Please read on to some of the case samples and its application of the Human Becoming Theory. May these create a better understanding and idea of the theorist concept and will serve as a guide in our career and practice.
Case Study 1
In the following practice situation, the nursing approach is structured according to the practice dimensions and processes of Parse's theory. Comparisons between Parse's practice methodology and the traditional problem-focused approach highlight the differences in the nursing practice.
Mr R, a 58-year-old married man, was admitted to the OR for aortocoronary bypass and possible left ventricular aneurysm repair. While the patient was being admitted, a cardiovascular nurse checked the patient's record for information such as known allergies and completed preoperative procedures. These activities fulfilled the responsibilities related to institutional policy. When the nurse went to talk to Mr R, she used Parse's practice dimensions and processes as a guide. As she approached Mr R, he looked at her and said, "I want all of this to be over with." The nurse asked Mr R to tell her what he meant.
Mr R said he had been through enough, and that he did not want to live without taking part in family life. Mr R said he was terrified about going on the heart bypass pump, but that he had madeup his mind that it was worth the risk to be able to live with his family and be active and free from pain.
The nurse asked Mr R to tell her more about his fear of the pump. Mr R said he was afraid something might happen to his blood or the machine. He started to talk about mechanical failures then stopped and said, "I know this is silly, it doesn't make any sense that I'm talking this way. I've decided to trust that things will work out; I must trust to go on. I guess I just needed to talk about it.
"I know I may not come out of this, I know there's a chance that I might not make it." He sadly said he had prepared for the worst with his family, and that he was not afraid because he had made peace with his Maker.
The nurse asked Mr R if he could see himself after the surgery and what he hoped would happen. Mr R said he knew he was going to wake up,and that he hoped he had the strength to deal with the pain and the tubes. When asked what might give him strength, he hesitated for a moment and said he could see his family waiting for him and that it helped to keep them in his mind.
Analyzing the Approach The nurse had just 20 minutes to be with Mr R. Practice guided by Parse's theory does not require assessment tools, use of diagnoses, or interventions aimed at eliminating problems. Rather, it requires the nurse to be truly present as the patient explores personal thoughts and feelings.
When Mr R said he wanted this whole thing to be over, the nurse asked him to tell her more about that. From the traditional problem-focused approach, Mr R's statement might have been labeled as anxiety or fear. Or a traditional nurse may have offered a statement such as, "I am sure you will be relieved."
From Parse's perspective, there is no labeling, diagnosing, or reassuring.Offering reassurance does not encourage a person to talk about thoughts and feelings. Being told not to feel a certain way or that everything will work out denies that each person's situation is unique.
Being able, however, to speak about the meanings and feelings of situations in the presence of another creates change, and in that way patients can move beyond the present moment. The nurse using Parse's theory provides the human presence that enhances that process.
Case Study 2
Patient CH, 32-year-old female, was admitted to the emergency room after having a third degree burn injury on both hands due to a factory accident related to operating a high pressure steam engine. The third degree burn injury covered entire distal thumb, index, middle, ringer, and little finger regions as well as the distal palmar regions of both hands. Upon admission, Mrs. CH was subject to initial escharotomy followed by debridement. Skin grafting was to be considered after further interventions. During admission, patient said that she was anxious on the surgical procedure. Aside from being uncomfortable upon seeing needles and other invasive medical equipments, she also gets anxious on the mere thought of undergoing a surgical procedure. The nurse still remains by her side listening, thus Mrs. CH 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 Mrs. CH change her decision and go for the surgical procedure.
A. Key Concepts and its assumptions:
The goal of nursing in caring for Mrs. CH is to assure that she regains her quality of life based on her own perspective. In order to attain this, the nurse must “be with” the patient, unfold the patient’s perspective, and assist her in attaining desired health outcomes.
Totality Paradigm
Black – the opposite paradox that Mrs. CH faced involves the dilemma of deciding whether she should undergo escharotomy and debridement or not. She was able to establish a lived rhythm by choosing to continue and take the surgery despite her anxiousness.
Green –Mrs. CH has gained hope and strength on overcoming her anxiousness during the surgery by keeping her family in mind.
Center – the joining of the intertwining swirls at the center represents the ongoing process of Mrs. CH’s human becoming through the nurse-patient interaction.
Man
Mrs. CH freely decides to go undergo escharotomy and debridement. She is aware of the possibilities of experiencing anxiousness during the procedure; however, she still chooses to bear the anxiousness in order to recover and see her family.
Becoming
Mrs. CH is aware that her priority is her family. Because of this, Mrs. CH transcends from her anxiousness and decides to undergo escharotomy and debridement. After recovery, Mrs. CH will be able to fulfill her priorities again.
Mrs. CH was able to demonstrate the major assumption of transcendence. Mrs. CH was able to go past beyond her fears and accept the process of transforming so as to reach the aspects that she cherishes – her family and work.
B. Major Components:
Man
Despite having a third degree burn on both hands, Mrs. CH must still be viewed as a being more than her parts. Aside from merely focusing on her burn injury, it is also important to look into her overall perspective.
Environment
Mrs. CH’s experiences in the environment become an integrated part of herself. The injury, family, and work are part of her lived experiences which she must synchronize with.
Health
Mrs. CH undergoes the open process of becoming by processing her values for synchronized rhythms. Through this, she is able to make a health decision and overcome her dilemmas.
Nursing
Nursing care involves utilizing the nursing body of knowledge to help Mrs. CH attain desired health outcomes through her own perspective. In order for this to take place, it is important for a nurse to “be with” Mrs. CH to establish a nurse-patient relationship. This relationship facilitates Mrs. CH towards her human becoming.
