Dorothy E. Johnson, Rosemarie Rizzo Parse, and Virginia Henderson's Nursing Theory Application

by - December 01, 2018


Case Number 1 Overview
Johnny Smith, age 6 weeks, was brought into the clinic for routine check-up. He presents with no weight gain since his check up at age 2 weeks. You as the nurse interview his mother regarding this assessment. His mother verbalized," I feed him, but it seems that he does not eat much. He sleeps 4-5 hours between feedings." You also observed that his mother held him in her arms without making trunk-to-trunk contact. As the assessment is made, you noted that Mrs. Smith never looks at Johnny and never speaks to him as any other mothers do. She even shared to you, "We planned for this baby, but I never realized how much work an infant could be. He keeps me up almost 24/7. It's so tiring and frustrating not knowing what he wants when starts to cry. My mother has told me that I'm not a good mother because Johnny is not gaining weight as he should. I never got the chance to call a nurse and raise my concern because I was afraid that the nurse will also think of me as a "bad mother”.

The Theorist and the Theory applied

Johnny Smith is a 6 weeks old child who is not showing any progress to his health prior to his last check-up. The nurse was able to assess that his mother is not showing any sign of affection toward him and the mother also confessed that she had a hard time in taking care of his child because she didn’t know that being a mother is really hard and challenging. This case is a best example of Dorothy E. Johnson’s Behavioral System Model because it showed changes in behavioral pattern that causes a negative effect to her child. The mother is experiencing a stressor that makes her difficult to adjust to the new environment that she is entering, which is the motherhood. She wasn’t able to adapt well that causes tension in which her equilibrium state is being disturbs.

Evidence of Behavioral System Imbalance or Threat of Loss of Order

            Through interviewing the mother, it was made possible to grasp all of the information needed to determine why Johnny’s health didn’t show any improvement. It shows that there is really a behavioral system imbalance or threat of loss of order happening in Johnny Smith’s mother. In a such a way that the mother never make a trunk – to – trunk contact with Johnny which is very important for the baby because through this, the baby will able to feel the love and security that every baby needs.  The mother never look and speak to the baby which is one of the needs that baby should attain because through this, the baby can slowly develop his understanding and he can feel that he is really important. For her, her duty as a mom is tiring and frustrating because she don’t know what the baby wants when he starts to cry. These emotions are acceptable because every mother feel it too but Johnny’s mother is different because she wasn’t able to cope – up and adjust to be a mother instead she let every emotions eat her in a way that she didn’t try to exert effort in taking care of her child.

Insights in the theory that can be related to the patient’s condition

The attachment – affiliative subsystem of the patient is not maintained because of the stressor that she had that results to a tension which makes her state of equilibrium be disturbed. She wasn’t able to attain her responsibility to provide the survival and security of her baby because she won’t show any signs of intimacy towards to her baby that results to a weak social bond between them. So as a nurse, to regain the loss stability of Johnny’s mother, he or she must use the functional requirement and sustenal imperatives – nurturance so that he or she can help the mother by encouraging her to change and develop her ways to interact with the baby for the improvement of the wellness of her baby. Actively doing the new ways in interacting with the baby will result to a dynamic behavioral system wherein their relationship will be preserve and integrated to each other. Having a positive feedback in the new behavior of the mother means she was able to learned, experienced, and matured. She can now also tolerate the stressors that will make her equilibrium to be back in shaped and functional.

Case Number 2 Overview
Patient AB, 32-year-old female, was admitted to the ER after having a severe burn injury on both hands due to a factory accident related to operating a high-pressure steam engine. The burn covered the entire surface of her both hands. Upon admission, she was subject to cleaning and treatment of the affected parts. Skin grafting was to be considered after further treatments. During admission, the patient said that she was anxious on the operation that will done to her. Aside from being uncomfortable upon seeing needles and other medical equipment, she also gets anxious on the mere thought of undergoing an operation. The nurse remains by her side listening; thus, patient AB further expressed her desire to avoid medical treatment; however, she remembered that she has a family with whom she would still like to live with. This made her change her decision and go for the surgical procedure.

