Carmencita M.

Abaquin
Carmencita M. Abaquin

 With Master’s and Doctoral Degree in Nursing from the
University of the Philippines College of Nursing.
 An expert of Medical Surgical Nursing with subspecialty in
Oncologic Nursing, which made her known both here and
abroad. She had served the University of the Philippines
College of Nursing, her Alma Matter, as faculty and held the
position as Secretary of the College of Nursing. Her latest
appointment as a Chairman of the Board of Nursing speaks of
her competence and integrity in the field she has chosen.
Dissertation
 "PREPARE ME" Interventions and the Quality of Life of
Advance Progressive Cancer Patients
Conceptual Model

 Basic Assumptions and Concepts

 PREPARE ME (Holistic Nursing Interventions) are the nursing
interventions provided to address the multidimensional problems
of cancer patients that can be given in any setting where patients
choose to be confined. This program emphasizes a holistic
approach to nursing care. PREPARE ME has the following
components:

 Presence – being with another person during the times of need.

This includes therapeutic communication, active listening, and
touch.

 Reminisce Therapy – recall of past experiences, feelings and

thoughts to facilitate adaptation to present circumstances.

 Prayer
 Basic Assumptions and Concepts

 Relaxation-Breathing – techniques to encourage and elicit relaxation for the
purpose of decreasing undesirable signs and symptoms such as pain,
muscle tension, and anxiety.

 Meditation – encourages an elicit form of relaxation for the purpose of

altering patient’s level of awareness by focusing on an image or thought to
facilitate inner sight which helps establish connection and relationship
with God. It may be done through the use of music and other relaxation
techniques.

 Values Clarification – assisting another individual to clarify his own values

about health and illness in order to facilitate effective decision making
skills. Through this, the patient develops an open mind that will facilitate
acceptance of disease state or may help deepen or enhance values. The
process of values clarification helps one become internally consistent by
achieving closer between what we do and what we feel
 Basic Assumptions and Concepts

 Quality of Life is a multifaceted construct that
encompasses the individual's capacity and abilities
with an aim of enriching life when it cannot longer
be prolonged. This includes proper care of the body,
mind, and spirit to maintain integrity of the whole
person despite limitations brought by the present
situation. This can be seen with the following
dimensions brought by the present situation. This
can be seen with the following dimensions of man -
physical, psychological, social, religious, level of
independence, environment, and spiritual.
 Metaparadigms and
Interventions

 The theory of Carmencita Abaquin did not specifically mention her
definitions of the major paradigms: person, health, nursing, environment.
However, by understanding her theory we can deduce some implications
of her views.

 Person/Patient. Her theory is specific to patients in advanced stages of

cancer. They are holistic being with physical, psychological, social,
religious, level of independence, and environmental aspects. Patients who
are terminally-ill or those with incurable diseases as with cancer must be
approached in multifaceted care to improve their quality of life.

 Environment. Just like all the other paradigms, environment was not
defined accurately. Nevertheless we can assume that environment is an
aspect or dimension integrated to the cancer patient. Her quality of life can
also be assessed in this aspect thus it must be given consideration in the
provision of care.
 Metaparadigms and
Interventions

 Health. The concept of her theory revolves around illness,
particularly cancer and the provision of holistic care to improve
quality of life despite their terminal cases. Quality of life is defined
as a multifaceted construct that encompasses the individuals
capabilities and abilities of enriching life when it can no longer be
prolonged. This includes proper care and maintaining integrity of
the body, mind and spirit despite the limitations brought about by
the present condition. The quality of life is seen through the
patient's many dimensions.

 Nursing. The goal of nursing care is the improvement of quality of

life for advance stage cancer patients despite their current
situation. Her concept of providing holistic nursing care in
addressing the multidimensional problems that cancer patients
face is summarized in the acronym PREPARE ME.
 PREPARE ME Theory

 Provides a framework on non-pharmacologic, non-
surgical approach of care to advanced cases of cancer
patients. The focus is not on cure but on assisting the
patient to explore her humanity and internal serenity as
one is faced with the challenge of life and death. Nurses
must be seen not as mere caregivers but facilitators of
peaceful acceptance of condition. The following are some
techniques according to PREPARE ME theory that nurses
can use in their care.
 http://upoun2072013.blogspot.com/p/metaparadigms.h
tml
Rozzano Locsin
 Rozzano Locsin

