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SISTER LETTY G. KUAN order to have a rewarding retirement period even
“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”
● Dr. Kuan is a nurse. She had 2 Masters Degrees,
MA in Nursing and MA education, (Guidance and
Counseling). For her vast contributions 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 had clinical fellowship and specialization in
neuropsychology at the University of Paris,
France. Neurogerentology in Watertown, New
York. She also had bioethics formal training at the
Institute of religion, Ethics and Law at Baylor
College of Medicine in Houston Texas. She is a
recipient of the Metrobank Foundation
Outstanding TeachersnAWard in 1995.
● Sister letty kuan has a very unique nursing theory
which focuses on the older adults. Those who are
going to retire and those who are on the retirement
stage, for short, the gerontology patients.
● The main goal of her theory is to help elderly
people on how to achieve fruitful and aging alike.
● The Theory of Sister Letty G. Kuan is about
“Graceful Aging”. Her interest in old people
initiated her to formulate a theory for the purpose
of knowing the reasons and variables on how to
make people happy at retirement by
conceptualizing a framework:
● It is of primary importance to prepare early in life
by cultivating other role options at age 50-60 in
amidst the presence of role discontinues
experienced by this age group.
RETIREMENT AND ROLE
DISCONTINUITIES
RETIREMENT
● An inevitable change in one’s life. It is evident in
the increasing statistics of aging, increasing
statistics of the aging population accompanied by
related disabilities and increased dependence.
This developmental stage, even at the 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 options at age
50 to 60 in order to have a 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.
● As we add more years to our age, our body is
also aging. We have wear and tear, meaning the
condition of our body will not be as 100% good as
compared to when we grow old.
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.
● It is also a set of 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 a complementary
set of roles in the social structure among which
interaction constantly occurs.
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● For short, role means, what is the specific role
that this person is working on for the past years
of his or her life (was he or she a teacher, a
nurse, a doctor, a mother, etc.).
CHANGE OF LIFE
● Is the period between near retirement and post
retirement years. In the medico-physiologic
terms, this equates with the climacteric period of
adjustment and readjustment to another tempo of
life.
● If you are entering your change of life or if you
are about to retire, you have to start adjusting
yourself since you will be entering another phase
of life which is retirement.
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.
● In the Philippines, it is between 50-65 years old
or our senior citizens.
ROLE DISCONTINUITY
● Is the interruption in the line of status enjoyed or
role performed. The interruption may be brought
about by an accident, emergency, and change of
position or retirement.
● If an individual was once a teacher, a nurse, or
any other professional occupations, if an
individual discontinues that, there will be an
interruption in the lines of status that individual
performed.
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.
● Of course, our elederly clients or elderly folks, will
also need to undergo coping approaches since
the retirement phase or retirement life is a drastic
change in their life. Hence, they have to cope up
to maintain equilibrium and normal functioning so
that they will not go through depression or
physical deterioration.
Determinants of positive perceptions
in retirement and positive reactions
toward role discontinuities:
(1) HEALTH STATUS
● Refer to the physiological and mental state of the
respondents, classified as either sickly or healthy.
● If an elderly is healthy, meaning he or she can still
function and can still do activities of daily living.
According to Sr. Letty Kuan, there is still a good
chance that this person will have fruitful aging
and positive reaction towards role discontinuity as
compared to those who are sick already in the
first place.
(2) INCOME
● (Economic Level) Refers to the financial affluence
of the respondent which can be classified as
poor, moderate or rich.
● Money or income can change how a person can
see his or her retirement phase. Does he or she
have enough money or savings to go through the
retirement phase? Will there be other sources of
income when he or she will stop working?
(3) WORK STATUS
● After you retire, will you apply for another job that
will not have age requirements, or will you stay at
home?
● Status of an individual according to his or 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.
● The support group, especially the family, is a
strong determinant for positive perception in the
retirement phase. According to Sr. Letty Kuan, if
an elderly person will have a good family
constellation, support group, etc. the elderly will
better accept his or her fruitful aging because he
or she will have more time to spend with the
family in the remaining years of his or her life.
(5) SELF PREPARATION
● It is the preparation of self to the possible
outcomes in life.
● Were you able to prepare physically, financially,
emotionally, and spiritually? Before retirement do
you have insurance, pension, monthly money you
will receive from the government or any private
agencies. Were you able to prepare for that
ahead of time? What if you get sick? Do you
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have health insurance, health card? Do you have
businesses you can still continue after you retire?
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 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 ank 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.
➔ Health status and family constellation will
have a great impact on how a person will
perceive retirement stage.
3. Income has a high correlation with both the
perception of retirement and reactions toward
discontinuities.
➔ Since income is one of the factors that secure
the outlook of an individual, efforts must be
exerted to save and spend money wisely
while still actively earning in order to have
some reservation 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 benefit
adjustment.
4. Work status goes hand in 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 at an old age.
5. Self Preparation which is said to be both
therapeutic and recreational in essence pays its
worth in old age. This does not only account for
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
dignity; enhancing their feelings of self-worth
and happiness.
➔ Elderly people start doing things that they
like, that they will be passionate about even
after they retire. So that when they retire,
they still have something else to do that they
like.
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 perceive retirement positively, it requires
early socialization of the various roles we take in
life. The best place to start is at home extending
to schools, neighborhood, the community and
society in general.
➔ In retirement, their fellow retirees are their
own best advocates. To facilitate this, barriers
to 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.
➔ The challenge to other people is to make
retirement fruitful, enjoyable, and desirable.
So how can we help our elderly people so
that they may feel that their retirement
phase is happy and enjoyable? We should
start making a comfortable home for them,
we should start having more community
programs that elderly people can enjoy, etc.
8. Government agency to construct a holistic pre
retirement preparation program which will take
care of the retiree’s finances, psychological.
Emotional and social needs.
➔ A challenge for the government to have a
holistic retirement program for our elderly
people. Increase in pension, increase
programs that can assist the mental health
and emotional needs of the elderly.
9. Retirement should be recognized as the
fulfillment of every individual’s birthright and must
live meaningfully.
➔ Retirement should be something to look
forward to.
APPLICATION TO NURSING
● The theory of Sister Letty G. Kuan stated that
without positive acquisitions during childhood, the
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person (patient) will be “in a pathological state” to

