I. Relevant Theories

A. Kolcaba’s Comfort Theory American nursing theorist and nursing professor. Kolcaba is responsible for

comfort theory, a mid-range nursing theory that has been implemented at the institutional level.

Kolcaba earned a nursing diploma from St. Luke's Hospital School of Nursing. She earned a Master of Science in Nursing from Case Western Reserve University in 1987 and a PhD from the same school in 1997.

Kolcaba's Theory of Comfort was first developed in the 1990s. It is a middle-range theory for health practice, education, and research. This theory has the potential to place comfort in the forefront of healthcare. According to the model, comfort is an immediate desirable outcome of nursing care.

Kolcaba described comfort existing in three forms: relief, ease, and transcendence. If specific comfort needs of a patient are met, the patient experiences comfort in the sense of relief. For example, a patient who receives pain medication in post-operative care is receiving relief comfort. Ease addresses comfort in a state of contentment. For example, the patient's anxieties are calmed. Transcendence is described as a state of comfort in which patients are able to rise above their challenges. The four contexts in which patient comfort can occur are: physical, psychospiritual, environmental, and sociocultural.

B. Watson’s Human Caring Theory

American nurse theorist and nursing professor who is best known for her Theory of Human Caring.

Watson was born on June 10, 1940 in Williamson, West Virginia.

Jean Watson graduated from the Lewis Gale School of Nursing in Roanoke, Virginia,

in 1961. She continued her nursing studies at the University of Colorado at Boulder, earning a B.S. in 1964, an M.S. in psychiatric and mental health nursing in 1966, and a Ph.D. in educational psychology and counseling in 1973. She has been awarded nine honorary doctoral degrees in six countries.

Watson developed the Theory of Human Caring. She founded the non-profit Watson Caring Science Institute in 2008.

Jean Watson refers to the human being as "a valued person in and of him or herself to be cared for, respected, nurtured, understood and assisted; in general a philosophical view of a person as a fully functional integrated self. Human is viewed as greater than and different from the sum of his or her parts."

II. Intoduction and Background of the Case

The word "asthma" originates from the Greek meaning short of breath, meaning that any patient with breathlessness was asthmatic. The term was refined in the latter part of the 19th Century with the publication of a treatise by Henry Hyde Salter entitled "On Asthma and its Treatment".

Asthma (AZ-ma) is a chronic (long-term) lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing (a whistling sound when you breathe), chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning. Asthma affects people of all ages, but it most often starts during childhood.

Patient’s Profile:

Name: Mikee Leigh Gianan

Age: 22 Years Old

Initial Visit: Asthma symptoms have become an increasingly frequent interruption throughout the day.

Treatment: SYMBICORT 160/4.5, 2 puffs twice daily.

Weight: 53 kg

Height: 5’1

History of present illness:

The night before the attack, the patient’s husband had a card game with friends at their home, the players were smoking cigarettes. It was tiring for the patient because she had to do the cooking and entertained the house guests. By 3 am on the following day the patient woke up and thought that she just had a bad night because she was coughing persistently and had difficulty sleeping. At around 5 am, she cleaned the house and did some dusting. By 7:30 am, she had a bad attack, severe coughing and wheezing and she also experienced shortness of breath. Her metered dose inhaler did not help too much so that is when her husband decided to take her to the hospital to undergo medical check up.

Current Visit:

A. improved lung function

B. reduced short-acting beta2-adrenergic agonist (SABA) use

Physical:

Temparature: 37° Celsius

Pulse Rate: 120

Respiratory Rate: 36

Blood Pressure: 140/80

Emotional:

Q. Inaatake po ba kayo ng asthma nyo pag may iniisip kayong mabigat na problema?

A. Oo, kaya hindi ko masyadong pinapansin ang mga bagay na yan. Para na ri sa kapakanan ko.

Social:

Q. May kasama po ba kayo sa bahay para mag assist sa inyo kapag inaatake kayo?

A. Kasama ko ang nanay ko at asawa ko sa bahay at alam na rin nila ang gagawin pag inatake ako.

Spiritual:

Q. Nagsisimba po ba kayo tuwing Linggo?

A. Hindi kami nagsisimba kasi malayo sa amin yong dasalan. Nagdarasal na lang kami tuwing gabi.

III. General Problem and Specific Problem identified:

General Problem: The inside walls of an asthmatic's airways are swollen or inflamed. This swelling or inflammation makes the airways extremely sensitive to irritations and increases the susceptibility to an allergic reaction.

