THEORETICAL FOUNDATION OF NURSING
MODULE 10: LENZ & PUGH I
ABAQUIN I KUAN
I. THEORY OF UNPLEASANT SYMPTOMS
ELIZABETH LENZ
"Theory of Unpleasant Symptoms"
• Master of Science (MS) from Boston College in
1967 and Obtained a PhD from the University of
Delaware in 1976
• Expertise in doctoral nursing education, directing
research-focused doctoral programs at the University
of Maryland and Columbia University
• Dean and Professor at The Ohio State University
College of Nursing
LINDA PUGH
"Theory of Unpleasant Symptoms"
• Served in leadership roles at multiple institutions,
including as a tenured professor and Coordinator of
the Doctor of Nursing Practice Program and held
directorial positions
• Co-developed the Johns Hopkins Nursing Evidence-
based Nursing Model and focused on implementing
best practices in healthcare
• Awards such as the Nightingale Award for
Excellence in Nursing Practice through Research
and the Research Utilization Award at Sigma Theta
Tau International in 2004.
THEORY OF UNPLEASANT SYMPTOMS
• Provides a comprehensive framework for
understanding various symptoms within a broad
range of contexts.
• Emphasizes the subjective experience of symptoms
and their impact on daily life and overall well-being.
• Integrates physiological, psychological, and
situational factors to explain how they affect the
symptom experience.
• Its principles are applicable in clinical settings,
guiding healthcare professionals in assessing and
managing patients' symptoms more effectively.
METAPARADIGM IN LENZ & PUGH'S THEORY
➢ Person
o The patient who is exhibiting the symptoms and
to whom the nurse is giving care
o May also include family and/or friends
➢ Nursing
o Involves the nurse's role in evaluating and caring
for these symptoms and their contributing
factors, emphasizing a relationship-based
approach to better evaluate and manage
symptoms.
➢ Health
o Absence of unpleasant symptoms
o Symptoms are: "perceived indicators of change
in normal functioning as experienced by
patients"
➢ Environment
o Where the care is taking place and situational
factors that contribute to the symptom
experience (employment status, marital status,
social support, access to health care)
ASSUMPTIONS IN THEORY OF UNPLEASANT
SYMPTOMS
• Symptoms are multidimensional, They include
aspects like timing, intensity, quality, and distress.
• Symptoms are influenced by a variety of factors,
including physiological, psychological, and
situational elements.
• The experience of symptoms can affect an
individual's ability to perform daily activities, and
conversely, changes in performance can influence
the experience of symptoms.
• Multiple symptoms can occur at the same time and
may interact with each other, potentially amplifying
the overall symptom experience.
SYMPTOM
- A subjective indication of a disease or a change
in condition as perceived by the patient. It is
something the patient experiences and reports,
but it may not be directly observable by others
- Example: Pain, Fatigue, Nausea, or Dizziness.
THE SYMPTOMS
• Change in normal functioning, Symptoms are
deviations from a person's usual health status.
• More often occur simultaneously, Multiple
symptoms occurring together results in a multiplying
effect
• Measured by their intensity, timing, and quality
perceived, these dimensions help in quantifying and
THEORETICAL FOUNDATION OF NURSING
characterizing symptoms, aiding in their
management.
CHARACTERISTICS OF SYMPTOMS
➢ INTENSITY
o Refers to the severity or strength of the
symptom. Usually measured on a scale, like 1 to
10, with higher numbers indicating more severe
symptoms.
o How severe is the symptom?
➢ TIMING
o Involves when the symptom occurs and its
duration. Timing can include frequency (how
often it happens), onset (when it starts), and
duration (how long it lasts).
o When does the symptom occur, and for how
long?
➢ QUALITY
o Describes the specific nature or characteristics of
the symptom. For pain, quality could be
described as sharp, dull, throbbing, or burning.
o What is the nature of the symptom?
➢ DISTRESS
o Refers to the emotional or psychological impact
of the symptom on the patient
o How distressing or bothersome is the pain?