1976 – BSN &1978 - MAN
◦ Silliman University of the Philippines
1988 - PhD
◦ University of the Philippines
1991 - PROFESSOR
◦ Christine E. Lynn College of Nursing, Florida Atlantic
University
Program of Research: “Life transitions n the
health- illness experience”
 Awards

2000 - Fullbright Scholar to Uganda

2004–2006 - Fullbright Alumni Initiative Award to Uganda

Fullbright Senior Specialist in Global andPublic Health and

International Development

Edith Moore Copeland Excellence in Creativity Award: Sigma Theta

International

Lifetime Achievement Awards from Schools of Nursing in the

Philippines
 Book Publications

Advancing Technology, Caring and Nursing
(2001)

Technological Caring in Nursing: A Model

for Practice (2005)

A Contemporary Process of Knowing: The

(Unbearable) Weight of Knowing in Nursing
(2009)
 ASSUMPTIONS


 Persons are whole or complete in the moment
(Boykin and Schoenhofer, 2001)
 Knowing persons is a process of nursing that
allows for continuous appreciation of persons
moment to moment (Locsin, 2005).
 Nursing is a discipline and a professional
practice (Boykin and Schoenhofer, 2001)
 Technology is used to know persons as whole
moment to moment (Locsin, 2004).
FOCUS & INTENTION OF NURSING

Focus of Nursing
◦ A human being whose hopes, dreams, and
aspirations are to live fully as a caring person
(Boykin & Schoenhofer, 2001)
Intention of Nursing
◦ To know human beings fully as a whole person
By affirming, appreciating, and celebrating
personhood
Through expert and competent use of nursing
technologies
 TECHNOLOGY OF
COMPETENCY

Conceptualized as:

◦ An expression of Caring
Co-existence of technology and caring in
nursing

◦ Providing a framework for practice

Purpose:


 Acknowledge wholeness of persons asa focus
of nursing

 Technological means are used to knowwholeness

more fully

 Technology used to know “who is person”

rather than “what is person”
THE WHAT IS / WHO IS PERSON

What is Person?

◦ Empirical facts about the compositions of the
person
◦ Persons as objects
Who is Person?
◦ Understanding the unpredictable,
irreducible person who is more and
different than the sum of his or her
empirical self
◦ Persons as unique individual
 PERSON ARE COMPLETE AND
WHOLE IN THE MOMENT

Persons are complete, unique and
unpredictable
◦ Expressions of completeness vary from moment to
moment
Nursing interventions are not focused on
“fixing” or making persons “whole again.”
Nurses come to know persons as whole.
Nursing responses are based on the
persons’ uniqueness.
 FOCUSING ON RECEIVED
TECHNOLOGICAL DATA ALONE TO
KNOW PERSON

 Provides the nurse with an
understanding of persons as
objects who need to be fixed or
made whole again
 PROCESS OF KNOWING PERSON AS A
WHOLE AND COMPLETE IN THE
MOMENT

Persons choose whether or not to allow nurses
to know them fully.

In holding the idealization of persons as

“complete in the moment,” nurses must
◦ Choose to enter the world of the other
◦ Establish rapport, trust, confidence,
commitment, and compassion
WHOLENESS PARADOX

Because persons are unique and
unpredictable
Persons can only be fully known
◦ In the moment
◦ If the nurse chooses to enter the world
of the other
◦ If the person allows the nurse to know
him/her
FROM THIS PERSPECTIVE

The condition in which the nurse and
other allow each other to come to know
one another is the nursing situation.
 NURSING SITUATION

Shared lived experience between the nurse
and nursed
Condition in which the nurse and the other
allow each other to know one another
Nurse’s responsibility to know the
person’s hopes, dreams, and
aspirations
 VULNERABILITY


The nurse and nursed become

vulnerable as they enter each
other’s world and move toward
continuous knowing of one
another
VULNERABILITY IN CARING
SITUATIONS
Allows participation
Embodiment of vulnerability enables
recognition of it in others
Allows engagement of “power with”
rather than “power over"
Nurses’ work is to ameliorate
vulnerability (Daniels, 1998)
 PROCESS OF NURSING

The process of nursing is a dynamic unfolding
of situations encompassing knowledgeable
practices (Locsin, 2005)
Knowing and appreciating uniqueness of persons
Designing participation in caring
Implementation and evaluation
Verifying knowledge of person through
continuous knowing (Swanson, 1991)
KNOWING IS THE PRIMARY
PROCESS OF NURSING

