UNIVERSITY OF CEBU – MAIN CAMPUS

GRADUATE SCHOOL

Midterm Examination
Nursing 201A

March 16, 2024

Name: Miguel Vergel Y. Busa, RN_________ Rating: __________________

General Instruction: Please DISCUSS COMPREHENSIVELY the answers on the following items:

Situation:

Mrs. M.D., a 60 year old widow with seven (7) siblings was admitted at Y hospital due to bloody
vaginal discharge 5 moths PTA. This was accompanied by abdominal discomfort and pain. She
sought consultation with her gynecologist and was referred to oncologist for further management,
and then biopsy revealed uterine carcinoma stage III. Surgery was recommended, radical
hysterectomy and bowel resection were performed. Diagnosis was stage IV uterine carcinoma with
metastasis to small intestine. Patient exhibited depressive symptoms like crying, despair, refusal to
cooperate in the treatment regimen and worries over survival rate, family’s financial resources and
restoration of self care capabilities. The siblings are all working and taking turns in providing care.
Possible discharge is one of the plans with continuous home treatment including possibility of
chemotherapy sessions.

Mrs. M.D. expressed to resort to herbal medicines and preparations and all vegetables and fruit
diet, absolutely no pork and pork products. She desires to continue attending masses as source of
spiritual strength.

Questions:

1. As postulated by M. Leininger, which mode of nursing care decisions/actions (cultural care

preservation, cultural care accommodation or cultural care re-pattering) are applicable to
Mrs. M.D.
As a nurse-clinician, I am able to see a lot of cancer patients in my experience. We all know that cancer is
a curable in its early stage when it is early detected. As cancer progress and reach its full blown stage
(stage 4) we will be able to note that patient already have very poor prognosis and is experiencing
devastating signs and symptoms already. In line with Madeleine Leininger theory of transcultural nursing,
the most applicable mode of nursing care decision is cultural care preservation. Under this theory, its
concept is to include those assistive, supporting, facilitative or enabling professional actions and
decisions that help people of a particular culture to retain and or preserve relevant values so that they
can maintain their wellbeing, recover illness or face handicaps and/or death. With that as we try to
embed it in the situation we would be able to consider that with regard to the situation of Mrs. M.D. stage
IV uterine carcinoma with metastasis to small intestine is already an advance stage. With poor prognosis,
the only thing that we could do is to assist the patient for a painless and good quality of life in her
remaining days. Resorting to unconventional therapies such as herbal medicine could be a values that she
learned from her ancestors or has been inculcated in her culture. This goes the same with allowing her to
gain spiritual strength by allowing her to attend masses with no restrictions. Allowing it and facilitating it
will somewhat give her the notion that we are respecting her decision and facilitating patient’s autonomy.

Personally, with my experience, these types of patients with a full blown carcinoma with metastasis,
opting with conventional therapy such as chemotherapy, radiation and surgical procedure, this only gives
an extra burden the patient physiologically. The conventional therapy with it’s side effects slowly destroy
the patients body. With her age that comes with higher risk of having a slow recovery she might succumb
to a painful situation physiologically due the incompetence of immune system to respond to infection due
to immunosuppression brought about by chemotherapy. As we try to facilitate and accommodate her
request I believe that we are able to give a quality of life to her remaining days, follow her request, honor
her culture and at the same time facilitate beneficence by avoiding inflicting pain to the patient through
the effects of chemotherapy.

2. Based on Jean Watson’s Theory, what clinical caritas are applicable to Ms. M.D. situation.
Discuss at least 5 caritas/curative factors.

1. The formation of a humanistic-altruistic system of values – practice of loving-kindness and

equanimity within the context of caring consciousness.This clinical caritas is applicable to the
patient. Practicing loving-kindness and equanimity within the context of caring consciousness
in this situation involves approaching Mrs. M.D. with compassion, empathy, and
 understanding while maintaining a sense of calmness and acceptance in the face of her
challenges. Approaching Mrs. M.D. with genuine care and concern, acknowledging her
emotional distress and validating her feelings of despair and worry and as well as showing
empathy by actively listening to her concerns without judgment and offering emotional
support are just some of the examples of it. In addition, as we all know that equanimity is the
state of calmness, we must foster a sense of acceptance and non-attachment to outcomes,
recognizing that Mrs. M.D.'s journey may unfold in unexpected ways and that fluctuations in
her emotional state are a normal part of the process and then focus on providing steady and
consistent support to Mrs. M.D. and her family, regardless of the ups and downs they may
experience along the way.

