PREPARE ME THEORY: A DIFFERENT PERCEPTION ON NURSING CARE Jaemie Marie M. Carait Carmencita Abaquin’s Prepare Me theory implies a type of Nursing Care that deals on how to improve the quality of life a patient with Cancer and other Chronic diseases already has. A person diagnosed with cancer or other chronic diseases has the same reactions: fear, anxiety, curiousness, sadness and sometimes they feel lost. That’s the same reaction I observed with my aunt who was diagnosed with Stage III Lung Cancer in October 2014. She’s a very active and jolly person. She’s optimistic and an approachable woman in her early 40’s. She loves water sports like scuba diving and wake boarding. She still has her youthful glow and energy, as she always believes that life starts at 40. But one thing struck her last year and that is when she was diagnosed of Lung Cancer Stage III. From this and my past experiences, the first question of patients in this situation are: “Why me?” followed by “What did I do to have this?” and “What will I do after this?” With these questions in mind, I learned that we must anticipate where to prioritize in giving our holistic care. Firstly, they must feel our PRESENCE. This means that they must feel we are there to support them, help them in anyway we can and not just merely standing in front of them. Not only physically present but we should be emotionally present as well. Secondly, as medically inclined professionals, we must give them an insight about their situation, not to put their hopes up but to make them see the real situation. We must help them accept their situation as soon as possible to create action plans that will help them alleviate any symptoms that may arise in the future. Third, We must give ideas on treatments that can be beneficial to them and why other treatments are not applicable on their situation. They must understand that cancer or every disease is unique in every patient and the treatment is i s personalized according to the patient’s current condition. One thing I also realized during this situation, you must not think of the patient alone, but to include their family as well. Their feelings, how they will cope, and how will they be able to help. Their presence also makes a good motivation for the patient. Being with them, having conversations of the past and future plans. The family is also the best people to be with to incline the patient on their faith, as they share the same beliefs, values and traditions. Its one way of making the patient feel satisfied. As the disease is progressing my aunt is deteriorating at the same time, we did everything we can to make her feel that she had a good life. We prepared her kids to accept the situation and her kids were able to take care of her during her last days, which made her feel great. She felt almost complete and for her that’s more than enough. She died in January 2015 able to bid her last words to us. And the most memorable is she doesn’t have any worries at all.
With terminally ill patients, we must give the best we can to prepare them for the external life as they call it. The Prepare Me theory will be applied to prepare them physically, mentally and most importantly spiritually and emotionally as this will give them a sense of achievement that they were able to fulfill their life mission and that is to have an improved quality life despite their health condition. The Prepare Me theory uses identified intervention in assisting patients but most importantly it uses our hearts and mind in taking care of the people which makes a lot of difference. Like what Maya Angelou said, “People will forget what you did, but people will never forget how you made them feel”.
PREPARE ME: A PERSONAL ENCOUNTER Claire P. Calabias This theory emphasizes the holistic nursing approach to care of patients having terminal illnesses specifically those having cancer. Cancer is one of the leading causes of death in the world to the fact that up to this point there is no definite assurance of cure, though the advancement of medicine offers a broader chance of discovering a cure for each terminal diseases including cancer. The mere fact of the complexity of this disease makes someone think of death just by thinking of it. How much more on the person encountering this and who is really experiencing the tortures, the pain, knowing that maybe his days are numbered. I for one doesn't have a direct contact in a clinical based practice to these patients who have been diagnosed with cancer. But I know someone, and she has been working with me everyday. She is a nurse and yes she has been employed in our hospital for at least 27 years. Last year, 2014 she was diagnosed of renal carcinoma stage 2. She has a strong personality, I can really testify on that. Aside from the fact that she is away from her family, she is also a single parent.She is a jovial, loving, friendly person. Furthermore, she loves her work that even though she is tired and not feeling well with a temperature of 39 degrees she still wants to work. But behind those smiles and laughter I can feel loneliness and sometimes she confides to me her fears. I am a nurse and I am also a human being. In here being able to be there for the person, my mere presence and understanding her situation and having a comforting relationship promotes her well being. Our vivid presence is important to health care as pointed out by Zaner in his treatment of presence (Zaner,1981). During our duty hours, as her colleagues try to help her especially when we are not busy we let her rest. In addition to, we are part of a religious group and every time we have a chance to attend the religious gatherings, we always pray for her.This somehow gives her the courage and peace of mind that amidst her sufferings, she is closer to God. I also encourage her to perform meditation and some relaxation activities that is beneficial for her health. She has undergone chemotherapy but the doctors advised her lately to do undergo dialysis and she will continue the treatment in the Philippines when she go home by this first week of October. Nursing is not just a profession but is also a passion where nurses are flexible in all aspects of caring and utilizes all the resources available. We give our whole services to our patients we encounter. And we do not only focus on the medications that are ordered by the physicians to be given to the patients. In cancer cases, we can surely make a difference in the improvement of their quality of life by using alternative ways and a perfect example is this PREPARE ME approachpresence,reminiscence,prayer,relaxation activities,meditation,values clarification.