INFLUENCING FACTORS
• Elements that affect the experience and
characteristics of symptoms
• Includes Physiological, psychological, and
situational Influence the symptoms alone or in
concurrence
• These can impact the type, severity, duration, and
patient's perception of symptoms, identifying the
need for a holistic approach in healthcare
assessments and interventions.
INFLUENCING FACTORS
➢ PHYSIOLOGICAL
o Refer to biological or bodily aspects, such as
health conditions, genetics, age, or medication
effects.
oFor example, a chronic disease like diabetes can
influence symptoms like fatigue or dizziness
➢ PSYCHOLOGICAL
o Involve mental and emotional states, such as
stress, anxiety, depression, or coping styles
o A patient's anxiety, for instance, might intensify
their perception of pain or discomfort
➢ SITUATIONAL
o Include environmental and social contexts, like
living conditions, cultural background, support
systems, or work-related stress
o Lack of social support can exacerbate a patient's
experience of illness-related stress
PERFORMANCE OUTCOMES
• Refer to how the experience of symptoms affects a
person's ability to carry out daily activities and tasks
• Assessing how symptoms like pain, fatigue, or
nausea affect routine activities like bathing, eating,
working, or socializing.
• Understanding how symptoms influence overall
well-being, including mental health, social
interactions, and job performance.
THEORY OF UNPLEASANT SYMPTOMS MODEL
• Symptoms may interact with one another, perhaps
even catalyzing each other.
• Through feedback, symptoms may also affect
influencing factors, and changes in performance may
also have a reciprocal influence on symptoms and/or
influencing factors.
II. PREPARE ME THEORY
CARMENCITA ABAQUIN (1940-2021)
"Prepare me Theory"
• University of the Philippines - Philippine General
Hospital (UP-PGH) School of Nursing, BSN in
1969, MSN in 1975, and PhD in 2000
THEORETICAL FOUNDATION OF NURSING
• Head nurse at PGH, professor and administrator at
UP-Manila College of Nursing, Expert in Medical
Surgical Nursing with subspecialty in Oncology
• Chairperson of the PRC Board of Nursing from 2006
to 2016
PREPARE ME THEORY
• Interventions and the Quality of Life of Advance
Progressive Cancer Patients
• Emphasizes a comprehensive approach, addressing
not only medical but also psychological, social, and
spiritual aspects of patient care
• Prioritizes maintaining patients' control and dignity
during the progression of the disease
• Aims to enrich patients' lives with the understanding
that prolonging life may not always be possible.
ASSUMPTIONS IN PREPARE ME THEORY
• Terminally-ill patients benefit from a holistic nursing
approach that addresses physical, psychological,
social, religious, and environmental factors.
• "PREPARE ME" interventions are effective in
enhancing the quality of life for cancer patients.
• These interventions should be integrated into both
the care of cancer patients and nursing education
curricula.
• Training programs incorporating these interventions
for caregivers and healthcare professionals are
recommended
• Open communication about illness and management
can improve service quality and patient-healthcare
provider relationships
• A supportive environment is essential for the dignity
and peace of terminally ill patients, also providing
necessary support for their families.
METAPARADIGM IN ABAQUIN'S THEORY
➢ Person
o Terminally ill patients or cancer patients of all
types and ages are viewed as holistic beings with
certain needs in psychological, physical,
emotional, or spiritual well-being.
➢ Health
o Health for terminally ill patients or those with an
incurable disease like cancer is measured by the
quality of life they are experiencing
o Acceptance and acknowledgment of the
condition, understanding of the disease's nature
➢ Nursing
o Nurses act as facilitators, counselors, and
advisers to provide holistic care to these patients
who require assistance in all aspects of life and
disease.
o Nurses must be seen not as mere caregivers but
facilitators of peaceful acceptance of the
condition as well.
➢ Environment
o External factors ranging from peaceful
surroundings to moral support from significant
others have a big impact on a patient's
improvement of quality of living
BACKGROUND
- 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 regardless of stages of
development.
