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Dependent-Care
Nursing
&
Contents
Editorial
Original Manuscripts
Spotlight on Vietnam
Announcement of Awards
I have spent most of the last year rereading articles and books written by Dorothea
Orem and once again being impressed by the
clarity of her thinking and writing about the
science of nursing and about the development
of the discipline of nursing. Her use of the
English language is exquisite. Requisite is
not the same as requirement. Have you ever
tried to paraphrase her writings? It is almost
impossible. I once overheard her say very
quietly to a speaker who had just presented
a paper referring to self-care requisites as air,
food, water put the verbs back. When working
with Orem there was always a dictionary and
a thesaurus at hand. A nurse I worked with,
who questioned the language of Self-Care
Deficit Nursing Theory, checked the dictionary
definition of every concept of the theory and
found Orems definitions all consistent with
those in the dictionary. And always, somewhere
in the discussion ,no matter how theoretical,
there was a return to a practice situation.
Since her very earliest writings, Orem challenged
nurses, both in practice and in academia, to
develop and make known the foundational
sciences and the practice sciences of nursing.
She established the Orem study group as
just that a study group in which views could
be exchanged to work toward this end of
developing nursing science. Papers reporting
on the work of this group were presented at the
IOS congress in Belgium in 1997, in Atlanta in
2001, in Germany in 2004, and in Vancouver in
2008. In 2001 several articles were published in
the spring issues of Nursing Science Quarterly.
Several more articles are to be published in upcoming editions. Springer has agreed to publish
a book authored by Susan Taylor and myself
in which we have tried to continue dialogue
related to the development of nursing science
and the meaning it has for practice. Through
these activities and conferences, such as the
upcoming one in March in Thailand, continuing
development of Self-Care Deficit Nursing Theory
takes place. I hope to see you there.
Co-Editors
Violeta Berbiglia and Virginia Keatley
Self-Care, Dependent-Care & Nursing
Conference Announcement
Co-Editors Column
Vigilance
As health care systems globally face
skyrocketing costs to meet the growing needs
of consumers, perhaps it is time to revisit the
power components proposed by Orem. Power
components are defined as human capabilities
that are empowering for engagement in the
operations of self-care (Orem, 2001, p. 264).
These capabilities, according to SCDNT, are of
a nature intermediate between human functioning
and human dispositions (p. 264) and empower
people as they strive to provide self-care.
Ten power components were formulated by
the Nursing Development Conference Group.
Vigilance is the first identified power component.
In simple terms, it is watchfulness and awareness.
It is the power to maintain attention to internal and
external stability or change and recognize how
that affects self-care.
The ability and disposition to maintain
vigilance must be stressed as nurses teach and
empower patients to provide self care. In a world
where chronicity is rising, lifespan is increasing,
and the effects of war, migration, immigration, and
poverty take a toll on health, the ability to maintain
vigilance becomes increasingly important.
Nurses enable vigilance through both individual
and family interventions and population based
initiatives. Awareness campaigns to promote
health needs, such as breast cancer screening,
immunization clinics, nutritional counseling,
and water treatment empower individuals and
communities to be aware of self care responses
that maintain health. Early intervention programs
mitigate some of the developmental and health
deviation challenges faced when self care
demands increase or abilities decrease.
Health deviation self care requisites were
identified by Orem at a time when most nursing
care was focused on managing acute conditions.
In todays world, the effects of the environment and
lifestyle behaviors are causing a renewed interest
in managing chronic conditions and maintaining
quality of life. Here again, the power component,
vigilance, comes to the forefront. In todays health
care systems, diabetics learn to be the watch
guards for their own health, patients with chronic
lung conditions learn to monitor and supplement
their oxygen requirements, adult children care for
elders who may become increasingly forgetful and/
or dependent, and young children are exposed to
loss and violence. It is increasingly important
The IOS is pleased to present the IOS New Scholar Award to Ausanee Wanchai.
Her scholarship is best described in her mentors letter:
Sinclair School of Nursing
University of Missouri-Columbia
July 7, 2010
Selection Committee
2010 International Orem Society New Scholar Award
To Whom It May Concern:
It is my privilege to write this letter of
recommendation and strong support for Ms.
Ausanee Wanchai, PhD nursing student at
University of Missouri Sinclair School of Nursing,
for consideration for the prestigious 2010
International Orem Society New Scholar Award.
