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Nursing theorist Jean Watson emphasizes the importance of caring in promoting health and wellness and also preventing illness in Theory of Human Caring. To Watson, it was essential to care for the whole person and to form a transpersonal caring relationship with patients. According to her theory, caring can be demonstrated in her ten carative factors or the translated carative factors called caritas processes. In the situation with the 10 year old Hispanic boy with asthma, Watson would approach the situation with a holistic perspective, doing her best to form a transpersonal caring relationship with him while also applying her carative factors. To form a transpersonal caring relationship with him Watson would sit down with the patient and his parents and go beyond the traditional objective assessment by displaying concern toward the patient’s deeper meaning regarding his own health care situation (Cara, 2003). Waston believes that in forming this transpersonal relationship, the nurse “seeks to recognize, accurately detect, and connect with the inner condition of spirit of another through genuine presencing and being centered in the caring moment” (Watson, “Theory of Human Caring”).
The patient is a 10 year old overweight Hispanic boy with decreased exercise tolerance during recess due to increased asthma exacerbations. This had led to increased visits to PNP at school for inhaler use. Three priority issues for assessment and care planning include ineffective asthma management, weight issues, and the boy’s feelings about his asthma, weight and any other concerns. For all three priority issues, caritas process 1, 3, 4, and 9 will be applied. These caritas processes lead to a thorough assessment of all his issues. According to her theory, caritas process 1 relates to “practicing loving-kindness & equanimity for self and other” (Watson, 2007, p. 131). As a nurse, it essential to show kindness, listen, and show genuine concern toward the patient. Caritas process 3 relates to “cultivating of one’s own spiritual practices; deepening self-awareness” (Watson, 2007, p. 131). This increased self-awareness and sensitivity opens up the nurse to be more capable of learning about the patient’s concerns. Caritas process 4 relates to the nurse “developing and sustaining a helping-trusting, authentic caring relationship” with the patient and his family (Watson, 2007, p. 131). This relationship lets the patient and his family be more comfortable and trusting of telling their concerns to the nurse. Finally, caritas process 9 relates to the nurse “assisting with gratification of basic human needs, while preserving human dignity and wholeness” (Watson, 2007, p. 134). Based on Watson’s hierarchy of needs, the issue of ineffective asthma management is prioritized first, second is his weight issues, and lastly his feelings over his asthma and weight. These caritas processes provide an effective way to begin and lead an assessment to learn more about his issues and to form an transpersonal relationship with him.
It is evident that it is important to find out the cause of the patient’s increased exacerbations. For his specific issue of ineffective asthma management, caritas process 6 and 7 will be applied to find out more information. Caritas process 6 consists of the nurse “creatively using presence of self and all ways of knowing… as part of the caring process” (Watson, 2007, p. 131). This translates to the nurse using everything such as knowledge, instincts, intuition, and skills to assess the patient and to help him manage his asthma. Caritas process 7 relates to “engaging in genuine teaching-learning experiences that attend to whole person” (Watson, 2007, p. 131). This caritas process promotes the opportunity for the nurse and the patient to learn from each other. The patient and his family can explain their concerns over his increased exacerbations, and then the nurse can use that information along with a formal assessment to figure out what to teach the patient to ensure that he knows how to effectively control his asthma symptoms. The goal is to improve the patient’s asthma control.
Applying Watsons’ caritas processes 1,3,4, 6, 7 and 9, a thorough assessment is performed. First, the patient and his family are asked to explain their concerns while the nurse is listening intently and showing genuine concern. Then, the patient’s asthma control is assessed using the asthma control chart which looks at his asthma symptoms and lung function. Next, any triggers for his asthma is identified. All his asthma medications are also identified. His technique for administering his medication is then assessed to ensure that he is properly administering his medication. Then, his adherence to the prescribed medication regime is assessed. After the assessment, the patient is educated on avoiding his identified triggers and the importance of adhering to the medication regime. The dose for his inhaled corticosteroid is also increased based on the assessment. A follow up appointment is scheduled in one month to reassess his asthma control. The worsening of his asthma could be possibly due to his weight which leads to his next priority issue.
Similar to the first issue with his asthma management, caritas process 6 and 7 will be applied toward the issue about his weight. Caritas process 6 implies using all ways of knowing to care for the patient and for this issue, studies will be looked at. It has been shown that people who have excess weight have increased risk for health conditions. The results of a meta-analysis of asthmatic children and adolescents showed that obese children compared with non-obese peers had a small but significant increased risk of asthma exacerbations (Ahmadizar et al, 2016). The authors of another study concluded that asthmatic overweight and obese adults who lose weight experience a high symptomatic remission rate and significant improvements in asthma control (Juel, Ali, Nilas, & Ulrik, 2012). Besides the effects on asthma, being overweight increases the risk of developing type 2 diabetes. Applying caritas process 7, it will be important learn from the patient about his food habits and his readiness to lose weight and the educating the patient and his family about the significance of losing health to better his health. The goal is to for the patient and his family to verbalize understanding of weight loss benefits, readiness to lose weight, and to begin a weight loss regime.
First, the patient’s weight, BMI, and readiness to start a weight loss regime is assessed. A nutrition assessment that includes a daily food intake, approximate caloric intake, activity at time of eating, feeling at time of eating, and snacking patterns is performed. Additionally, the patient and his family should be questioned on their culture’s cuisine. Latin American cuisine is known to consist of meals high in calories and carbohydrates. Afterwards, the patient is educated on eating healthy, not overeating snacks, limiting sugar-sweetened drinks, drinking more water, and eating less fast food. His family will be taught about healthy cooking methods and cooking meal options with less carbohydrates and fats. Although he has been having difficulty with exercising due to his asthma, he should get at least 60 minutes a day of exercise on most days of the week and hopefully the above listed interventions for his asthma will help with any exacerbations.
It’s important for the patient to voice his feelings toward having asthma and his weight and their effects on his life. Unfortunately bullying can be a common occurrence at school and someone who is overweight or obese is an easy target for bullies. Bullying can have detrimental effects on his social health. Besides the aforementioned caritas processes, caritas process 5 and 8 should be applied. Caritas process 5 relates to the nurse “being present to, and supportive of, the expression of positive and negative feelings” (Watson, 2007, p. 131). Caritas process 8 refers to the nurse “creating healing environment at all levels” so the patient is comfortable and can heal. The goal is for him be comfortable in expressing his feelings and verbalizing seeking counsel if needed.
A welcoming environment is provided for the patient, attending to noise, comfort, and privacy. The nurse encourages the patient to freely express reflection of feelings and experiences of his asthma, weight, school or anything else.
Watson’s theory has no stated outcomes, but she had emphasized the importance of forming a transpersonal relationship with the patient. After the application of the caritas processes and interventions, a transpersonal relationship was reached with the patient and the goals were met. The combination of education and the increased dose of the corticosteroid greatly improved the patient’s asthma control with exercised induced exacerbations occurring very rarely. Additionally, with the education on healthier meals and improved asthma control which led to regular exercise, the patient has managed to lose a several pounds. In forming a transpersonal relationship with the nurse, the patient was able to admit to being bullied and had sought counsel from his school’s guidance counselor. With Watson’s theory as a guide, the patient’s physical and social health successfully improved.
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