- For patients with advanced progressive cancer,
these problems are compounded, thus the need
to develop interventions that can address the
needs especially those concerning the ability to
be in control and maintaining their dignity
QUALITY OF LIFE
• a multifaceted construct that encompasses the
individual capacities and abilities with an aim of
enriching life when it can no longer be prolonged
• Tailored to each person's unique capacities and
abilities, it Prioritizes enriching experiences and
personal fulfillment, not just prolonging life
• Particularly relevant when life-extending options are
limited, shifting focus to comfort and contentment.
6 INTERVENTIONS/COMPONENTS
1. PRESENCE
o Defined as being physically and emotionally
available to patients in times of need.
o It involves active listening, empathy, and
providing comfort simply through one's
company, often without the need for words.
THEORETICAL FOUNDATION OF NURSING
o Example: A nurse stays by a patient's side during o It supports informed decision-making and aligns
a difficult emotional breakdown, offering silent treatment choices with the patient's own beliefs
support and a comforting hand. and preferences.
2. REMINISCENCE THERAPY o Example: A nurse facilitates a conversation with
o Involves discussing past experiences to help a patient to clarify their values regarding end-of-
patients connect with their history, often evoking life care, ensuring their treatment aligns with
positive emotions and aiding in coping with their wishes.
current situations.
o It's beneficial for enhancing mood, self-esteem,
and identity, especially in older adults or those PREPARE ME THEORY MODEL
with dementia.
o Example: A nurse encourages a patient to share
stories from their youth, which helps the patient
reconnect with cherished memories and cope
with current hospitalization.
3. PRAYER
o A spiritual practice that may offer solace, hope,
and a sense of connection to a higher power for
patients.
o Can be used to address spiritual needs, provide
emotional support, and bring comfort in difficult III. RETIREMENT AND ROLE
times DISCONTINUITIES
o Example: A nurse prays with a patient before
surgery, providing spiritual comfort and meeting SISTER LETTY KUAN (1936 - PRESENT)
the patient's religious needs. "Retirement and Role Discontinuities"
4. RELAXATION-BREATHING • Born on November 19, 1936 in Katipunan-Dipolog,
o Techniques like deep breathing exercises help Zamboanga del Norte
reduce physiological symptoms of stress and • Holds a Master's degree in Nursing and Guidance
anxiety. and Counseling, and a Doctoral degree in Education.
o Can be employed before procedures to calm • Completed a Clinical Fellowship and Specialization
patients or integrated into daily routines to in
manage chronic symptoms • Neuropsychology at Paris, France, and studied
o Example: A nurse teaches a patient deep Neurogerontology in New York.
breathing techniques to manage anxiety during a • Served as a member of the Board of Nursing.
panic attack. • Authored several books on Gerontology, Care of
5. MEDITATION Older Persons, Bioethics, and the Essence of Caring.
o A mindfulness practice focusing on an image or
thought to reach a relaxed state of RETIREMENT AND ROLE DISCONTINUITIES
consciousness. THEORY
o Meditation can lower stress levels, improve
• Also called as "Graceful Aging Theory", it advocates
concentration, and contribute to a patient's
for early preparation for retirement, starting as early
overall sense of well-being
as 50-60 years old, to ensure a fulfilling post-
o Example: A nurse guides a patient through a
retirement life and to mitigate role discontinuity
meditation session, focusing on peaceful
stress
imagery to alleviate stress.
• Highlights the importance of maintaining physical
6. VALUES CLARIFICATION
and mental health, financial stability, and social
o A process that helps patients identify and
roles, which all contribute to a positive retirement
consider their personal values related to health
experience and adjustment to role changes
and illness.
• Stresses the need for family support, economic
security, and self-preparation activities that enhance
THEORETICAL FOUNDATION OF NURSING
self-worth and happiness, advocating for
government-backed holistic pre-retirement
programs.
METAPARADIGM IN KUAN'S THEORY
➢ Person
o Retirees adapting to changes in their life roles,
emphasizing the importance of preparation and
adjustment for a fulfilling retirement.
o Focuses on the elderly in their later years,
aiming for them to be active and a contributing
members of society
➢ Health
o Seen as a gradual maturation process
encompassing mind, body, and spirit, where
aging is understood and accepted as a natural
progression toward life fulfillment.