PREPARE ME: GIVE LOVE Luzviminda Bautista For almost 8 years of my career I can count on my hand how many times I was able to talk to a cancer patient because most of the time they are already weak and intubated when admitted in ICU. Just recently we admitted a 78 years old woman diagnosed with breast cancer metastasized to bone and lungs so on that we concluded that the prognosis is very poor and needs only supportive management. Upon admission patient is very agitated, shouting and looking for her relative that caught all of our attention then we give sedation right away as patient is very uncooperative and wants to remove her invasive lines as she doesn't like to be admitted in our unit. A day after her admission I become her primary nurse, I've noticed that she’s already bald cause of her previous chemotherapy treatment and have a very dry skin that makes her very uncomfortable. Every time I tried to hold her to check or do some procedure on her she will shout and tell me that she doesn't like and seems that you’re hurting her and most of the time she will send you out from her room and don’t like to communicate and ask for any help. As her primary nurse I didn't give up I've tried to communicate with her even she didn't
answer, give her food, massage her back and legs and hold her hands every time I want to do something on her just to ask permission if she would allowed and our day ends quietly and without misunderstanding. A day after that I handled new patient, I heard her shouting from our room and decided to visit her, when I got there she was staring at me I asked her how was she and if she needs anything as expected she didn't answer but when I tried to hold her she hold my hand back and my colleagues are very much surprised because they said this patient didn't allowed them to touch her and she was very much agitated on that time. Deep inside I am very glad because I know in my 12 hours shift with her without any verbal communication and just a therapeutic touch I was able to give my total nursing care with her and shares my love. On that I concluded that non-verbal communication is very much effective for this kind of patient, they don’t need you to talk but to feel your presence and sincerity on them is the key of effective nurse and patient relationship. Furthermore, we have patient with same diagnosis and illness but each have different personality, beliefs and needs so we should addressed each of them on that basis. Prepare me theory by Carmencita Abaquin will give us guidance on how to approached patient who are terminally ill not only extending their life but giving them a good QUALITY of LIFE.
A PERSONAL NOTE Lampel R. Capistrano The word "CANCER" would be the most dreaded thing you would hear your doctor tells you that you have. Finding out that you have cancer is like finding out that your days are numbered. People with this type of illness tends to be either angry or depress in this situation is where the PREPARE ME theory comes in. This theory is about the holistic approach in caring for a person who has a terminal disease. Let me share my experience where I think that I utilized this theory without even realizing it until now. It was 2009 when my friend's mom was first diagnosed with breast cancer stage II. She underwent radical mastectomy her biopsy result said it was be nign. Her thought was how could it be cancer if it was benign. Her doctors wanted to make sure so she still went on 6 session chemotherapy. After chemo her doctors said that she was cleared of cancer. Litt le did we know, a year after she discovered a lump at her left axilla. CT-scan of the lungs and upper abdomen was done that's when we found out that cancer cells metastasized to the lungs. The metastasis did not end at the lungs, after a month she had seizure episodes the cranial ct-scan revealed not only 1 but 4 tumors in her brain. That was the time her jolliness wore off. She was afraid of what will happen to her. She went angry and depress. As a nurse and a friend her daughter (who is also a nurse) came to me for help. The diagnosis of stage 4 cancer did not only affect the patient herself but also her family. I went to their home on a regular basis to give support, answer their queries as best as I can, and I accompanied them during follow-up check ups and radiotherapies. While I was consoling the patient's feelings at the same I was preparing the family on what to expect for the days to come. Instructing the family on what to do incase something happens while making the patient feel happy and secure was my role in the family for the next 6 months. Even after the series of radiotherapy after 6 months she went in a coma and eventually joined our creator in heaven. With this experience I have fully understood the theory better. It is not only concern with the medication and treatments that phys icians orders but it is also concern with the patient's feelings and how to improve their quality of life despite the reality of having a terminal disease. Family involvement is also important in giving care to patients with cancer. As nurses it is our role to teach,
encourage, prepare, and help not only our patients but their family as well.