delinquency. Now, this is the challenge that
nurses will face. The role of the nurse is to put
back what they have missed during childhood
and to fill this gap. Nurses need to let them
acquire good things through setting an example
and to make them feel loved and important. The
role of the nurse is to become a therapeutic self
and spiritual self by showing empathy and
compassion.
● She quoted this:
“The Longer you stay in life, the more you have
acquired, the better you should be, the Legacy is
given.”
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CARMENCITA M. ABAQUIN ● During the past decade, the incidence of cancer

has significantly increased not only in the
Philippines but also worldwide. Cancer has been
associated with multifaceted issues and concerns
To Nursing, may be able to provide the care that
regardless of stages of development. For patients
our clients need in maintaining their quality of life
with advanced progressive cancer, these problems
and being instrumental in “birthing” them to
are compounded, thus the need to develop
external life”
interventions that can address the needs,
especially those concerning the ability to be in
● Abaquin is a nurse with a Master's and Doctoral
control and maintain their dignity.
Degree in Nursing obtained from the University of
the Philippines College of Nursing. She is an
expert of Medical Surgical Nursing with PREPARE ME has the following
subspecialty in Oncologic Nursing, which made Components
her known both here and abroad. She had served
the University of the Philippines College of Nursing
her alma mater as faculty and held the position as PRESENCE
secretary of the college of nursing. Her latest
● Being with another during the times of need. This
appointment as chairman of the board of nursing
includes therapeutic communication, active
speaks to her competence and integrity in the field
listening, and touch.
she has chosen.
➔ If a nurse is called, and the nurse is not just
physically present but mentally and
PREPARE ME emotionally present with the patient, it is a big
help for the patient that someone is there to
● “Prepare Me” Interventions and the Quality of life care for them. That someone is really and
of Advance Progressive Cancer Patients” genuinely concerned for them.
● According to Abaquin, holistic nursing intervention
is “Prepare Me”.
REMINISCE THERAPY
● Recall of past experiences, feelings, and thoughts
to facilitate adaptation to present circumstances.
➔ This is a non-pharmacological intervention,
meaning you do not have to give any
medication, a non-pharmacological
intervention that boosts the self-esteem of the
patient for them to be happy and satisfied.
➔ How will you do Reminisce Therapy? By
helping them remember events, people,
places from their past lives so that they can
be happy.
➔ How are we (the nurses) going to remind
them of the happy places, events, and
significant people in their lives? You can
use different senses like the sense of sight,
touch, taste, smell, and sound.

PRAYER
● You have to encourage prayer whatever religion
your patient might believe in. As a nurse, you
should always encourage prayer. A nurse may
also pray together with the patient.