For the past three years, I have served as
the faculty mentor and PhD advisor for Ausanee,
a young faculty member from Boromarajonani
College of Nursing, Buddhachinaraj, Thailand.
During that time, she has made highly satisfactory
and very timely progress toward completion of
her PhD at the University of Missouri. In addition,
Ms. Wanchai has also performed exemplarily
in her role as a graduate research assistant in
the Lymphedema Research Laboratory and as
a student completing independent studies and
research practicum under my guidance. In April
2010, Ausanee was recognized as one of three
outstanding PhD student nominees for the MU
Sinclair School of Nursing 2010 Nursing Alumni
Organizations PhD Student Award for Overall
Excellence. We anticipate she will complete
comprehensive examinations in Fall 2010 and
proceed with the preparation of her dissertation
proposal.
Ausanee was destined to be a nurse and
a nurse educator/researcher from her early
childhood and her earliest days in nursing school.
She determined as an eleven-year-old child that
she would make a difference in the world by being
an excellent nurse in caring for persons with
illness. She was ranked at the top of her nursing
class and has earned five awards of excellence
as a teacher as recognized by her students at
Boromarajonani College of Nursing, as well
as being the recipient of multiple scholarships
awarded by the Thai government in recognition
of her exceptional abilities and dedication.
Living and studying in an environment a world
away from ones home and communicating in a
second language is a challenging experience!
Ausanee aptly bridges the cultural and language
Introduction
Early detection and advances in treatment of
breast cancer have increased the number of breast
cancer survivors. The American Cancer Society
(2010) reported that the 5-year relative survival
rate for women with breast cancer has improved
from 63% in the early 1960s to 90% today. This
increase in survival presents an opportunity for
Figure 1. Nursing system to enhance self-care agency for breast cancer survivors using CAM
Results
From the literature review, 44 articles were
identified, of which 11 met all of the criteria. Most
of the selected articles (63.6%) reported studies
which were conducted in the United States,
followed by Canada (27.3%) and Germany (9.1%).
The participants in all of the samples were breast
cancer survivors. The size of samples in these
studies ranged from 36 to 2,527 (median = 411).
These studies included eight quantitative and
three qualitative designs. Of eight quantitative
studies, six studies used self-administered
questionnaires to collect data (n = 263 to 2,527)
(Boon et al, 2000; Boon, Olatunde, & Zick, 2007;
Buettner et al., 2006; Hann, Baker, Denniston,
& Entrekin, 2005; Nagel, Hoyer, & Katenkamp,
2004; Saxe et al., 2008), whereas the other two
studies used telephone interviews (n = 371 and
115, respectively) (Carpenter, Ganz, & Bernstein,
2009; Matthews, Sellergren, Huo, List, & Fleming,
2007). Of three qualitative studies, two studies
used focus group (n = 36 and 66, respectively)
(Boon, Brown, Gavin, Kennard, & Stewart, 1999;
Canales & Geller, 2003), and another study used
ethnographic methods to collect data (n = 42)
(Ribeiro & Harrigan, 2006a) (see Table 1).
Types of CAM
Types of CAM have been defined by the
National Center for Complementary and Alternative
Medicine (2009). Past empirical research findings
indicate that breast cancer survivors use a variety
of CAM. Biologically-based practices which use
substances found in nature, such as herbs, foods,
and vitamins, were most frequently used by
breast cancer survivors (Boon et al., 2000, 2007;
Carpenter et al., 2009; Matthews et al., 2007;
Nagel et al., 2004). The next most frequently used
type of CAM was mind-body medicine, a variety
of techniques designed to enhance the minds
capacity to affect bodily function (Buettner et al.,
2006; Hann et al., 2005). Some examples of mindbody medicine used by breast cancer survivors
included meditation, prayer, and imagery. Other
types of CAM used by survivors were energy
medicine, which uses energy fields surrounding
the human body as a method of therapy (e.g.
massage, Reiki, and therapeutic touch) (Canales
& Geller, 2003), and whole medical system (e.g.
homeopathic medicine, naturopathic medicine,
and traditional Chinese medicine) (Saxe et al.,
2008).
