Overview
The writer of this paper had the opportunity to experience different aspects of patient care in long-term care (LCT) facility during his clinical replacement. During the placement, the writer had an opportunity to interact with a 75-year old diabetic client (Mr. X), who also had kidney complications. The client had failed to comply with medications. As a result, the client was admitted to the renal unit and scheduled for dialysis. To manage his condition, he had to undergo dialysis regularly.
The writer had an opportunity to listen to the client’s stories and health experiences. Through the interactions, the writer was able to understand his care needs, which was a new learning experience for the writer. The patient was worried that he will have to undergo dialysis at least twice a week. The writer spent three weeks with Mr. X. During this period, he interacted with the client daily and helped him develop an appropriate plan of care for his condition. The writer also had the opportunity to work alongside experienced nurses, social workers and a multidisciplinary care team caring for this client. He learned that the client, besides specialist medical care, needed constant social support from the nurses and family. Through interpersonal interactions, the client revealed his views and concerns in relation to the dialysis procedure. The writer also honed his nursing skills on blood sugar monitoring and patient referrals after complications. He also learned about the complications that arise due to renal failure and the ethical and legal issues associated with end-of-life care. In summary, the experience helped the writer to understand the challenges that the residents face. It also allowed the writer to help the client formulate his plan of care.
The Human Becoming Theory
The human becoming theory, which was put forward by Rosemarie Parse in 1981, focuses on a new approach to nursing that is different from the psycho-social-spiritual and bio-medical theories. In this theory, a patient’s quality of life is defined by the patient and becomes the central goal of nursing care (Edwards, 2008). Parse called this approach the man-living-health theory. However, later the theory was renamed to the human becoming theory to reflect the changes in the definition of the term “man” (Edwards, 2008). The three basic assumptions of Parse’s theory include transcendence, ‘rhythmicity’, and meaning, which are derived from the works of Merleau-Ponty, Sartre, Martha Rogers, and Heidegger.
Transcendence means that the “human” element in a person transcends all possible environmental limits (becoming) and exceeds his/her set limits (Melnechenko, 1995). This means that an individual will constantly transform to reach personal goals. ‘Rhythmicity’ refers to the rhythmic patterns of interpersonal relationships in the larger universe (Melnechenko, 1995). It entails the relationships between a person and his/her environment (becoming). A person establishes some patterns of relating in the universe, which are multi-dimensional. Meaning is the tendency to choose a subjective meaning in a given situation, which is shaped by individual experiences and priorities. It implies that a person will tend to assume responsibility for choices that reflect his/her values or priorities.
In summary, the human becoming theory presents two new paradigms: (1) the totality paradigm; and (2) the simultaneity paradigm. Under the totality paradigm, man is viewed as a social, biological, spiritual, and psychological being (Edwards, 2008). In contrast, under the simultaneity paradigm, a person is viewed as a “unitary being in a continuous, mutual interaction with the environment” (Edwards, 2008, p. 194). In the context of nursing, Parse’s theory describes a person as an open being who is influenced by physical, social, psychological and spiritual factors (the environment). The environment is the inseparable component in a person’s lived experience. On the other hand, health entails the process of ‘human becoming’, which is structured around personal values. In light of this view, nursing, as a science, should serve different aspects of a person’s health, which should reflect his/her lived experiences, values, or priorities.
Critical Analysis
The writer’s professional goals are rooted in Parse’s theory and the assumption of “meaning”. According to Edwards (2008), meaning refers to the perceptions that a person has about his/her beliefs and values in their interactions with the environment. Based on this point of view, nurses are expected to serve their patients without prejudgment regarding the person’s state of health, age, or culture. The writer utilizes this concept of nursing care in his interactions with patients. During the writer’s placement, he perceived Mr. X as someone’s father and grandfather, who deserves respect and consideration when seeking medical advice about his condition. The writer considered his interaction with Mr. X as sacred. Tanner (2006) defines a human interaction as a “learning moment” for a nurse (p. 204). It is through interpersonal interactions that nurses build therapeutic relationships with the patients.