The Theorist and the Theory applied

Patient AB experienced a factory accident so he or she was admitted to hospital because the severe burn on both of his or her hands. The patient is anxious on the operation that will perform to her because he or she is not comfortable in medical equipment that will be use to her and he or she is nervous just by hearing the word operation. So the nurse that was assigned to him or her, remained to his or her side and listened to all of his or her uncertainties. In this case, the Human Becoming Theory of Rosemarie Rizzo Parse was used. This theory is all about the capacity of the nurse to know the perspective of the patient that makes the nurse to be with the patient in attaining his or her stability.

Experience of the nurse guided by the theory

According to Parse, nursing is a science and art where the science is the abstract knowledge and art is the nursing practice. In this situation, the nurse showed the science in a way that he or she know what to do for those patients who are having uncertain thoughts and he or she also showed the arts through applying the perceived knowledge learned throughout his or her entire studying and experiences. The action that the nurse applied is the Human Becoming Theory in which he or she listened the perspective of Patient AB regarding to the operation.  Through the listening skills of the nurse, the patient can actually feel his or her true presence that makes the patient to trust the nurse which is very helpful to promote Patient AB’s health and life.


Ways how the nurse make the client feel her true presence

This situation, where the client don’t know what to do anymore because of his or her doubts on what will happen in the operation, is very crucial to the nurse so they always make sure that they are available anytime to address their patient’s uncertainty. The nurse make the client feel her true presence by staying at her side when the client thoughts and emotions are overflowing because of his or her negative ideas about the upcoming operation. The nurse connects with the client by listening and respecting to all of his or her views regarding how uncomfortable him or her in hospital procedures and equipment. When the nurse is practicing this kind of relationship to the client or by doing any means in making the client feel their true presence, the patient can get new understanding in illuminating meaning, shifting rhythms, and inspiring transcending.

Case Number 3 Overview
You are a company nurse. The company where you work with administer routine check-ups to its employees on an annual basis. One of the company's employee is Mr. Santiago. Mr. Santiago is 26 years old, married, and the father of two preschool-age (3-5 years old) children. His wife is 6 months pregnant for their 3rd child. Mr. Santiago is a high school graduate. He works 8 hours a day as a skilled laborer in a factory owned by the company and holds a second job washing dishes at a restaurant for an additional 8 hours to meet family expenses. Your assessment includes: Respiration rate of 18, regular, no shortness of breath observed; temperature 37 °C; height is 5 ft, 10 inches, weight 164 lbs, skin is good and hydrated; he wears clothes to match weather conditions.

During the interview Mr. Santiago states “I smoke 2 packs of cigarettes per day. I usually experience dry cough in the morning, but it does not persist for the rest of the day. My usual meal will include rice meal, fruit, potato chips for lunch. I skip breakfast since I'm usually in the hurry to go to work. I also buy and drink soft drinks most of the time. For supper, I take from the restaurant where I work as a dishwater. I have no problems related to elimination. I also have no problems with mobility, but I have pain in both legs after 8 hours of washing dishes. For sleep, I usually sleep for 5 to 6 hours per night, but I still feel tired most of the time. I observe proper hygiene daily. My family and I attend a Baptist church every other Sunday. "I'm really happy with both of my jobs but it seems that it's eating all my time. That I haven't got any time left for my family. I wish I could have a time to spend with them as well as time to pursue a college education."

Basic needs that needs to addressed using Henderson’s Theory

Henderson formulated the 14 basic human needs that is based in nursing care. In this theory, some of the basic needs where actually met by an employee of a certain company named Mr. Santiago. He can eliminate all of his body waste properly to avoid internal damage. He manage to wear a suitable clothes that will match the weather conditions. He maintain the normal body temperature that is needed for the normal body functioning. He keep his body clean and well-groomed by observing proper hygiene daily that results of him having a good skin. He fearlessly communicate his emotions, opinions, fears, and needs that results of him having a light feeling because he manage to pour out his problems to the nurse. He keeps his faithfulness intact with God that makes him to have a positive outlook in life. He works so he can feel the sense of accomplishment that he can actually sustain the needs of his family.

