence was high, similar to that of other nurses, but higher than
that of non-nurses. ACSRNs level of work engagement was at the high end of the
"average" range. There was a significant positive correlation between self-transcendence
and work engagement. Nurses with higher levels of self-transcendence had more energy
toward and were more dedicated and absorbed in their work.

15. What is the most significant application of Ruland and Moore’s Peaceful end
of Life theory in the care of client with degenerative disorder? Why?

Study is about applying the theory of a peaceful End of life, through the process of
nursing care, to a patient with end-stage cancer, based on the care provided to a 24
years old patient with osteosarcoma, allowing us to integrate the theoretical groundwork
of Cornelia Ruland and Shirley Moore, using NANDA, NIC, NOC. Thus providing care
with priority diagnoses and effective interventions from the nursing concept. Through
the assessment-the first element of the nursing process-priority diagnoses are
demonstrated and interventions are planned, which allows to achieve partial pain
control, decrease in anxiety and improvement of the family situation with levels of 4 and
5respectively, as well as, the communication process and infection prevention during
hospitalization. Therefore, it is established that the processes of nursing care combined
with the theory of a peaceful end of life, aims to a constant interaction of the nurse and
the patient, not only to provide care, but also give emotional support during the death
process.

For nursing, caring for a terminally ill patient is a challenge, although this health
situation is not new in their professional careers, the patient, his family and their
evolution, may test their level of competence and performance especially in their
final days, so the resourcefulness with which the nursing professional will manage
to solve their patient’s problems and needs as well as their respective solutions have
to be based on scientific principles that support the profession. Moreover, the nursing
professional plays an important and accountable role in the deceasing process,
providing adequate comfort and care to the patient and his family members. They
are the intermediaries between patient, family and the rest of the team, cooperating with
their needs and preferences. They are professionals who work to provide an adequate
and calming denouement. Their role requires personal commitment, interest, love,
dedication; and above all treatment management, drug preparation, control of
symptoms, and of course emotional and spiritual support to his or her family both in
the hospital and at home, seeking to alleviate the suffering. Consequently, it is vital that
from the nursing schools, these health professionals learn and become prepared to deal
with death, thus the description of the situations in nursing where the moment is
elaborated and analyzed and the actions that the professionals have before patients are
important, to provide tranquility and care and making them feel self-worth.

Evaluate and interpret the manifestations that reflect the person's experience with the
end of life, and intervene in an appropriate manner to achieve or maintain a serene
experience, although the dying person cannot express him or herself verbally.
Nursing should include the patient and their relatives in making decisions regarding
patient care, treat the patient with dignity, empathy and respect, and be attentive to the
needs, wishes and preferences expressed by the patient.

The objective of care of the end of life, is not to optimize his or her health, but to provide
the best possible care using technology and welfare measures, to achieve closure and
peaceful death. Maintain the state of health, for this theory is to control and administer
analgesics, apply pharmacological and non-pharmacological interventions that
contribute to the patient's relief.

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of care, should have standardized plans that enable efficient actions within the
healthcare process. These plans provide continuity to the work, effective coordination
between the interventions, and prioritizes the different caring steps, thus turning into
an instrument for the nurse to continuously evaluate the care quality. Consequently, in
this situation, a caring plan model was provided to a patient with end-stage cancer
(osteosarcoma), with particular family dynamics, using as a reference the theory of the
peaceful end of life. Nurses express difficulties relating and communicating with
terminally ill patients and their families, in many occasions, especially dealing with the
fact of a close death, hence they may relate to these incidents and project it towards
their own families and lives. This is perceived as a threatening situation that should be
blocked, picturing a sudden death as a better option, that’s why the nursing
professionals must create affectionate relationships maintaining "emotional distance",
in addition to providing care based on effective communication. This article describes
a young woman with a terminal illness, in a half-hearted state towards her condition,
this is where the nursing professional identifies a need for an effective communication
with the patient, to help her express her feelings and improve her family ties. It
is important that the professionals recognize the patients’ fears, preferences and values,
so that they can understand their perspectives and wishes, helping them to guide,
monitor, explain and advise on the caring measures. Confronting a patient’s death can
generate emotional conflicts and confusion, particularly if it’s on a daily basis. This leads
to the rise of feelings such as helplessness, frustration, pain and grief. The nurse, when
analyzing the context of the patient’s situation, intervenes applying a caring plan with
a palliative approach, participating the patient’s family in coping therapies and
involving herself proactively to improve their bonding. Applying the

16. As a nurse how will Beck’s Postpartum Depression Theory be beneficial in the
management of at risk mothers in order to prevent suicide?
Beck's Theory of postpartum depression

Theory is an attempt to explain the world around us. It is defined as a set of concepts,
definitions, and propositions that projects a view of phenomena by designating specific
interrelationships among concepts for purposes of describing, explaining and predicting
phenomena. In the world of healthcare the nurse through the understanding of theories
attempt to explain why nurses do what they do. Nursing theories are the creative
products of nurses who seek to thoughtfully describe relationships and interactions that
exist within nursing practice. Nursing theorist Cheryl Tatano Beck (1949- present)
developed a middle-rang theory that focused on postpartum depression (PPD). Beck.
The SST is a subset of middle-range theory that is developed for a specific area of social
concern, in this case women with PPD. Data for this theory was obtained through
participant observation; analysis of the data revealed loss of control as the basic social
psychological problem and was the foundation for her theory development (Beck, 2012).
In relation to the nursing metaparadigm, Beck’s theory was intended for women with
PPD and to serve as an educational tool for nursing students; healthcare professionals
including nurses, doctors, mental health care workers and those within social services.
Beck did not clearly define health; however, her focus was on mental health as PPD is
a mental health disorder. Holistic health was a predominate factor in her theory,
referring to the “wholeness” of a person, where the entire being, physically, emotionally,
and psychologically are entwined with the environment as one. Beck determined that
the interpersonal environment of the individual woman, if unstable, has an outward
effect on them as well as on the family. Regardless of the setting of the individual’s
environment, variables, be it rich or poor, famous or non-famous, different cultures and
backgrounds, all are subject to the effects of PPD (Lasiuk & Ferguson, 2005).
Beck believed that obstetrical nurses as well as nurses outside of obstetrical nursing
need to be educated to identify