Not to be Overlooked in Hospice Care: The Empirical Pattern of Knowing
Leslie Brown and Craig Smith
Undergraduate Students, University of Arizona College of Nursing
The authors creatively apply a standard nursing theory, Oremís Self-Care model, to plan nursing care of a man facing end of life. They also demonstrate the important contribution that the empirical pattern of knowing can make in understanding human need and providing thoughtful care that enhances well-being at the end of life.
Mr. C, a 73 year
old man, was admitted to the Veterans Affairs Hospice unit for a Stage IV ulcer
located on his coccyx. The ulcer developed while the client was enrolled at an
extended care facility. Prior to being admitted to the Hospice unit, Mr. Cís
wife was caring for him at home. In addition to the ulcer, the client was
diagnosed with MRSA in his nares, osteomyelitis, kidney cancer, and dementia.
The client is on pain medication via a subcutaneous medication pump and his bed
has a pulsating air mattress on it.
Oremís theory also alerted us to the importance of developmental self-care requisites, which may be overlooked in end of life care if dying and human development are thought of as contradictory processes. Lifespan developmental theorists such as Erik Erikson explained that human beings possess the capacity for development throughout life, including the end of life, which is another developmental phase of life with its own tasks and strengths. So, end of life care may extend beyond pain management to also address developmental needs such as interpersonal or intrapersonal issues (Byock, 2004).
While various patterns of knowing were important in providing holistic care for Mr. C., the empirical pattern of knowing (Carper, 1978) was foundational, particularly given the breakdown in physical care that led to ulcer formation and pain. For our empirical frame of reference, we used Thompson, Langemo, Anderson, Hanson, and Hunterís 2005 evidence-based article on skin care protocols for pressure ulcer treatment. In the lecture setting we had been instructed on the basics of pain management as well as the care of clients with ulcers. From this previously obtained knowledge we were not only able to identify care strategies (for example, use one log roll to wash his back, listen to heart and lung sounds, and assess his skin) that limited the clientís pain but we were also able to recognize when he was in pain.
In conclusion, from our clinical experience and reflecting upon those events, we learned the importance of nursing competence and ability to function as a substitute for self-care to prevent life-threatening events like Mr. Cís stage IV ulcer. In addition, esthetic and ethical knowing were pivotal in translating empirical knowing into nursing care strategies specific to Mr. C as a unique human being facing end of life.
Byock, I. (2004). The four things that matter most: Essential wisdom for transforming your relationships and your life. New York: The Free Press.
Carper, B. A. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1 (1), 13-23.
Parissopoulos, S., & Kotzabassaki, S. (2004). Oremís self-care theory, transactional analysis and the management of elderly rehabilitation. [Electronic version]. ICUS Nursing Web Journal, (17), 1-11. Retrieved May 2, 2006.
Thompson, P., Langemo, D., Anderson, J., Hanson, D., & Hunter, S. (2005). Skin care protocols for pressure ulcers and incontinence in long-term care: a quasi-experimental study. [Electronic version]. Advances in Skin and Wound Care, 18(8), 422-429. Retrieved April 1, 2006.
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