It can be seen here, that only seven human needs where attained by Mr. Santiago and that means that there are still seven remaining that needed to be addressed. First, is having normal breathing. He having a normal respiration rate during this assessment can actually change over time because of fact that he smoke two packs of cigarettes per day. Small changes is slowly appearing to his stability and that is his dry cough every morning. Though it is a minor change, it can still gradually increase so it is important to advise him to lessen or better yet to stop smoking so that his condition will not be complicated. Second, eating and drinking adequately. He can’t eat and drink properly because of the needed attention to his work. He cannot eat his breakfast anymore because he is always in hurry for work which is not good for his health. The nurse should encourage the patient to manage his time correctly in order for him to eat his breakfast everyday especially that breakfast is known as important meal because it can replenish his glucose level and it can provide him some nutrients that will sustain his energy level throughout the day. He also mentioned that he always drink soft drink most of the time and this is a bad habit. The nurse should educate him that excessively intake of this can make him a diabetic person and it is more advisable to drink water in order maintain the balance of his body fluids that will help to function the system of his body. Third and fourth, moving and maintaining desirable postures and sleeping and resting, respectively. He may not be experiencing some mobility problems but the fact that he feels pain in both of his legs after eight hours of washing dishes can actually be the cause of him being immovable. He cannot achieve the eight hours of sleeping because of the two jobs that he is doing. Because of his wanting to sustain the needs of his family, he wasn’t able to think for himself. He only work and works to the point that he forgot to rest even for a while. The nurse should counsel him that sleeping is important and ask him to add to his goal list the eight hours of sleeping because a complete sleep will make him healthier and livelier. The nurse should also recommend him that if he feels pain in his leg or in any other parts of his body, he should stop and take some rest because resting doesn’t mean slacking off, it means you are only recharging for the upcoming tasks that needed to be accomplished. Fifth, avoid dangers in the environment and avoid injuring others. Sad to say, Mr. Santiago is inflicting danger to the environment and injury to others because he is a smoker. Smoking is dangerous to the environment because of the toxic chemicals it produces that can actually worsen the pollution that is now happening around the world. It is also dangerous not only to his health but also to the health of others because whoever inhaled this, can increased the risk of lung cancer. The nurse should inform him about the detrimental effects that it can bring to the environment and health so that he can control his self in using this product. Sixth, play or participate in various forms of recreation. Mr. Santiago doesn’t have any time left for his family because his jobs took mostly of his time. The nurse should give an ideas to Mr. Santiago how can he can still have time for his family despite of having a hectic schedule. Like, a simple and complete family dinner, helping his children to their homeworks, watching their favorite television series together, and others. Spending time with the family doesn’t actually mean spending the whole day outside with them because what is more important here is the interaction that is continuously happening between them that symbolizes that their family relationship is strong and healthy. Lastly, learn, discover, or satisfy the curiosity that leads to normal development and health, and use the available health facilities. Mr. Santiago is only a high graduate so it is assumed that some things are not yet familiar to him. The nurse, should educate him more, about proper attaining of basic needs of a human and the health care facilities that are available to address his needs, in order for him to learn and discover more and to satisfy the questions that are clouding in his mind for the normal development of a healthy lifestyle.

Relate and apply the theory and key concepts

Virginia Henderson’s Need Theory is about the importance in increasing the patient’s independence in maintaining their stability as rapidly as possible and also to be able to attain the fourteen basic needs of human in order to progress even after being hospitalized. In the situation given, it was seen that Mr. Santiago need a help of a nurse because he cannot achieve some of the basic human needs like physiological, psychological, and sociological functioning. He need the nurse to guide, support, and educate him to all of the things that he need to do and know so that he can be independent enough to assist his own self for his health development.

There are three levels of nurse – patient relationship in which the nurse acts as substitute, helper, and partner to the patient. In this case, the nurse is a substitute to Mr. Santiago in a way that he or she assessed him by getting all of his vital signs and checking, in behalf of Mr. Santiago, if he was able to meet the standard basic human needs. The ability to define the needs of the client is the function of nursing. The nurse is a helper to him in such a way that he or she manage to get all of the relevant information about him and using this information so that the nurse can now formulate ways in addressing the human needs that he or she thinks lacks to him. The nurse is also a partner to Mr. Santiago because he or she helps him in achieving the living independently by assisting and supporting in the process of meeting all of the basic human needs that a person should have in order gain his stability which is known as the nursing care that the nurse need to apply to their patients.


References:

Alligood, M. (2018). Nursing Theorists and Their Work. Ermita, Manila: Elsevier Inc.

Mercado, M. et al., (n.d.). Virginia Avenel Henderson: Key Concepts. Retrieved from             http://vhenderson2011.blogspot.com/p/key-concepts.html


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