The main focus of all nursing interventions is to improve the quality of life among patients who are suffering from diseases. Unfortunately, the predominance of the biomedical model has restricted healthcare providers’ approach to a mechanistic model. Human beings are considered machines and treatments are done to fix the faulty parts (Parse, 1996). On the other hand, the Human Becoming theory of nursing has a distinctive approach towards patients’ care and improving quality of life from patients’ perspectives. Parse (2006) considers humans as unitary beings, as co-authors and co-participants in living their lives. This idea of nursing care has brought nursing practice to more client-centred care (Parse, 2006; Mitchell, 1992). Ms. Kareem, a 72 year-old client, was reported to the facility with asthma exacerbation. Ms. Kareem is a non smoker; she had her first asthma attack back in 2006 while she went to spend summer vacations in a trailer. The client has been interviewed for her personal health description, intents, and priorities. A pseudonym has been used for the client in this paper. The focus of this paper is to explore the nursing care guided by the Human Becoming theory, biomedical care, and how these two models of care can go together to improve patients’ quality of life.
Principles of Human Becoming and Patient Care
Nursing practice directed by the principles of human becoming, guides nurses to act differently from other nursing staff. Parse’s nurses provide care to their patients, the way their patients desire. The humanly guided nurses understand that patients are the masters of their own body (Parse, 2006). These nurses plan interventions based on non judgmental values, listening to clients by giving them proper respect, and honoring patients’ wishes (Bournes, 2006). An all-at-once approach is used by Parse’s nurses to understand patients’ priorities because patients are irreducible and changing constantly and unpredictably (Parse, 2006). Human beings are always in a state of becoming while at the same time choosing their ways to live their lives; a nurse guided by the principles of Human Becoming understands and values the lived priorities of clients (Bournes, 2006).
Ms. Kareem has been diagnosed with asthma and she has to take her inhaler every eight hours. At breakfast time, she took all of her daily medications, yet she refused to take the inhaler with her breakfast. When I spoke to the staff nurse about the client, I was upset to know that she described the patient as “annoying”. As Parse’s nurse, I respected the client and honored her wishes for not taking the inhaler. I waited for the client to finish her breakfast, went back to the patient’s room and requested her to take the inhaler; this time she did not refuse. As mentioned earlier, patients are always in a phase of change and finding ways to live their lives (Bournes, 2006). Ms. Kareem did not want to lose the taste of her food, so she discovered a new way to live with her disease and the use of her medications. It is known that inhalers leave a bad taste after use (McKeage & Keam, 2009) which made the client turn down the nurse’s request for the use of inhaler during her breakfast. Following the principles of human becoming theory helped me understand the patient’s perception, her priorities, and needs for the moment. The client received her medication, and the humanizing care enhanced the quality of life for the patient by maintaining the taste of her food.
True Presence, Practice Dimensions, and Processes in Patient Care
Quality of care can be enhanced in certain ways, such as true presence of the nurse involved in care, understanding the meaning of the situation in the patients’ perspectives, going with the flow of patients’ and families’ desires, and exploring patients’ hopes, dreams, and possibilities of the future (Pilkington & Jonas-Simpson, 2009). True presence is the key to all nursing interventions. This can be expressed by silence of the nurse or in a discussion with patients which would then be described as the synchronizing rhythms. The nurse with true presence honors patients’ wishes to move along the situation and developing new ways to live with their health. The true presence, practice dimensions, and processes help nurses to explore patients’ needs from their perspective and plan for them accordingly (Pilkington & Jonas-Simpson, 2009).
In a discussion with the client, Ms. Kareem mentioned that she wanted to go home. She was dangling on the side of the bed; I felt as if she was ready to go home. The client’s paradoxical behavior was evident from her discussion. She wanted to go home; however, she feared loneliness at home because she was not feeling well. She could not sleep last night due to this fear, and she was sharing the room with another client. To her, going home meant a restful sleep. Illuminating the meaning of patient’s perception for going home helped me understand her needs at that moment. The client heaved a big sigh and gave a big pause during her conversation. As Parse’s nurse, I did not want to interrupt her during the dialogue; rather I expressed a true presence by being silent to further explore the meaning of her perception. This helped me investigate her hopes and fears about the future and develop a comprehensive plan of care from her perspective, which would ultimately enhance the patient’s compliance and the quality of life for her.