Knowing nursing
◦ “All at once” knowing of personal, ethical,
empirical, and aesthetic realms (Boykin &
Schoenhofer, 2001)
Continuous knowing of person
◦ Occurs moment to moment
◦ Deters objectification
◦ Overpowers the motivation to prescribe
and direct the person’s life
THE ENTIRETY OF NURSING

Is to direct, focus, sustain, and maintain
the person (Locsin, 2005)

Through calls and responses for

nursing
 CALLS FOR NURSING

Calls
◦ Nurses rely on the person for calls
◦ Knowing persons allows the nurse to use
technologies in articulating calls
◦ Illustrations of the person’s unique hopes,
dreams, and aspirations
◦ Individual expressions
Desire to go home
Wishing to die peacefully
 NURSING RESPONSES

Nurses respond to calls from persons.

Nurses respond with authentic

intentions to fully know persons
continually in the moment.
Sister Letty G. Kuan
★ Born on November 19, 1936 in Katipunan-Dipolog,
Zamboanga del Norte
★ Master degree in Nursing and Guidance and
Counseling.
★ She also holds a Doctoral degree in Education.
★ Has a vast contribution to the University of the
Philippines College of Nursing Faculty and
Academic achievements.
★ She is now a Professor Emeritus, a title awarded
only to a few who met the strict criteria.
★ She has two Masters Degrees, M.A in Nursing
and M.S in Education, Major in Guidance and
Counseling, culminating in Doctor of
Education (Guidance and Counseling).
★ Has a Clinical Fellowship and Specialization
in Neuropsychology in University of Paris,
France (Salpetriere hospital).
★ Neurogerontology in Watertown, New York
(Good Samaritan Hospital ) and Syracuse
University, New York.
★ She also had Bioethics formal training at Institute
of Religion, Ethics and Law at Baylor College of
Medicine in Houston, Texas.
★ She is a recipient of the Metrobank Foundation
“Outstanding Teacher’s Award” in 1995 and an
“Award of Continuing Integrity and Excellence in
Service” in 2004. (ACIES)
★ Her religious community is the Notre Dame de Vie
founded in France in 1932.
★ As a former member of the Board of Nursing her
latest legacy the Nursing Community is without a
doubt, indisputable.
★ She authored several books giving her insights in
the areas of Gerontology, Care of Older Persons and
Bioethics and Essence of Caring.

★ Concepts of illness and health care intervention in an urban
community.
by Kuan, Letty Gurdiel; [Quezon City]: 1975.

★ Understanding the Filipino elderly: a textbook for nurses and

related health professional
by Kuan, Letty G.; Dipolog City: Jesus G. Kuan Foundation,
1993.

★ Essence of Caring
by Letty G. Kuan,
National Teacher Training Center for the Health Professions,
University of the
Philippines Manila, Learning Resources Unit, 1993
AND OTHER BOOKS...


★ Pag-aaruga Sa Mga Taong May Edad Na.
by Kuan, Letty G.; Quezon City: UP-KAT, 1998

★ Bioethics in Nursing
by Kuan, Letty G.; Manila: Educational Pub.
House, 2006
 CONCEPTUAL MODEL (as studied and
researched)


Determinants of Fruitful Aging
• Prepared retirement
•Health Status
•Income
•Family Constellation
•Self- Preparation

Retirement Role Outcome Fruitful

Discontinuities (Aging Change of Life Retirement and
Process) Aging
 BACKGROUND

Retirement – is an inevitable change in one’s life.
It is evident in the increasing statistics of aging
population accompanied by related disabilities
and increased dependence.
- this developmental stage, even at later part of
life, must be considered desirable and satisfying
through the determination of factors that will
help the person enjoy his remaining years of life.
It is of primary importance to prepare
early in life by cultivating other role of
options at age 50-60 in order to havea
rewarding retirement period even
amidst the presence of role
discontinuities experienced by this age
group.
 BASIC ASSUMPTIONS AND CONCEPTS


★ Physiological Age- is the endurance of cells and
tissues to withstand the wear-and-tear
phenomenon of the human body.
-some individuals are gifted with the strong genetic
affinity to stay young for a long time period.
★ Role – Refers to the set of shared expectations focused
upon a particular position. These may include beliefs
about what goals or values the position incumbent is
to pursue and the norms that will govern his behavior.
ROLE (CONT.)