2. The instillation of faith-hope – being authentically present and enabling and sustaining the
deep belief system and subjective life-world of self and one being cared for. In the context of
caring consciousness, practicing the instillation of faith-hope for Mrs. M.D. involves
nurturing her sense of optimism, resilience, and belief in the possibility of positive outcomes
despite the challenges she faces. We should acknowledge Mrs. MD’s strengths, provide
encouragement and support, engage in therapeutic communication, collaborate on goal
setting and explore more on her spiritual and cultural resources as this serves as one of the
source of her strength in her overall health experience.
3. The promotion and acceptance of the expression of positive and negative feelings – being
present to and supportive of, the expression of positive and negative feelings as a connection
with deeper spirit and self and the one-being cared for. In the context of caring consciousness,
promoting and accepting the expression of both positive and negative feelings for Mrs. M.D.
involves creating a supportive environment where she feels safe to openly communicate her
emotions and concerns. We should create a safe and supportive space, listen active and
empathetically, encourage expression of feelings, offer emotional support and validation and
offer emotional support and validation. By promoting and accepting the expression of both
positive and negative feelings within the context of caring consciousness, we can provide
Mrs. M.D. with the emotional support and validation she needs to cope with her cancer
diagnosis and treatment journey. This approach emphasizes empathy, validation, and respect
for Mrs. M.D.'s emotional experience, while also supporting her cultural and spiritual beliefs.

4. The provision of the supportive, protective and (or) corrective mental , physical, societal and
spiritual environment - “Creating healing environment at all levels (physical as well as the
 nonphysical, subtle environment of energy and consciousness, whereby wholeness, beauty,
comfort, dignity, and peace are potentiated). Providing a supportive, protective, and
corrective environment for Mrs. M.D. involves addressing her mental, physical, societal, and
spiritual needs to enhance her overall well-being. For mental support, we must offer
emotional support and counseling to address Mrs. M.D.'s depressive symptoms, such as
crying and despair. Provide opportunities for her to express her feelings and concerns in a
safe and non-judgmental environment. For physical support, we must provide comprehensive
physical care to address Mrs. M.D.'s medical needs related to her cancer diagnosis and
treatment. Ensure that she receives appropriate pain management, symptom relief, and wound
care following her surgery and throughout her hospitalization. For societal support, we must
reassess Mrs. M.D.'s social support network and identify resources to help her cope with
practical challenges, such as family's financial resources and caregiving responsibilities.
Connect her with social services, financial assistance programs, and community resources to
alleviate stressors related to her illness. And lastly for spiritual support, we must respect Mrs.
M.D.'s spiritual beliefs and practices, including her desire to continue attending masses for
spiritual strength. Encourage her to draw upon her faith as a source of comfort, hope, and
resilience during this challenging time.

5. The allowance for existential-phenomenological forces” became “allowance for existential-

phenomenological spiritual forces” - “Opening and attending to spiritual-mysterious and
existential dimensions of one’s own life-death; soul care for self and the one-being-cared
for”. Practicing allowance for existential-phenomenological spiritual forces for Mrs. M.D.
involves recognizing and honoring the spiritual dimensions of her experience, including her
beliefs, values, and sense of meaning and purpose. Respect for Spiritual Beliefs:
Acknowledge and respect Mrs. M.D.'s spiritual beliefs and practices, including her desire to
continue attending masses for spiritual strength. Recognize the importance of spirituality in
her coping mechanisms and healing journey. We must facilitate spiritual expression by
creating opportunities for Mrs. M.D. to express her spirituality and engage in meaningful
spiritual practices. This may include arranging for visits from a spiritual counselor, providing
access to religious texts or materials, or facilitating prayer or meditation sessions. We also
might want to integrate spiritual care into Mrs. M.D.'s overall care plan, recognizing its
significance in promoting holistic well-being. Collaborate with the healthcare team to ensure
that spiritual needs are addressed alongside physical, emotional, and social needs. Together
with this we are honoring spiritual values of Mrs. M.D. and her preferences in decision-
 making regarding her care. Respect her wishes regarding the use of herbal medicines and
dietary choices aligned with her spiritual beliefs. Overall, we must practice cultural
sensitivity. We need to practice cultural sensitivity and humility in addressing Mrs. M.D.'s
spiritual needs, recognizing the diversity of spiritual beliefs and practices among patients.
Avoid imposing personal beliefs or assumptions onto Mrs. M.D. and instead seek to
understand and support her unique spiritual journey.