RELAXATION
● Breathing-techniques to encourage and elicit
relaxation for the purpose of decreasing
NCMA110 - FINALS
undesirable signs and symptoms such as pain,
muscle tension, and anxiety.
➔ You should be able to provide relaxation
activities to your patient. The patient is
already terminally ill, and in order to provide a
good quality of life aside from taking
medications, you should also provide
relaxation activities.
MEDITATION
● Encourages an elicit form of relaxation for the
purpose of altering a 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.
➔ Relaxation and Meditation go hand in hand
together because it helps the patient relax
and be more comfortable.
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.
➔ Is an approach that helps clarify their goals,
priorities and their values.
➔ Even if they are terminally ill, they should
know their goals, priorities, and values in
order for them to arrive at a sound decision
making.
➔ A nurse should help with value clarification, to
prioritize the goals, to remember his or her
value so he or she can decide properly.
➢ If a nurse will be able to provide these
interventions or the PREPARE ME Interventions
to their terminally ill cancer patients, a nurse can
be able to help them physically, socially,
psychologically, religiously, spiritually,
environmentally, and even in the level of
independence. Hence, the patient will have a good
quality of life.
➢ If a nurse will be able to provide these
interventions, the output or the outcome will be
symptom relief and quality of life for the patient.
BASIC ASSUMPTIONS AND
CONCEPTS
PREPARE ME (HOLISTIC NURSING
INTERVENTIONS)
● Are the nursing interventions provided to address
the multi-dimensional problems chosen to be
confined. This program emphasizes a holistic
approach to nursing care.
QUALITY OF LIFE
● Is a multifaceted construct that encompasses the
individual’s capacities 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 of
man-physical, psychological, social, religious, level
of independence, environment and spiritual.
FINDINGS AND RECOMMENDATIONS
1. Terminally-ill patients require a holistic approach of
nursing that encompasses the different aspects of
man namely physical, psychological, social,
religious, level of independence, environment and
spirituality.
2. Prepare me intervention as a basic part of care
given to cancer patients is recommended, as well
as the incorporation of the intervention in the basic
nursing curriculum in the care of these patients.
3. The utilization of the intervention as a basic part of
care given to cancer patients is recommended. As
well as the incorporation of the intervention in the
basic nursing curriculum in the care of these
patients.
4. 4. Development of training programs for care
providers, as well as health care professionals
where intervention is a part of treatment
modalities, is also recommended.
5. For patients, an honest view and feedback
regarding their illness and management and
obtaining their perceptions can lead to
improvement of services and communication
between patients with advanced progressive
cancer, their families and health team.
6. Supportive environment where patients with
advanced progressive cancer and the terminally ill
patients can attain dignity of dying with peace
while their families are given the necessary
support they need to cope up with. Thus,
healthcare professionals and family members
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have to provide this kind of venue whether in the

home or hospital setting. This will maintain a
holistic support for this special type of clients.
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CECILIA LAURENTE ● The first 5 caring behaviors cited by patients

are:

a) Respectful
● Local nursing theorist in the Philippines, who
b) Patience
focused her work on helping a patient through
c) Various helping acts
support systems, specifically the family. She has a
d) Gentleness
publication entitled "Categorization of Nursing
e) Guidance
Activities as Observed in Medical Surgical Ward
Units in Selected Government and Private
➔ These are the five caring behaviors that the
Hospitals in Metro Manila.
patients were able to determine.
● BSN Graduate from the University of the
➔ These are the patient's perception of a caring
Philippines (1967).
nurse.
● Dean College of Nursing 1996-2002 UP-Manila.
● She is known for her work in the field of nursing. In
● The rest of the findings are:
her theory of nursing practice, she emphasized
effective communication and championed using
✓ Competence
the family as an entry point to help a patient.
✓ Therapeutic touch
● Focused her work on helping a patient through
✓ Verbal communication
support systems, specifically the family.
✓ Close proximity/is accessible
● She has a publication entitled "Categorization of
✓ Active listening
Nursing Activities as Observed in Medical Surgical
✓ Smiling/cheerful/with humor
Ward Units in Selected Government and Private
Hospitals in Metro Manila.
● It is a fact that these caring behaviors require extra
● In the recent study of Laurente, she states that
time and energy on the part of nurses, but these
another entry point of helping the patient is
behaviors would pave the way to infuse quality of
through the family, when nurses can be of great
life on the clients. They feel that they are persons
assistance to prevent at the very beginning
with dignity and it is at this time when they are ill
serious complications. The nurse can help
that they need caring the most. The client's
strengthen the family’s term of knowledge, skills,
perception of the effects of nurses' caring
and attitude through effective communication,
behaviors was varied.
employed informative, psychotherapeutic,
● Some of them feel happy/satisfied (99.53 percent),
modeling, behavioral, cognitive behavioral, and
secured/relaxed (7.42 percent), with increased
hypnotic techniques that are summarized and
fighting spirit (92.58 percent), with increased hope
evaluated.
for early recovery (86.77 percent), trustful of the
nurse (55.16 percent): Any combination of these is
THEORY OF NURSING PRACTICE AND characteristic of well-being. They feel that
although they are ill, there is someone, the nurse,
CAREER
whom they can entrust their whole being.
● A unique trademark of a genuine nurse who ● Based on the results of the study, it can be
demonstrates excellence in nursing practice is concluded that nurses' caring behaviors have an
caring behavior. This is said to be a subconscious impact on the well-being of the clients that go
effort to be sensitive and respond to human needs beyond physiologic responses. They feel that they
and the human person. The study was undertaken are cared for by nurses, not merely to improve
to determine the effects of nurses caring behaviors their nutritional status or maintain fluid and
on the clients. electrolyte balance but to boost their personhood
and dignity.
● Specifically, the following questions were
asked:

1) What are the perceptions of the clients of

what a caring nurse is to them?
2) What are the perceptions of the clients of
the effects on them of the nurses caring
behavior?