➢ Nursing
o Involves preparing individuals for fulfilling
retirement and supporting graceful aging.
o Role of nursing or support professionals in
facilitating a positive transition to retirement
through education, preparation, and community
engagement.
➢ Environment
o A supportive society that values and assists the
aged.
o Social support systems, including family and
community, which play a crucial role in
buffering the effects of role discontinuity during
retirement.
ASSUMPTIONS IN RETIREMENT AND ROLE
DISCONTINUITIES THEORY
• Health status dictates the capacities and the type of
role one takes both for the present and for the future.
• Family constellation is a positive index regarding
retirement positively and also in reacting to role
discontinuities.
• Income has a high correlation with both the
perception of retirement and reactions toward role
discontinuities.
• Work status goes hand in hand with economic
security that generates decent compensation.
• Self-preparation which are said to be both
therapeutic and recreational in essence pays its worth
in old age.
• To cope with the challenges 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.
• To perceive retirement positively, it requires early
socialization of the various roles we take in life.
• Government agency to construct pre-retirement
preparation which will take care of the retiree's
finances, psychological, emotional, and social needs.
• Retirement should be recognized as the fulfillment
of every individual's birthright and must be lived
meaningfully.
THEORETICAL ASSERTATION OF THE THEORY
• Aging process is dependent on: Healthy genetic
background, Happy, fulfilled, childhood foundation,
Successful middle-aged life experience, Healthy
surroundings, Relaxation, Recreation and nutrition
• Had been recipient of being recognized, appreciated
and honored with love
• Has attained a mastery of knowing oneself and a
mastery of skill
• Elements of Life's early imprints: importance of
love, the hug factor, good parental and sibling
modeling roles, sense of humor and relaxation, value
of work and prayer life and growing closer to God
CONCEPTS & DEFINITIONS
➢ Physiological Age
- is the endurance of cells and tissues to withstand
the wear- and-tear phenomenon of the human
body
➢ 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
➢ Change of Life
- Is the period between near retirement and post-
retirement years
➢ Role
- refers to the set of shared expectations focused
upon a particular position
➢ Role Discontinuity
- is the interruption in the line of status enjoyed or
role performed
THEORETICAL FOUNDATION OF NURSING
➢ Coping Approaches 5. SELF PREPARATION
- refer to the interventions or measures applied to o (according to Webster's dictionary): it is
solve a problematic situation or state in order to preparing of self to the possible outcomes in life.
restore or maintain equilibrium and normal o Refers to the psychological readiness and
functioning practical planning for retirement.
o Example: An individual who has planned
financially and mentally for retirement is likely
to find the transition less stressful and more
satisfying.
5 DETERMINANTS OF FRUITFUL AGING
- refers to the various factors that contribute to a
positive and productive experience of aging.
THEORY OF RETIREMENT AND ROLE
DISCONTINUITY MODEL
1. HEALTH STATUS
o refer to physiological and mental state of the
respondents, classified as either sickly or
healthy
o Affects one's ability to enjoy retirement, with a
healthier state allowing for more active
engagement in life.
o Example: A retiree with good health can travel,
participate in hobbies, and maintain
independence
2. INCOME
o (economic level) refers to the financial affluence
of the respondent which can be classified as
poor, moderate, or rich
o Directly impacts the quality of retirement,
affecting the ability to afford healthcare, leisure,
and living expenses.
o Example: A retiree with a higher income level
has more options for leisure activities and can
better manage healthcare costs.
3. WORK STATUS
o (according to Webster's dictionary: status of an
individual according to his/ her work
o Relates to the sense of identity and fulfillment
gained from one's career and the transition away
from work life.
o Example: A retiree who had a fulfilling career
may find it easier to adapt to retirement by
finding new roles that provide a sense of purpose
4. FAMILY CONSTELLATION
o The type of family composition described either
close knit or extended family
o The family support system can significantly
influence the adjustment to retirement, offering
emotional support and practical assistance.
o Example: A retiree with a close-knit family may
experience smoother role transitions with the
support of family members.