Specific Problem: As inflammation causes the airways to become narrower, less air can pass through them, both to and from the lungs. Symptoms of the narrowing include wheezing (a hissing sound while breathing), chest tightness, breathing problems, and coughing. Asthmatics usually experience these symptoms most frequently during the night and the early morning.

IV. Scope of the Case:

According to World Health Organization (WHO) estimates 235 million people worldwide suffer from asthma. Asthma is not just a public health problem for high income countries: it occurs in all countries regardless of level of development. Over 80% of asthma deaths occurs in low- and lower-middle income countries.

Asthma is under-diagnosed and under-treated, creating a substantial burden to individuals and families and possibly restricting individuals’ activities for a lifetime.

V. Significance of the Case:

This study will help measure the burden of work-related asthma and evaluate long-term health outcomes using administrative databases. Potentially this study may lead to identification of previously unrecognized causes of work-related asthma and better understanding of jobs/workplaces where asthma is exacerbated.

Work-related asthma surveillance will promote proper planning, implementation and evaluation of programs aimed at improving the health of patients with work-related asthma. This study may also foster early recognition and diagnosis of work-related asthma.

VI. Related Literature:

According to George Richardson of University of Plymouth, there is evidence of a link between asthma and a small number of indoor environmental factors. There is currently only reasonable evidence for one causative factor for asthma in the indoor environment and that is house dust mite allergen. Although there are many studies of different remedial actions that can be taken in the home, often these give evidence of reduced risk of exposure but not clinical improvement in asthma. Although there is a lack of medical evidence for the reduction of known sensitizers such as mould, this is because of a dearth of research rather than evidence of no association.

VII. Correlate actual care to the Theory:

A. Kolcaba’s Comfort Theory

In this theory, the role of a nurse is to assess a patient's comfort needs and create a nursing care plan to meet those needs. As a patient's comfort needs change, the nurse's interventions change, as well. Through this method, nurses are able to ensure their patients are properly cared for, and that they are comfortable. If a patient is comfortable, he or she will feel emotionally and mentally better, which will aid in recovery.

B. Watson’s Human Caring Theory

Today’s nursing practice is very much influenced by the theories created by Dr. Watson. Many institutions are introducing Jean Watson’s Theory of Human Caring as a guide to patient care. Applying Watson’s theory not only allows for nurses to better care for patients as a whole, but is also allows for nurses to better care for themselves as whole beings as well. By following Watson’s Carative factors, nurses are able to look at the patient as a whole living, breathing, thinking, feeling person- not just a bed number or a lab report value. When Watson’s theories are applied in acute and chronic health care settings it provides a “guide to help articulate what nursing is and does, beyond task orientation”

VIII. Nursing Intervention:

1. Maintain respiratory function and relieve bronchoconstriction while allowing mucus plug expulsion.

2. Control exercise-induced asthma by having the patient sit down, rest, and use diaphragmatic and pulse-lip breathing until shortness of breath subsides.

3. Supervise the patient’s drug regimen.

4. Demonstrate the proper use of metered dose inhaler properly.

5. Reassure the patient during an asthma attack and stay with him.

6. Place the patient in semi-fowler position and encourage diaphragmatic breathing.

7. Assist him to relax as much as possible.

8. As ordered, administer oxygen by nasal cannula to ease breathing and to increase arterial oxygen saturation during an acute asthma attack.

9. Adjust oxygen according to the patient’s vital functions and ABG measurements.

10. Administer drugs and I.V. fluids as ordered.

IX. Impact of the case to:

A. Nursing Education

The case’s impact on nursing education is…

B. Nursing Research

The case is significant to nursing research in a way that it provides…

X. References

http://en.wikipedia.org/wiki/Nursing_theory

http://nursing.unc.edu/people/merle-mishel/

http://www.nursing-theory.org/theories-and-models/pediatric-nursing.php

http://www.nurses.info/nursing_theory_midrange_theories.htm

http://www.nursing-theory.org/theories-and-models/kolcaba-theory-of-comfort.php

http://www.nursing-theory.org/theories-and-models/watson-philosophy-and-science-of-caring.php

http://onlinelibrary.wiley.com

http://nursingfile.com/nursing-care-plan/nursing-interventions/nursing-interventions-for-asthma.html