The human becoming theory highlights the true character of a nurse, which is to serve as a witness, to help patients face reality through social support, and to guide clients during their difficult times. It requires nurses to give a non-controlling environment that would allow patients to freely share their thoughts, views and feelings (Tanner, 2006). A non-controlling environment also gives patients an opportunity to reflect on their condition and transcend their current situation. In light of this, the writer learned the importance of listening as a skill that helps nurses learn the feelings of their patients and develop a holistic nursing care plan for them. By listening to Mr. X, the writer was able to learn his physical, social and emotional needs, and guide him to formulate his plan of care in the LTC facility. Parse’s theory is relevant to nursing as it emphasizes holistic patient care, which includes psychological, physical, sociological, and spiritual well-being. In the writer’s view, true nursing care and support must be holistic.
Parse’s theory provides important insights to students in clinical placement. It underscores the significance of providing nursing care from the perspective of the patient. According to Hansen-Ketchum (2004), holistic nursing care requires a positive nurse-patient relationship, which should aim at improving the patient’s health outcomes or quality of life. This approach, as the writer learned during his placement, guides nurses on the appropriate physiological action, which includes, among other things, the nurse’s presence around the patient. A nurse’s presence strengthens the therapeutic relationship between the nurse and the patient, which helps the nurse to gain a deeper understanding of the patient’s perspective regarding his/her current situation. It is through knowing the patient’s perspective that a nurse can develop an effective care plan that would help the patient achieve higher health outcomes through behavior change.
Also, the theory can help nurses and nursing students understand the patient’s individualized experiences. Through his interactions with Mr. X helped, the writer learned the unique experiences of the patient and acquired a new perspective on the clinical challenges facing elderly clients under long-term care. Achieving high-quality care is the central goal of nursing care. Quality nursing care transcends simple patient care. It requires nurses to listen and respond to all patient needs in a humane manner (Johns, 2007). Thus, the theory values human dignity, which can be achieved through empathy. During his placement, the writer realized that, in an LTC facility, a high premium is placed on work output at the expense of empathy and compassion.
The theory also sets forth the ideal nursing role and skills. The theory centers on the human possibilities and aspirations, which play a crucial role in the achievement of long-term goals of a nurse through lifelong learning. It goes beyond the physiologic part and focuses on all aspects of a person. The writer’s experience with Mr. X helped him perceive the patient’s health and life from his perspective, which is an important part of personal development. This theory also values client empowerment. The empowerment of a client would enable a nurse to develop a care plan that is consistent with the client’s personal goals. In this way, the client can learn to manage his/her condition without the nurse’s assistance. It requires nurses to listen to the client’s experiences, opinions, and feelings to understand how he/she perceives his/her environment (condition).
Conclusion
Parse’s theory focuses on a nurse’s understanding of the client’s perception of a phenomenon. It advises nurses to listen and understand their clients’ perspectives to develop an effective plan of care for them. The writer’s experience with the client (Mr. X) helped him learn the role of the nurse in guiding the client to formulate an ideal care plan for him. The theory underscores the importance of using a participatory approach in long-term care, whereby the client chooses his/her care plan based on his/her values, priorities, and life experiences.
References
Edwards, S. (2008). Critical review of R. R. Parse’s The Human Becoming School of Thought. A Perspective for Nurses and Other Health Professionals. Journal of Advanced Nursing, 32(1), 190–196.
Hansen-Ketchum, P. (2004). Parse’s theory in practice: An interactive analysis. Journal of Holistic Nursing, 22(1), 57-72.
Johns, C. (2007). Toward easing suffering through reflection. Journal of Holistic Nursing, 25(3), 204-210.
Melnechenko, K. (1995). Parse’s Theory of Human Becoming: An Alternative Guide to Nursing Practice for Pediatric Oncology Nurses. Journal of Pediatric Oncology Nursing, 12(3), 122-127.
Tanner, C. (2006). Thinking like a nurse: A research based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204-211.