Theory Letter to a Young Nursing Student Research Proposal

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Theory

Letter to a young nursing student: Palliative care and nursing theory

To a young nursing student:

One of the most difficult issues for a nurse is confronting a patient with a terminal illness. No matter how fully lived the patient's life, no matter how many friends and family members surround the patient's bedside, there is always a profound sense of loss and grief at the end of the possibility of hope. How much more so when confronted a young person facing the end of her life, alone! Such was the case with a twenty-four-year-old cancer patient I tended to as a young nurse, about the same age as you. She was diagnosed with cancer of the ovaries, and her father refused to visit her because he said her condition upset him.

But the nursing theory of Rosemarie Rizzo Parse of "Human Becoming Theory" provides profound aid in helping the patient in such cases deal with the end of their lives, regardless of the patient's circumstances. Parse gives guidance to the nurse and helps the nurse give a sense of meaning to the patient's life. At the time, I was dimly aware of Parse's theory, and knowing what I know now of Parse, I think I translated Parse's core principles in action in acting as an advocate for the patient to receive appropriate palliative care and treatment. I acted as an advocate for the patient with her lawyer, accountant, and ultimately her family. I tried to uphold Parse's ideas that health should be seen in terms of patient empowerment over his or her own treatment, and also Parse's three-part core approach to health treatment.

Fundamentally, Parse's theory stresses the "humanly lived experiences of health," which is "defined as an open, unitary process of becoming with the universe." In this theoretical system, each human being is viewed as the expert on her or his personal health (Cody, 2008, Parse's human becoming theory). Prolonging health, in short, is not the only goal of treatment -- the nurse and the patient must ask how the patient defines health, as it is a subjective category, and what methods and means are available to improve upon the patient's health, realistically, and fulfill the patient's desired health goals, given the current limits of the patient's physical state of being. In the case of my patient, despite her youth, she had already been recommended for palliative care, rather than intensive treatment, because of the swift progression of her illness. "The human becoming theory posits quality of life from each person's own perspective as the goal of nursing practice" (Cody, 2008, Parse's human becoming theory). In the case of my patient, she believed that the quality of her life was extremely poor.

My patient had been diagnosed with cancer when she was only twenty-two years old and a student at York University studying political sciences. Before she was diagnosed, according to my patient, she had been enjoying the happiest time of her life. She had just been accepted into a master's program in her field of academic specialty. Then doctors found the cancer. In short, she had experienced rapid emotional highs and lows very quickly in her young life, and I, a person who was also studying and had my 'whole life ahead of me' had to treat her emotionally and physically. Acknowledging the validity of her experience and allowing her control over her health and treatment was thus particularly important, as well as extending my empathy to her as a caregiver. She felt as if all of her control over life had been swept away and I was resolved to give at least some sense of control back to her.

The first, core principle of Parse's three-dimensional approach to treatment that of meaning, suggests that "Structuring meaning multidimensionally is cocreating reality through the language of valuing and imaging" in the way that it "immediately touches upon this individual's experience" (Cody, W. 2008, Parse's theory of human becoming: a brief introduction). The tools with which this patient had used to make meaning of her life, planning for her future, exercising her intellect in school, and enjoying her youthful existence with her university friends in a carefree fashion was shattered. Helping her recreate meaning out of her short life, through, for example, disposing of her funds and belongings to those she cared about so she felt that her life 'meant something,' for example, was very important to her. While I cared for her as a nurse, discussing the profound and seismic shift that had occurred I viewed as another but equally vital part of her treatment as the physical care I dispensed. This would be true for any nurse caring for the patient under Parse's guidance, I believe. Helping a terminal patient undergoing palliative care speculate about what illness and the end of life 'means' is necessary, even if no answers can be provided by the nurse or caregiver as to why the patient should be afflicted with such an ailment. The patient's frequent questioning 'why me,' is only natural, as was, unfortunately, her bleak state of mind when she came for palliative care.

A first came into contact with the patient after she had endured her third round of chemotherapy. She had first experienced six months of chemo following extensive surgery where her ovaries and uterus were removed. All told, she had been subjected to five rounds of chemotherapy to control her cancer. Her platelet count was 4,000, while the normal count is 150- 300,000 and she was bleeding from all orifices. At first, it might be tempting to ask, what insight can a healthy person have to give, emotionally to such an individual who is so bereft, after two solid years of fruitless treatment? However, according to Parse's second principle, core part of her theory that "cocreating rhythmical patterns of relating is living the paradoxical unity of revealing-concealing and enabling-limiting while connecting-separating," or humanely acknowledging the uniqueness of patient's suffering can often be a profound relief (Cody, W. 2008, Parse's theory of human becoming: a brief introduction). Instead of saying 'I feel your pain,' listening to the patient's perception of quality of life can be profoundly validating, even if the patient's state of health is poor. Sometimes simply acknowledging reality, as seen by the patient can be beneficial, as opposed to doctors who may try to cushion the blow of the information to one so young, or to seek aggressive treatment because of the patient's age, regardless of the prognosis or what she had already endured. At the time I cared for her, the patient's pain was under very poor control, even while we were giving her platelets to staunch the bleeding. Particularly in the field of palliative care, providing appropriate pain relief is very important in the concept of how the patient really feels pain on the 'pain scale.'

The third principle of Parse's theory is that of transcendence which states: "Cotranscending with the possibles is powering unique ways of originating in the process of transforming" (Cody, W. 2008, Parse's theory of human becoming: a brief introduction). This principle means that moving beyond the "now" moment requires "forging a unique personal path for oneself in the midst of ambiguity and continuous change," and not simply treating the patient in the moment but treating the patient with an eye upon the future (Cody, W. 2008, Parse's theory of human becoming: a brief introduction). In short, coming to terms with the patient's state of health and absence of wellness, and focusing on where her treatment was 'going' is undoubtedly the most difficult part of the treatment process but also the most necessary when dealing with the terminally ill.

The patient expressed her wish to cease treatment, and receive a fatal dose of morphine. Keeping in mind the idea that "a nurse needs information about the purpose, action and anticipated effects of the substance" to fulfill his or her "professional responsibility to assess the risks and benefits of providing this treatment in relation to the health status of the client," and also in respect to her Parse's belief in focusing on a realistic future. I did not give her false hope about her condition even while not encouraging her suicidal ideation. Of course I did, as I would in the future, keep in mind the "limiting" aspect of fulfilling client's choice in terms of understandable suicidal impulses in the case of intense pain but also the Parse and the values of allowing patients to be "leaders of their own health" (RNAP, 2006, pp. 19-24). To restore her "human dignity" was not to fulfill her request, but it was, along the lines of Parse's stress on patient control over his or her care, to offer her an ear. I also offered very practical assistance in practical matters.

Again consistent with Parse's empowerment emphasis, I arranged for her to get her 'affairs in order,' to speak to an accountant and lawyer about her finances, as she had some assets that she… [END OF PREVIEW] . . . READ MORE

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