C. Nursing application
Every individual is an active participant in his or her own health. Mrs. CH chose to undergo surgery. This makes her an active participant in the surgical process. Under Parse’s theory, nurses would not just merely focus on “fixing” her injury through complying with the hospital procedures because providing nursing care is more than that -- it also involves focusing on utilizing a nurse’s presence with the patient. Thus, the nurse will apply the processes of illuminating meaning through explicating, synchronizing rhythms through dwelling with, and mobilizing transcendence through moving beyond. The application of Parse’s process is as follows:
Step 1: Illuminating meaning through explicating. The nurse first strives to gain a clearer understanding of Mrs. CH thoughts and feelings. This is achieved by truly “being with” Mrs. CH as she eventually reveals more of her thoughts and feelings.
Step 2: Synchronizing rhythms through dwelling with. Once Mrs. CH reveals her thoughts and feelings, the nurse must decide to follow it and avoid any attempts to counter it. This enables Mrs. CH to express more of her thoughts resulting to further self-discovery. This results in making her more synchronized thus developing better health patterns.
Step 3: Mobilizing transcendence through moving beyond. As Mrs. CH expresses her outlook, the nurse realizes that she is anxious with invasive medical equipments and surgery itself. The nurse must guide Mrs. CH towards overcoming this anxiety. This will make Mrs. CH “move beyond” her anxiousness and go towards the direction of returning to what she cherishes – her family.
The participative approach of the nurse guidedMrs. CH towards obtaining health-changing patterns thus improving her quality of life.
A. Key Concepts and its assumptions:
The goal of nursing in caring for Mrs. CH is to assure that she regains her quality of life based on her own perspective. In order to attain this, the nurse must “be with” the patient, unfold the patient’s perspective, and assist her in attaining desired health outcomes.
Totality Paradigm
Black – the opposite paradox that Mrs. CH faced involves the dilemma of deciding whether she should undergo escharotomy and debridement or not. She was able to establish a lived rhythm by choosing to continue and take the surgery despite her anxiousness.
Green –Mrs. CH has gained hope and strength on overcoming her anxiousness during the surgery by keeping her family in mind.
Center – the joining of the intertwining swirls at the center represents the ongoing process of Mrs. CH’s human becoming through the nurse-patient interaction.
Man
Mrs. CH freely decides to go undergo escharotomy and debridement. She is aware of the possibilities of experiencing anxiousness during the procedure; however, she still chooses to bear the anxiousness in order to recover and see her family.
Becoming
Mrs. CH is aware that her priority is her family. Because of this, Mrs. CH transcends from her anxiousness and decides to undergo escharotomy and debridement. After recovery, Mrs. CH will be able to fulfill her priorities again.
Mrs. CH was able to demonstrate the major assumption of transcendence. Mrs. CH was able to go past beyond her fears and accept the process of transforming so as to reach the aspects that she cherishes – her family and work.
B. Major Components:
Man
Despite having a third degree burn on both hands, Mrs. CH must still be viewed as a being more than her parts. Aside from merely focusing on her burn injury, it is also important to look into her overall perspective.
Environment
Mrs. CH’s experiences in the environment become an integrated part of herself. The injury, family, and work are part of her lived experiences which she must synchronize with.
Health
Mrs. CH undergoes the open process of becoming by processing her values for synchronized rhythms. Through this, she is able to make a health decision and overcome her dilemmas.
Nursing
Nursing care involves utilizing the nursing body of knowledge to help Mrs. CH attain desired health outcomes through her own perspective. In order for this to take place, it is important for a nurse to “be with” Mrs. CH to establish a nurse-patient relationship. This relationship facilitates Mrs. CH towards her human becoming.
C. Nursing application
Every individual is an active participant in his or her own health. Mrs. CH chose to undergo surgery. This makes her an active participant in the surgical process. Under Parse’s theory, nurses would not just merely focus on “fixing” her injury through complying with the hospital procedures because providing nursing care is more than that -- it also involves focusing on utilizing a nurse’s presence with the patient. Thus, the nurse will apply the processes of illuminating meaning through explicating, synchronizing rhythms through dwelling with, and mobilizing transcendence through moving beyond. The application of Parse’s process is as follows:
Step 1: Illuminating meaning through explicating. The nurse first strives to gain a clearer understanding of Mrs. CH thoughts and feelings. This is achieved by truly “being with” Mrs. CH as she eventually reveals more of her thoughts and feelings.
Step 2: Synchronizing rhythms through dwelling with. Once Mrs. CH reveals her thoughts and feelings, the nurse must decide to follow it and avoid any attempts to counter it. This enables Mrs. CH to express more of her thoughts resulting to further self-discovery. This results in making her more synchronized thus developing better health patterns.
Step 3: Mobilizing transcendence through moving beyond. As Mrs. CH expresses her outlook, the nurse realizes that she is anxious with invasive medical equipments and surgery itself. The nurse must guide Mrs. CH towards overcoming this anxiety. This will make Mrs. CH “move beyond” her anxiousness and go towards the direction of returning to what she cherishes – her family.
The participative approach of the nurse guidedMrs. CH towards obtaining health-changing patterns thus improving her quality of life.
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A PARSE GROUP of nursing students created this video for nurse applications on 2009. Please try to look and listen to the conversations going on. Please make your own comparison of Nurse 1 and Nurse 2 on both Scene 1 and 2. Whose applying the theory and whose not? -H Team-
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