Running head: NURSING WITH FEMALE WITH UTERINE CANCER

Theory Application Majd Hussein The Hashemite University Nursing Theory Roger's Model in Nursing Practice

Running head: NURSING WITH FEMALE WITH UTERINE CANCER Introduction and background Nursing is science and art that controlled by code of ethics. Nurses as professional

workers, and health care providers, they provide the nursing care that involved all patient aspects to achieve well-being, promote or restore health and enhance the quality of life. Martha Roger, the founder of the unitary of human being conceptual model, she was a nurse. She had a continuous work to meet the patient's need through the application of her conceptual framework. Her conceptual framework focused on four concepts: energy field, open system, pattern and dimensionality. In the energy field concept, she considered human being and the environment as an energy fields. These two energy fields were viewed as an open system. So, the energy will be exchanged between human being and the environment. The pattern concept indicates that the fields have not distinguished characteristic, rather than the fields are changing continuously, and as application to nursing the change from healthy person to unhealthy one. Finally, pan dimensionality mean infinity and no limit. The goal of this paper is to apply Martha Roger conceptual model to one of model paradigm. I choose to apply this model in a clinical practice through the application of nursing care plan for a female patient with uterus cancer, by using all model concepts, especially in clinical setting as a continuum of care, professional practice, mutual exploration, understanding, plan, intervention and finally freedom of choice.

Running head: NURSING WITH FEMALE WITH UTERINE CANCER Case Study with Theory

Mrs. F is a 28 years old female, she is a mother for a child; she has a medical diagnosis of a stage two uterine cancer. Before surgery she received 2 doses of chemotherapy. Mrs. F described her diseases as the most obstacles in her life, she afraid from death and trying to rationalize this by her concern toward her child. The most common side effects of chemotherapy were hair loss, weight gain and fatigue. She concerned toward these changes especially fatigue, because it interferes her ability to meet her house requirements. Two weeks after completion of chemotherapy, she had total hysterectomy to remove the uterus. No complication, no bleeding and infection occurred after the surgery, and the ultrasound suggest the total absent of the tumor. In the third day after the surgery, she has an appointment with oncology nurse to start a comprehensive nursing care plan for the post surgical period. The nurse knocked the door then she entered the room, she noted that the patients closed the window and turned her face toward the wall. The nurse intended from this visit to educate the patient about what she should expect after the surgery and how to deal with new situation. She started the interview with an open question, she stated "how are you today", and her response was a one word, she says "good". The nurse took the permission to sit with her to speak

Running head: NURSING WITH FEMALE WITH UTERINE CANCER

about her condition, she accepted this, and told the nurse that she can sit in the chair. The women verbalized "I want to ask you something, why this happened to me, I lose my life, I can't get pregnant again, and I can't imagine the shape of my life. What they will talk about me?". During the interaction, she shared that she has growing increasingly depressed and anxious from what happened, and from the future, she distressed from her role as a wife and a mother after loss her uterus. The oncology nurse assessed the patient deeply from all aspects. She started with physical level; she was fully oriented and well groomed. During communication with the nurse she fidgeted with her hands, changed position frequently in the chair, bitted the lower lip intermittently. Her speech was low and not audible at some times. She was hesitated. With assessment of spiritual aspect, she verbalized that she has a strongly feeling of guilt. She viewed the cancer as a punishment from God, and this is not consistent with Islamic standard. The nurse assessed the psychological aspect, thinking was organized and logical. Memory and concentration were intact, and no patterns of disturbances and suicidal thoughts were noted. She indicated that she had disturbances in sleeping pattern since the diagnosis was confirmed, in which this is limiting her ability to perform the daily tasks. The nurse ended the interview with an explanation about the next plan for both, and the importance of collaboration between them to achieve the patient outcome. The aim of this visit

Running head: NURSING WITH FEMALE WITH UTERINE CANCER was to determine the base line data to monitor the changes. She applies a therapeutic touch the core of the unitary human being, by moving her hand over the patient hand in appropriate way, with consideration to the cultural norms.