Personal Health Description, Person’s Intents, Priorities, and the Plan of Care
Persons’ intents, priorities, and the perceptions of diseases can not be explored without developing a relationship of trust. In order to formulate this connection nurses must encompass strong communication skills, be truthful to their profession, and assess their own moral values (Burger, 2009). Fortunately, I was able to develop that bond of trust which helped me investigate her main concerns. In response to the questions asked to the patient regarding her perception about the disease, the patient described her disease as the cause of her depression. She further stated that for her, asthma meant being in a healthcare facility, away from her loved ones, such as her grandchildren, her boy friend, and her sister. She sensed that being in a healthcare facility posed a greater risk to her independence and rest.
The paradoxical nature of human being was dominant from the patient’s behaviors and expressions. She felt anxious and worried about simple things in life which meant a lot to her; however, she was also concerned about her asthma. She had to go to the Toronto Western Hospital for colonoscopy, see the dental surgeon, and attend a wedding next month. She seemed to be so overwhelmed as if she had problems from all directions. Her priority at the time was to get well and get back on track and enjoy life with her loved ones. She was concerned about her daughter who was going to be divorced, and distressed about her step-son who committed suicide. She had so many problems going on in her life at the moment that could provide an emotional trigger towards her asthma (Papiris, Manali, Kolilekas, Triantafillidou, & Tsangaris, 2009).
The actions taken to provide patient care were authentic presence and caring for all aspects of the patient. These aspects include giving the patient due respect, honoring the patient’s wishes, accepting her perception and her knowledge about the disease. I described to her the proper techniques of using an inhaler and benefits of rinsing her mouth after use of inhaler. I reminded her that there is always room for making things better. Rinsing her mouth would make the bad taste go away and would also prevent the development of thrush due to steroid inhalers (McKeage & Keam, 2009). To deal with her restlessness, I requested the staff nurse to transfer her to a separate room. Honoring her wishes, it was decided that she would be discharged as soon as she feels better and be able to spend time with her loved ones.
Person’s Evaluation of the Care
Improving the quality of life from patients’ perspectives is the prime objective of all nursing interventions (Parse, 2006). Reflecting upon the situation, I found that the client was happy about the care plan that was developed for her. The role of authentic presence, using all at once approach, and accepting her perception of the situation were also helpful in dealing with the client’s distress, and meeting the client’s perception about the quality of life. Ms. Kareem wanted the authentic presence of nurses which is not always possible in the busy schedule.
Patient’s Autonomy in Decision Making
All the nursing interventions are developed for the patients’ beneficence and better outcomes. We can expect enhanced outcomes only if nursing plans are laid down in accordance with the national standards of nursing practice (Oberle & Bouchal, 2009). Canadian Nurses Association (2008) has recommended that patients have the right to choose. They have the autonomy or the freedom of choice in decision making. This should be kept in mind that patients are human beings and must be treated with dignity and respect. Their wishes must also be honored (as cited in Oberle & Bouchal, 2009). Looking back at the situation, the client refused to take the inhaler. However, I honored her wishes and tacit perceptions for not taking the inhaler. Respecting the client and providing her with autonomy or freedom of choice helped me build up that nurse-client relationship to further explore the patient’s needs which would ultimately help improve the quality of life for the patient.
Care Guided by Biomedical Knowledge
In order to develop a care plan and meet the health related needs of patients, it is necessary to have the knowledge of the etiology and pathology of the disease, which also helps nurses communicate with patients, families, and other members of healthcare team (Burger, 2009). Asthma is a chronic disease of the airway, in which smooth muscles of the airway become constricted and block the air entry to the alveoli where the gaseous exchange takes place. Patients with asthma are usually hypoxic (deficient of oxygen in blood circulation) and develop shortness of breath as a result (Papiris et al., 2009). Ms. Kareem has bas been reported to the facility with asthma exacerbation and an excessive shortness of breath. She was hypoxic and her oxygen saturation (SaO2) was <90%. She was concerned about the shortness of breath. It has been shown that in asthma exacerbation, the expiratory flow of CO2 is most likely affected, resulting in accumulation of more H+ ions in the body which can cause respiratory acidosis. Respiratory acidosis can also lead to metabolic acidosis which would affect the kidneys to work more than normal to get rid of the acid accumulated in the body and would ultimately compromise the renal function (Papiris et al., 2009).