★ 
It is also the set shared expectations from the
retirees socialization experiences and the
values internalized while preparing for the
position as well as the adaptations to the
expectations socially defined for the position
itself.
★ For every social role there is complementary set of
roles in the social structure among which interaction
constantly occurs.
★ Change of Life - is the period between near
retirement and post-retirement years. In
medico-physiological terms, this equates with
the climacteric period of adjustment and re-
adjustment to another tempo of life.
★ Retiree – is an individual who has left the
position occupied for the past years of
productive life because he/she has reached the
prescribed retirement age or has completed the
required years of service.
★ Role Discontinuity - is the interruption in
the line of status enjoyed or performed.
The interruption may be brought about by
an accident, emergency, and change of
position or retirement.
★ Coping Approaches- Refer to the
interventions or measures applied to solve
a problematic situation or state in order to
restore or maintain equilibrium and
normal functioning.
 DETERMINANTS OF POSITIVE
PERCEPTIONS IN RETIREMENT AND
POSITIVE REACTIONS TOWARD ROLE

DISCONTINUITIES:
1. Health Status - refer to physiological and mental
state of the respondents, classified as either sickly
or healthy.
2. Income – (economic level) refers to the financial
affluence of the respondent which can be classified
as poor, moderate, or rich.
3. Work Status (according to Webster’s dictionary)-
status of an individual according to his/her work.
4. Family Constellation – Means the type of family
composition described either close knit or
extended family where three or more
generations of family members live under one
roof; or distanced family, whose members live in
separate dwelling units; or nuclear type of family
where only husband, wife and children live
together.
5. Self-Preparation (according to Webster’s
dictionary) - it is preparing of self to the
possible outcomes in life.
 FINDINGS AND RECOMMENDATIONS

1. Health status dictates the capacities and

the type of role one takes both for the
present and for the future.
- It fits for the everyone to maintain
and promote health at all ages because
only proper care of the mind and body is
needed to maintain health in old age.
2. Family constellation is a positive index
regarding retirement positively and also in
reacting to role discontinuities.
~ In the Philippines, the family undoubtedly
stands as the security or trusting bank where all
members, young and old can always run and get
help.
~When one retires, the shock of the role
discontinuities is softened because the family not
only cushions the impact, but also offers gainful
substitutes, as in providing monetary support,
absorbing emotional strains that often times with
discontinuities and other forms of surrogating.
3. Income has a high correlation with both the
perception of retirement and reactions towards
role discontinuities.
-Since income is one of the factors that secure the
outlook of individual, efforts must be exerted to
save and spend money wisely while still actively
earning in order to have some reserved when one
grows old.
-It also implies that retirement pensions should be
adjusted to meet the demands of the elderly.
-This should be done in order to have a more
relevant and realistic pension and benefits
adjustment.
4. Work status goes hand and hand with
economic security that generates decent
compensation.
~ For the retired, it implies that retirement
should not be conceptualized as a period of no
work because capabilities to function get
sharpened and refined as they practice it on a
regular basis.
~ Work enhances the aspects of self-esteem
and contributes to the feeling of wellness even
and old age.
5. Self-preparation which are said to be
both therapeutic and recreational in
essence pays its worth in old age.
~This does not only account
professionalism or expertise but also
benevolent work as in charitable actions
with the colleagues.
~ Self-preparation is investing not in
monetary benefits but in something that
gives them and dignity; enhance their
feelings of self-worth and happiness.
6. To cope with the changes brought by
retirement, one must cultivate interest in
recreational activities to channel feelings
of depression or isolation and facing
realities through confrontation with some
issues.
7. To perceiveretirement positively,
it requires early socialization of
the various roles we take in life.

 The best place to start is at home extending to
schools, neighbourhoods, The community and
society in general.
 In retirement, their fellow retirees are their own
best advocates. To facilitate this, barriers full
participation in the areas where important
decisions are rich should be eliminated in order to
give recognition and appreciation of the knowledge,
wisdom, experience and values which are the social
assets that make the retired age and the custodians’
folk wisdom.
 
8. Government agency to construct holistic pre-
retirement preparation program which will
take care of the retiree’s finances,
psychological,
emotional, and social needs.
9. Retirement should be recognized as the
fulfilment of every individual’ s birthright
and must be lived meaningfully
“I have grown and sown and now I
can reap the reward and blessing
of a life lived in joy and love, for I
too have made others grow. ”
~ Prof. Letty Gurdiel Kuan, RN, RGC, EdD~