Sources of Information about CAM
Previous research on CAM use by breast
cancer survivors has revealed that family
Table 1 Studies of Self-Care Agency Using Complementary and Alternative Medicine among Breast
Cancer Survivors
Author(s)
Sample
Method
Resources to
enhance self-care
agency related to
CAM use
Reasons to
enhance self-care
agency by using
CAM
-L
ay literature and
personal research
- Media
- CAM practitioners
- Physicians or
other conventional
health care
providers
- Friends
- Support groups
- Improve chance of
survival
-R
eact to bad
experience with
conventional
treatment
-B
e proactive to
prevent further
illness
- Try CAM because
there is nothing to
loose
-B
oost immune
system
-S
tabilize current
condition
-P
revent
recurrence of
disease
- Treat cancer
Boon,
Brown,
Gavin,
Kennard,
& Stewart
(1999)
n = 36
breast
cancer
survivors
(Toronto,
Canada)
Qualitative focus
group
- Analyzed by
using content
analysis method
Not specified
Boon,
Stewart,
Kennard,
Gray,
Sawka,
Brown,
Aaron, &
HainesKamka
(2000)
n = 411
breast
cancer
survivors
(Ontario,
Canada)
Self-administered
questionnaires
(22 items)
- Analyzed by
descriptive
analysis,
categorizing
respondents as
either CAM users
or CAM nonusers
- Vitamins/minerals - Friends
49.6%
-F
amily members
- Herbals remedies
24.6%
- Green tea 17.3%
- Special foods/diet
15.3%
- Essiac 14.8%
- Body work (e.g.
Reiki, massage, or
therapeutic touch)
14.1%
- Meditation 10.2%
- Shark cartilage
5.4%
- Homeopathy 3.9%
- Faith healing 3.4%
-B
oost immune
system
- Increase quality
of life
-P
revent a
recurrence of
cancer
-P
rovide a feeling
of control
- Aid conventional
treatment
- Treat breast
cancer
-S
tabilize current
condition
-C
ompensate for
failed conventional
treatment
Canales
& Geller
(2003)
n = 66
breast
cancer
survivors
(Vermont,
USA)
Qualitative focus
group
- Analyzed
by using the
software program
N*Vivo
-M
assage 54%
-P
hysical therapies
43%
-C
hiropractic 32%
- Acupuncture 18%
-S
piritual healing
11%
- Treat disease or
symptoms
-B
oost immune
system
-D
eal with
lymphedema,
early menopause
-M
edical and lay
publications
- The Internet
-F
amily
-F
riends
-C
lasses
-O
ther breast
cancer survivors
-C
onventional
health care
providers
Author(s)
Sample
Method
Resources to
enhance self-care
agency related to
CAM use
Reasons to
enhance self-care
agency by using
CAM
Nagel,
Hoyer, &
Katenkamp
(2004)
n = 263
breast
cancer
survivors
(Germany)
Self-administered
questionnaires
(items not
specified)
- Analyzed by
descriptive
analysis,
categorizing
respondents as
either CAM users
or non-CAM
users
- High dose
vitamins 64.2%
- Mistletoe 37.9%
- Ozone therapy
9.5%
- Selenium therapy
8.4%
- Diets 7.4%
- Thymus
preparations 4.2%
- Others 6.3%
- Physicians
- Media
- Friends
- Family members
- Other patients
- Self-help groups
- Pharmacists
Not specified
Hann,
Baker,
Denniston,
& Entrekin
(2005)
n = 608
breast
cancer
survivors
(Florida,
USA)
Self-administered
questionnaires
(75 items about
CAM and 17 items
of the Satisfaction
with life Domains
Scale-Cancer)
- Analyzed by
descriptive
analysis, dividing
CAM methods
into categories of
CAM published
by the American
Cancer Society
- Magazine or
books
- Other survivors
- Newspaper
- Media (TV, radio)
- Family members
or friends
- Medical journals
- The Internet
- Other cancer
organizations
- Tabloids
-R
educe risk of
cancer recurrence
-P
lay a more active
role in cancer
recovery
-M
anage stress
-G
ive hope
- Increase control
over recovery
-P
rovide
psychological
support
-C
ontrol physical
side effects (e.g.