Nurses’ role in collecting data from patients cannot be denied. These knowledgeable nurses collect subjective as well as objective data from clients that provide bases for diagnosis and treatment of patients (Burger, 2009). The subjective and the objective data that have been collected by kardex, patient’s chart, laboratory reports and the personal assessment of the patient, reveal that Ms. Kareem is a non smoker who had her first asthma exacerbation five years back; her last episode occurred when she was using a different toilet cleaner. This shows that certain allergens, such as second hand smoking, environmental pollutants, chemicals, certain foods, and drugs can trigger asthma; asthma can also be triggered by emotional distress (Papiris et al., 2009). Wheezes were heard upon auscultation of her lungs; she was experiencing breathlessness, tightness of the chest, and coughing. The temperature, blood pressure and pulse were in subclinical range. Her respirations were 28 and shallow which is beyond the normal range. The laboratory reports regarding urea in the blood and white blood cell (WBC) count were 7.3 mmol/L and 12.6×109/L respectively. The high WBC count can predict an infection while increased urea may reveal a compromised renal function which would result in edema of the extremities. Use of accessory muscles and atrial blood gases can also be used as an effective tool of assessment for asthma (Papiris et al., 2009).
Breathing is life and an open airway is a blessing. Ms. Kareem considered her asthma as the major cause of keeping her away from her loved ones. Tightness of her chest made her feel like a heavy stone placed on her chest. The extra effort needed for exhalation was taking away all of her energy. She felt that her asthma impedes her activities of daily living: she could not walk for long periods due to shortness of breath; speaking at length was also difficult. Patients are the masters of their own body (Parse, 2006); Ms. Kareem had asthma for last five years and she knew her body better than anyone else. Understanding her perspective helped me accept her leadership in decision making which ultimately enhanced patient’s compliance. This process involved giving the patient all available choices, addressing her with respect, honoring her wishes, and asking her to take leadership in her own care.
From biomedical point of view, it was decided to keep her airway open and SaO2 above 90 %. Excessive amount of oxygen could compromise her breathing by interfering with the hypoxic drive (Papiris et al., 2009). So, she was administered 2-4L of oxygen with nasal cannulae and bronchodilator through nebulizer with a face mask to keep her airway open. Positioning the client in semi-fowlers would ease and help her breathing. Pursed lips breathing helped the client to exhale most of the CO2 from her lungs which would ultimately prevent respiratory acidosis (Papiris et al., 2009). Adrenergic receptor agonists and other drugs were administered in timely fashion to achieve the desired effects of the therapy. A written action plan was developed for exacerbation, keeping in view her anxiety and perception for exacerbation, and it was also made sure that client understood those interventions (Kaufman, 2010). (See more nursing interventions in Appendix). In order to determine the effectiveness of the therapy, the client’s chest was auscultated for a patent airway and SaO2 was also monitored. No wheezing was heard, vital signs were stable. The client was satisfied with the care and she was so much better and so energetic that she had a self-bath that day.
Human Becoming Theory as a Complement to Biomedical Care
Biomedical science cures the person physically while human science helps the soul to heal (Mitchell, 1999). Ms. Kareem’s decision to not take the inhaler was to preserve the taste of her food. However, it would not make any difference if some adjustments were made to honor her wishes. Having care from both perspectives, the client had her treatment done and recovered from the acute episodes of asthma that she had been experiencing. She also appreciated that her self esteem, autonomy, and dignity was maintained which helped her get her strength back. Parse (1996) considers human beings as the co-writers of their health. Standard treatment regimes are unable to explore the mysteries of human beings. She further suggests that there is need for these clients to be made partners in treatment by understanding their perception because they are the masters of their own which would help them recover faster (Parse, 1996).
Challenges to Practicing Human Becoming Theory
There are numerous challenges in living human becoming theory while performing daily nursing activities, such as financial crises, the nursing shortage, and excessive biomedical needs of clients. Healthcare institutions are making efforts to reduce their expenses by decreasing the number of healthcare professionals, especially nurses. This downsizing effects patient to nurse ratio which ultimately increases the workload for nurses, and makes it impossible for nurses to be at the patients’ bedside (Duffield, Gardner, & Catling-Paull, 2008). Nonetheless, nurses do not find enough time to explore patients’ perceptions and ultimately choose biomedical model of care for their patients. I have observed this at my clinical placement. However, this issue can be addressed by hiring more nurses which would provide an appropriate nurse-client ratio. There is further need for time management, task prioritization, and making a standardized reporting system (Duffield et al., 2008).