3. Please discuss comprehensively how modeling and role modeling 5 goals of intervention
will be attained in the care of Mrs. M. D.
A. Build trust – as nurses, one of our greatest challenges in taking care of Mrs. MD is the
establishment of trust. Mrs. MD’s thought process could be clouded and influenced already by a
lot of factors such as experience, social or peer pressure, fear, and misconception. As nurses we
should be able to promote and establish a trustworthy environment for the client by facilitating
effective communication, demonstration of empathy, honesty, and reliability by providing
accurate data that would strongly promote not only the pros but as well as cons of committing to
the prescribed treatment regimen. By doing so, patient will be able to notice that we are not just
there to influence her to take and agree with the treatment regimen, but she would see us as an
avenue or medium that promotes autonomy and that we will allow her to decide for herself and
that we are just there to guide her but not influence her.
B. Promote Clients positive orientation – as we get in the situation of taking care of Mrs. MD, we as
nurses should be advocate of optimism and should be a model of a person who does have a
positive outlook and mindset. We already know that Mrs. MD refuses to the treatment regimen
due to fear and financial incompetency. As nurses who practice this theory, we should be able to
acknowledge the emotion of the patient and let her know that we fully understand her. In
addition, we should explore more on these factors and see to it that we would be able to address
it. We should be able to acknowledge the strengths of the patient and use this as a motivation for
her to commit on the prescribed regimen. By fostering a positive orientation, nurses help clients
maintain hope, motivation, and optimism, which are crucial for coping with health issues and
pursuing wellness.
C. Promote client’s control – as nurses, one of our main job is to be a client’s advocate. We should
be able empower the client and allow them to take control of their health and wellbeing. We
would be able to do this by allowing and respecting Mrs. MD health care decisions but at the
same time we are able to make sure that the patient are informed about the whole picture of the
 process. By doing so, we as nurses are able to enhance motivation, self efficacy and overall
engagement in health-promotion behaviors.
D. Affirm and promote client’s strengths-As nurses, aside from being an advocate for our patients,
we also serve as the best support system that they have. As a support system, we should recognize
the strength of the patient and affirm it. Through this, we are able to promote holistic well-being.
We must recognize the unique assets, capabilities and resources of our patient whether it comes
from emotional, physical, social or spiritual and leverage it to help the client develop resilience
and sense of competence as they manage their health challenges.
E. Set Mutual, health-directed goals- With regard to situation of Mrs. MD, as nurses, aside from
being an advocate of patient, it is also our duty to follow scientific-based management. It is our
duty to make sure that our patient knows what’s best for her and that we are able to make sure
that she has been given all the possible options that she has so that we would be able to make a
mutual health goals that both aligns to the principle of science and principle of the patient.

4. In addressing problems of Mrs. M. D., what principles or assumptions of Margaret

Neuman’s Health as Expanding Consciousness are applicable.

Humans are unique and must be treated uniquely and holistically. One of the major assumptions of
Margareth Newman in her theory Health as Expanding Consciousness is that "health encompasses illness
or pathology and that pathologic conditions can be considered manifestations of the pattern of the
individual". As we try to lay the story of Mrs. M.D. in the theoretical assumption of Margareth Newman,
we would be able to note that the situation of Mrs. M.D. having a metastatic cancer is a part of her overall
health experience. On a straightforward medical perspective , we may view this situation in a way that she
was able to obtain this infirmity due to possible exacerbation of comorbidities, incompetent lifestyle or
genetic predisposition. However, as we try to print out Mrs. MD’s story to the theory of Margaret
Newman, we would see the situation in a perspective in which the reason of acquiring the disease could
be a consolidation of various physical injuries, emotional stress, past traumas or unacknowledged spiritual
needs. With that, as a nurse who follows the framework of Margaret Newman, we should approach the
situation in a holistic manner encompassing both physiological, psychological, emotional, social and
spiritual realms. With that, to fully address the situation of Mrs. MD first, we should still facilitate the
physiologic needs of Mrs. MD such as the required chemotherapy, good nutrition, enough sleep and rest
and compliance to medication. Secondly, since Mrs. MD is also agitated with the treatment, we might
want to address the emotional needs of the patient such as addressing and exploring more on what causes
the agitation and fear of compliance in the treatment. Third, we should praise the social support provided
by the siblings of the patient and let them know that they are doing well. By doing so, we are increasing
the strength of the social support of Mrs. MD. Fourth, in addition we might want to give educational
reinforcement about the possible conventional options and clarify the blurred areas of this treatment to
Mrs. MD. By doing so, we are able to reinforce the psychological needs of the patient and restructure or
realign her belief. Lastly, since the patient opt to go to masses, we a nurses who follows the theory of
Margaret Newman, we must support the patient and assist her in achieving her goal to attend masses as
this activity is perceived by the patient to be the source of her spiritual strength that fuels her as she
undergo her overall health experience. By considering Mrs. MD’s condition within the framework of
Newman's theory, healthcare practitioners may adopt a more holistic approach to her care. Instead of
solely focusing on treating the physical symptoms, they may explore interventions that address Sarah's
emotional well-being, promote self-awareness, and support her in expanding her consciousness to find
meaning and healing in her experience of pain.