“PREPARE ME”: A TRANSITION Benitte D. Busaing
Cancer is one of among the maladies of man so devastating and ravaging that it will test the will of an individual and his/her family. It is “killing me softly” diseases that will wear and tear anyone who is afflicted with it bringing the family with it. Being a nurse, I have seen transitions of clients who have come to our institution for treatment. Some will survive the disease and live to inspire others but there are some I have the privilege to take care, unfortunately there disease is too advanced to cure or the disease has ravaged their body that it has given up on them. “Prepare Me” Theory by Carmencita Abaquin in my opinion is a “transition theory”. The theory describes components the following components where we as nurse come in.
Presence
Reminisce Therapy
Prayer
Relaxation Breathing
Meditation
Values Clarification
AS I understand PRESENCE component, we are there to help the client to use our skills in therapeutic communication, to help the client and the family through the five stages of coping. If I may relate this to other theory, Henderson’s second assumption states that “nurses are willing to serve and devote themselves day and night”. Moreover, she added that “people have little difficulty in satisfying these needs by themselves”. It is when our PRESENCE is most needed. By giving them information about the disease we empower them for them to make the right decisions about their health. Not only we are helping the client but also his/her family for that type of disease might be familial. In Reminisce Therapy, one experience I encountered in practice is that a patient can be an inspiration to other CA patients. One patient I encountered in the Emergency Room, she came in without no pulse or breathing and immediate attempt to revive her started, and unfortunately she did not make it. History reveals that she has stage IV breast CA, had undergone mastectomy but metastasized on the other breast. One doctor from the Gynaecology department where she once admitted said that she was once a leader of a group of patients who was often heard to share her story and experiences to other patients. She might have helped those other patients with her experiences and encouragements. She could have given them hope. I guess nurses are not alone when it comes to giving hope. I say it is a transition because if we join in their journey as nurses, we assist them in their needs, as Henderson put it, “they may require the assistance to achieve health and independence, or assistance to achieve peaceful death”. WE contribute to that transition from to life to death or life to a second life. Moreover, we should also consider their belief system as stated by Leinenger, “providing culture specific and universal nursing care practices in promoting health or well-being or to help people to face unfavourable human conditions, illness, or death in culturally meaningful ways”. A Holistic approach and quality nursing care.
Prepare Me Theory in Clinical Practice Karen Calagui Giving care to palliative patients during the end stages of life requires an extraordinary commitment, compassion and competence. Also anticipating the needs of the patient and family is a must. It is a complex responsibility involving a holistic approach. Just as the World Health Organization (2009) has defined palliative care , "An approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems such as physical, psychosocial and spiritual." All of these aspects were given attention in “Prepare Me” Theory. As a newly qualified nurse 6 years ago, I handled a 48 years old patient who has Breast Cancer, Stage IV with Lung metastasis. She was in and out of the hospital for several months due to complications of the disease. Patient’s main concern was pain control and possible options which would help her manage the pain. Hence, referral to our service, Palliative and Pain Management. At first, Pain team did full history taking and complete pain assessment. During the conversation, patient revealed that sometimes she has thoughts of “giving up” due to uncontrolled generalized body pain. When the pain doctor and I discussed about the pain management plan, the patient and family appeared to be more positive about the situation. The patient and family were given a lot of time to verbalize any concerns or issues regarding the condition. Patient’s feelings and needs were also taken into consideration. The issues discussed were all assessed and prioritized well. Goals of the therapy were made clear to the patient and family. After the meeting, I believed that our team had built rapport with the patient and her family. As the assigned pain nurse, I did my best to attend to the needs of the patient may it be physical, intellectual, emotional and spiritual aspect. I channeled every communication to our doctors and referral to other services was done based on her needs. Also, I made sure that pain was at acceptable level to patient. Aside from monitoring the analgesia given, Education about relaxation techniques was also provided. I reached out to the family as well. I involved them in assisting the patient doing simple routines like going for short walk, taking a bath, going to the Chapel and hospital’s Zhen Garden, etc. In addition, I encouraged the family to communicate to the patient as much as possible and reminisce happy moments. After 2 weeks of confinement, patient passed away. This experience made me realize how complex it is to take care of patients receiving palliative care. Holistic approach is needed to ensure the patient and family receives the best possible care. They must remain empowered and make informed choices about care and treatment with the help of health care team. Communication, support system and promoting quality of life are vital part of good nursing practice and can reduce anxiety and stress to palliative patients. Indeed,” Prepare Me” Theory is an essential guide to all nurses in dealing with cancer patients.