Nursing Care of Mrs. F with Roger's Model Assessment Using Roger's model for human being unitary, patient and her environment considered as energy fields. Therefore, a complete assessment for both of them is recommended. By applying the open system concept, both energy fields are open system and integral with each other. So, energy exchange will occur, and there are a continuous interaction between patient and her environment. When we applied the appreciate pattern. From the beginning, Mrs. F seemed to be handling her problem and treatment in inappropriate way. She complaining from stress, anxious, fatigue and spiritual disturbances, she viewing the cancer as a punishment from God; she stressing about her role in her family, in addition she doesnt mention her husband and this is

Running head: NURSING WITH FEMALE WITH UTERINE CANCER may indicate a large problem. So, the nurse must assess the surrounding social support for the

patient, her husband and her family, and to assess her in a holistic way she needs to apply a home visit. In addition to the pattern concept, changes occurred in response to her disease; changes were in her appearance "hair loss and weight gain", her role in the family and in energy level, she undergoes loss in energy level. This is may be referred to her attempt to decrease oral intake and her weight. So, additional assessment must be done for nutritional status to make nutritional adjustment. On pan dimensionality concept, Rogers viewed the human as infinite domain and with no limit. So, the application of this concept is occurred when the nurse assesses the patient in a holistic way from physiological, psychological and spiritual perspective. Cancer signs and symptoms or even any physical complication can overcome by oncologist, but the nursing role summarized by education about medication, nutritional and consultant method to adapt loss effectively. The nurse recognized that the patient undergoes the normal grief process, and this is normal reaction to loss process but the nursing role will facilitate patient transmission through the loss process, in addition the nurse is a female and she understands the meaning of loss the uterus in an early age like this patient, but she will treat her in empathic way.

Running head: NURSING WITH FEMALE WITH UTERINE CANCER she used therapeutic touch which defined as a natural human process in a way that nurses (healer) move their hand rhythmically on the patients energy field to promote balance, which will result in calming, smoothing and caring (Kunz and Krienger, 2004). So the nurse applies all concepts of Rogers model through the assessment phase. Nursing Care Plan The medical care is provided by physician. So, the goals of nursing care for Mrs. F are to

recover from her present complication, facilitate the loss process by application of basic concept for clinical practice according to Martha Roger, and by applying professional practice, the nurse must apply additional assessment for what is meaning women without uterus in our society. What is the perception of this situation by her husband and his family, then the nurse will try to build care plan to regain confidence in her ability to be a mother for her child. The second concept is the continuum of care by starting the assessment to take a base line data, in addition to continuing the interview even after discharge, and the need for a home visit to assess her environment, and making arrangement with the husband and family members. The nurse must respect the patients right to determine her choices in a free way, and her privacy. Mutual exploration and understanding are important in applying the nursing care plan; each one must know her own role, what is the expectation for each one. In addition the nurse must restate some sentences in her language to ensure the proper understanding for the patient words.

Running head: NURSING WITH FEMALE WITH UTERINE CANCER Nursing diagnosis,

The best diagnosis for the patient and according to initial assessment will be situational low of self-esteem related to functional loss. Evaluation After the application of the complete intervention the follow up care should be arranged for the patient and her family, her child interaction with her, and her husband role, the nurse will assess the self esteem for the patients, energy and fatigue level. The nurse may be determine the time for next appointment, some referral probably needed and the nurse may give Mrs. F with a list of phone numbers and information about when and whom to call in emergency.

Running head: NURSING WITH FEMALE WITH UTERINE CANCER

Conclusion Rogers's model of human being unitary is a very useful way in assessing, implementing, and evaluating the nursing care. The theory is applicable in a wide variety of settings. It is applied in all setting, pediatric, obstetric, medical, surgical, intensive care unit, community setting, school, clinics, nursing home and all other nursing setting. Finally, Rogers model not only provide a framework of practice but also a framework for nursing research, because the nature of human being is complex and the variety of variables according to this model will be available . Using of Rogers model is enhance nursing care for the patients, and enhance the quality of life, and put a framework for care is provided.

Running head: NURSING WITH FEMALE WITH UTERINE CANCER

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References Marriner tomy alligood, nursing theory and their work, 6th edition. http://boatbling.co.uk/blog/rogerian-theory-4you.html Arlene T. Farren, RN, PhD, AOCN (2009). An oncology case study demonstrating the Use of Rogers's science of unitary human being.