The main focus of all studies is to improve the quality of life for human beings. Patients’ care does make a difference, if it includes respect, dignity, and honor for patients’ wishes and perceptions. Biomedical sciences have been developed for the beneficence of human beings. Human sciences and biomedical sciences are complement to each other (Mitchell, 1999). Human sciences enhance the quality of life when employed with biomedical sciences. Nurses can provide better care and improve the quality of life for their patients by knowing patients’ perspectives (Parse, 2006). There is need for nurses to have knowledge of therapeutic communication skills to develop that nurse-client relationship which would help explore patients’ perceptions. It should be kept in mind that some adjustments can be made to nursing practice which would enhance patients’ fulfillment according to their perceptions and meet the biomedical needs of patients. As a nursing student, I understand the importance of the Human Becoming theory in nursing practice and how it would help me provide quality care to my clients. There is further need to explore how this theory is applicable in clients with assisted suicide.
Bournes, D. A. (2006). Human-becoming-guided practice. Nursing Science Quarterly, 19(4), 329-330. Retrieved from http://BAERESRV01.georgianc.on.ca/download. php?f= Nurs SciQuart_19_4_HumanbecomingGuidedPractice.pdf
Burger, J. (2009). Communication. In P. Potter & A. Perry (Eds.), Canadian fundamentals of nursing (pp. 245-262). Toronto: Elsevier Canada.
Duffield, C., Gardner, G., & Catling-Paull, C. (2008). Nursing work and the use of nursing time. Journal of Clinical Nursing, 17, 3269-3274. doi: 10.1111/j.1365-2702.2008.02637.x
Kaufman, J. S. (2010). Nursing management: Obstructive pulmonary diseases. In S. Lewis, M. Heitkemper, S. Dirksen, P. O’Brien, & L. Bucher (Eds.), Medical-surgical nursing in canada (pp. 670-720).Toronto: Elsevier Canada.
McKeage, K., & Keam, J. S. (2009). Salmeterol/fluticasone propionate: A review of its use in asthma. Adis Drug Evaluation, 69(13), 1799-1828. Retrieved from http://web.ebscohost .com.rap.ocls.ca/ehost/pdfviewer/pdfviewer?hid=108&sid=916352f8-b20f-4715-a8a7-d73304e67b 20%40sessionmgr113&vid=4
Mitchell, G. J. (1992). Parse’s theory and the multidisciplinary team: Clarifying scientific values. Nursing Science Quarterly, 5(3), 104-106 retrieved from http://BAERESRV01. Georgia nc.on.ca/download.php?f=NursSciQuart_5_3_ParseTheoryMultidisciplinaryTeam.pdf
Mitchell, G. J., & Cody, W. K. (1999). Human becoming theory: A complement to medical science. Nursing Science Quarterly, 12(4), 304-310. Retrieved from http://BAERESRV0 1.georgian c.on.ca/download.php?f=NursSciQuart_12_4_HumanBecoming TheoryComp lement.pdf
Oberle, K., & Bouchal, S. (2009). Ethics in canadian nursing practice. Toronto: Pearson Canada Inc.
Papiris, A. S., Manali, D. E., Kolilekas, L., Triantafillidou, C., & Tsangaris, I. (2009). Acute severe asthma new approaches to assessment and treatment. Therapy in Practice, 69(17), 2363-2391. Retrieved from http://cinahl.com/cgi-bin/refsvc?jid=2084&accno=20105681 14
Parse, R. R. (2006). Rosemarie rizzo parse’s theory of human becoming school of thought. In M. E. Parker (Ed.), Nursing theories and nursing practice (pp. 187-216). Philadelphia, PA: F.A Davis Company.
Parse, R. R. (1996). Reality: A seamless symphonyof becoming. Nursing Science Quarterly, 9(4), 181-184. Retrieved from http://BAERESRV01.georgianc.on.ca/download. php?f= NursSciQuart94RealitySeamlessSymphony.pdf
Pilkington, B. F., & Simpson-Jonas, C. (2009). The humanbecoming school of thought: A guide for teaching-learning. Toronto: International Consortium of Parse Scholars.
These articles have been written by Nasir Ahmad BSc. (HONS) Nursing, a graduate from York University Toronto, Ontario, Canada. The writer of these articles authorize Peace In-Home Health Care Services Inc to use these articles on their website as an additional resource for their clients. However, any unauthorized copying or distribution of these articles will be dealt strictly by the laws of the state. Please contact author for any queries at 416-648-2717 or email: firstname.lastname@example.org