pain)
-U
se a more
holistic approach
-E
stablish a
more involved
relationship with a
practitioner
-D
issatisfied with
conventional
treatment
- Avoid negative
experience with
conventional
treatment
Buettner,
Kroenke,
Phillips,
Davis,
Eisenberg,
& Holmes
(2006)
n = 2,022
breast
cancer
survivors
(USA)
Self-administered
questionnaires
(items not
specified)
- Analyzed by
descriptive
analysis,
categorizing
respondents as
either CAM users
or CAM nonusers
- Relaxation/
imagery 32%
- Massage 23%
- High-dose
vitamins 20%
- Herbs 19%
- Spiritual healing
13%
- Yoga 12%
- Chiropractic
12%
- Energy healing
8%
- Acupuncture 4%
- Homeopathy 4%
- Others 4%
Not specified
Author(s)
Sample
Method
Resources to
enhance self-care
agency related to
CAM use
Ribeiro &
Harrigan
(2006)
n = 42
Asian breast
cancer
survivors
(Hawaii,
USA)
Qualitative
ethnographic
methods
- Analyzed by
using constant
comparative
analysis method
- Books
- Alternative
- Friends
medical system
- support group
(traditional
Chinese medicine)
-M
ind body
intervention (e.g.
imagery, prayer,
self-healing,
humor)
-B
iologically
based therapy
(e.g. herbal teas,
noni, aloe, shark
cartilage, flax
seed)
-M
anipulative
and body-based
methods (e.g. hot
bath, massage)
-E
nergy therapies
(e.g. healing
touch, music
therapy)
- Improve quality
of life
Boon,
Olatunde, &
Zick
(2007)
n = 938
breast
cancer
survivors
(Ontario,
Canada)
(in 1998 n =
411; in 2005
n = 527)
Self-administered
questionnaires
(items not
specified)
- Analyzed by
descriptive
analysis,
categorizing
respondents
as either CAM
consumers or
non-consumers
Not specified
Matthews,
Sellergren,
Huo, List,
& Fleming
(2007)
n = 115
breast
cancer
survivors
(oncology
outpatient
clinic, USA)
Telephone
interviews (106
items)
- Analyzed by
descriptive
analysis,
categorizing
CAM use into
three patternsincluding no
current CAM use,
current CAM
use unrelated
to cancer, and
current CAM use
related to cancer
Not specified
Reasons to
enhance self-care
agency by using
CAM
Author(s)
Sample
Carpenter,
Ganz, &
Bernstein
(2009)
Saxe,
Madlensky,
Kealey, Wu,
Freeman,
& Pierce
(2008)
Method
Resources to
enhance self-care
agency related to
CAM use
Reasons to
enhance self-care
agency by using
CAM
n = 371
breast
cancer
survivors
(Los
Angeles,
California,
USA)
Telephone
interviews (items
related to CAM use
not specified)
- Analyzed by
descriptive
analysis,
categorizing
respondents as
CAM users or
CAM non-users
- Echinecea 29%
- Herbal tea 21%
- Ginko Biloba 19%
- St. Johns Wort
13%
Not specified
Not specified
n = 2,527
breast
cancer
survivors
(San Diego,
California,
USA)
Self-administered
questionnaires (22
items)
- Analyzed by
descriptive
analysis,
categorizing
respondents as
CAM users or
CAM non-users
and also as either
disclosers versus
non-disclosers
- Naturopathy 59%
- Homeopathy 37%
- Acupuncture 36%
- Chiropractic 8%
Not specified
Not specified
Discussion
Boon, H., Stewart, M., Kennard, M. A., Gray, R., Sawka, C.,
& Brown, J. B., et al. (2000). Use of complementary/
alternative medicine by breast cancer survivors in
Ontario: Prevalence and perceptions. Journal of
Clinical Oncology, 18(13), 2515-2521.
Bott, J. (2007). An analysis of paper-based sources
of information on complementary therapies.
Complementary Therapies in Clinical Practice.
13(1), 53-62.
Buettner, C., Kroenke, C. H., Phillips, R. S., Davis, R. B.,
Eisenberg, D. M., & Holmes, M. D. (2006). Correlates
of use of different types of complementary and
alternative medicine by breast cancer survivors in
the nurses health study. Breast Cancer Research
and Treatment, 100(2), 219-227.
Burstein, H. J., Gelber, S., Guadagnoli, E., & Weeks, J.
C. (1999). Use of alternative medicine by women
with early-stage breast cancer. The New England
Journal of Medicine, 340(22), 1733-1739.
Canales, M. K., & Geller, B. M. (2003). Surviving breast
cancer: The role of complementary therapies.
Family & Community Health, 26(1), 11-24.
Carpenter, C. L., Ganz, P. A., & Bernstein, L. (2009).
Complementary and alternative therapies among
very long-term breast cancer survivors. Breast
Cancer Research and Treatment, 116(2), 387-396.
Chen, Z., Gu, K., Zheng, Y., Zheng, W., Lu, W., & Shu,
X. O. (2008). The use of complementary and
alternative medicine among Chinese women with
breast cancer. The Journal of Alternative and
Complementary Medicine, 14(8), 1049-1055.
Garofalo, J. P., Choppala, S., Hamann, H., & Gjerde,
J. (2009). Uncertainty during the transition from
cancer patients to survivor. Cancer Nursing, 32(4),
E8-E14.
Hann, D., Baker, F., Denniston, M., & Entrekin, N.
(2005). Long-term breast cancer survivors use of
complementary therapies: Perceived impact on
recovery and prevention of recurrence. Integrative
Cancer Therapies, 4(1), 14-20.
Jacobsen, J. S., Workman, S. B., & Kronenberg, F.
(2000). Research on complementary/alternative
medicine for patients with breast cancer: A review
of the biomedical literature. Journal of Clinical
Oncology, 18(3), 668-683.
Janz, N. K., Mujahid, M., Chung, L. K., Lantz, P. M.,
Hawley, S. T., & Morrow, M. et al. (2007). Symptom
experience and quality of life of women following
breast cancer treatment. Journal of Womens
Health, 16(9), 1348-1361.
Knobf, M. T. (2007). Psychosocial responses in breast
cancer survivors. Seminars in Oncology Nursing,
23(1), 71-83.
Lee, R. T., Hlubocky, F. J., Hu, J. J., Stafford, R. S., &
Daugherty, C. K. (2008). An international pilot study
of oncology physicians opinions and practices on
complementary and alternative medicine (CAM).
Integrative Cancer Therapies, 7(2), 70-75.
Lengacher, C. A., Bennett, M. P., Kip, K. E., Gonzalez,
L., Jacobson, P., & Cox, C. E. (2006). Relief of
symptoms, side effects, and psychological distress
through use of complementary and alternative
medicine in women with breast cancer. Oncology
Nursing Forum, 33(1), 97-104.
Lengacher, C. A., Bennett, M. P., Kip, K. E., Keller,
R., LaVance, M. S., & Smith, L. S., et al. (2002).
Frequency of use of complementary and alternative
medicine in women with breast cancer. Oncology
Nursing Forum, 29(10), 1445-1452.
Loudon, L., & Petrek, J. (2000). Lymphedema in women
treated for breast cancer. Cancer Practice, 8(2),
65-71.
Abstract
The Diagnostic Related Groups (DRG) system was introduced
into the German health care system in 2004. This change
placed increased responsibility on the nurses as they shifted
focus toward more health promotion strategies that included
a greater emphasis on teaching patients to assume more
responsibility toward self-care. One hospital in Germany
sought to address this new focus by moving toward a nursing
theory-based service. Orems Self-care Deficit Nursing Theory
was chosen to conceptualize nursing practice. A program
of change was implemented with emphasis placed on the
structure of the nursing process as a means to coordinate
patient care in the hospital setting, thus enhancing the
decision making competency of the nursing staff. Although no
empirical evaluation has been conducted thus far, anecdotal
findings suggest a positive effect on shortening length of stay
for hospitalized patients and on the quality of nursing care
provided to complex patients (especially those who show a
high demand for case management due to risks related to
unmet self-care demands).
Keywords: clinical nursing practice, Orem Self-care Deficit
Nursing, self-care, practice development, nursing education,
Germany
Figure 1: Percentage distribution of care systems in patients admitted between February 2006 and
November 2008
certain characteristics of patients showing need
for attention. A slight reduction of days spent in
hospital can be noticed in this group of patients
who receive special attention through a nurse case
manager (see Box 1).
Summary
In 2005, hospital management in one agency
in Germany decided to implement a clinical nurse
assisted case management in order to enhance
quality of patient care and reduce length of hospital
stay. Hospital management made a significant
Spotlight on Vietnam
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The deadline for submission is April 1st of
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Note: The Foundation does not provide any
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office space, etc. and will not consider such costs
in an award. Where funds requested to partially
support work to be done in conjunction with other
funding support, any additional funds should be
included in the budget along with the potential
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ideas, knowledge utilization, and development
of health policy that supports self- care and
dependent-care.
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