Self-Care Dependent-Care Nursing

Transcription

Self-Care
Dependent-Care
Nursing
&
Volume 18, No. 1, October 2010
The Official Journal of the International Orem Society
Contents
Editorial
2 Letter from the Co-Editors
2 President’s Message
3Conference Announcement
4 Co-Editors’ Column
5 The Orem Collection
Original Manuscripts
6IOS New Scholar Paper: Self-Care Agency Using Complementary and
Alternative Medicine (CAM) Among Breast Cancer Survivors
Ausanee Wanchai, MSN, RN, Jane M. Armer, PhD, RN, FAAN,
& Bob R. Stewart, EdD
19Self-Care Deficit Nursing Theory in Ingolstadt – An Approach to Practice
Development in Nursing Care
Monika Hohdorf, RN; M.Sc
Spotlight on Vietnam
Announcement of Awards
28IOS Research Award
28 Sarah E. Allison Foundation, Inc.
Call for Papers
Letter from the
Co-Editors
Message from the
President
In this issue, we maintain the focus of the
IOS by publishing the works of international
contributors whose work is SCDNT-based.
Also, we announce the new dates for 11th World
Congress SCDNT that will feature the use of
the SCDNT in nursing research, practice and
education. The 11th World Congress SCDNT
is rescheduled for March 23 – 25, 2011 in
Bangkok.
Once again, we will highlight the progress
in theory-based research in Vietnam. One
impact of the first MSN program in Vietnam
(begun in 2007) has been to emphasize the
importance of theoretical guidance for nursing.
Dr. Berbiglia will comment on what this means
for the profession in Vietnam.
We are pleased to introduce you to the IOS
New Scholar and her research. And finally, the
application processes for the IOS Research
Award, the Sarah E. Allison Foundation Inc.
Award, and the IOS New Scholar Award are
presented. 
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 Orem’s 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
2 • Self-Care, Dependent-Care & Nursing • Vol: 18 • No: 01 • October 2010
Conference Announcement
Vol: 18 • No: 01 • October 2010 • Self-Care, Dependent-Care & Nursing • 3
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 today’s 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 today’s 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
for nurses to empower patients to develop the
capability to monitor change and adjust to or learn
to provide self or dependent-care. Orem reminds
us that it may be in the power components that
nurses find the tools to enable individuals to meet
the goal of self-care. 
Orem, D. (2001).
Nursing: Concepts of practice (6th ed).
Mosby: St. Louis.
Virginia Keatley & Violeta Berbiglia
Orem Collection in the Alan Mason Chesney Medical
Archives at Johns Hopkins University Medical Institutions
Below are the links for The Dorothea Orem
Collection, which is now live on the Alan Mason
Chesney Medical Archives at Johns Hopkins
University Medical Institutions website:
http://www.medicalarchives.jhmi.edu/papers/
orem.html
Complete Finding Aid:
http://www.medicalarchives.jhmi.edu/finding_
aids/dorothea_orem/dorothea_oremd.html
The related Joan Backscheider Collection
description is also available.
http://www.medicalarchives.jhmi.edu/papers/
backscheider.html
Complete Finding Aid:
http://www.medicalarchives.jhmi.edu/finding_
aids/joan_backscheider/joan_backscheiderd.
html 
IOS New Scholar
The IOS is pleased to present the IOS New Scholar Award to Ausanee Wanchai.
Her scholarship is best described in her mentor’s letter:
Sinclair School of Nursing
University of Missouri-Columbia
Jane M. Armer, Professor
Sinclair School of Nursing
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
Organization’s 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 one’s home and communicating in a
second language is a challenging experience!
Ausanee aptly bridges the cultural and language
gap between herself and her fellow students, work
colleagues, and patients with her smile and open
and caring personality. She has developed strong
relationships with her peers and colleagues in the
MU and nursing communities. She has worked
very diligently in developing her understanding
of the health care experiences of American
women undergoing breast cancer diagnosis and
treatment, and will apply these insights in her
work by making comparisons with Thai women
undergoing similar diagnosis and treatments.
Her work will lead to applications which will
improve quality of life for cancer survivors. Her
dedication to increasing her expertise in nursing
and research – to the extent of taking additional
coursework in statistics and other areas beyond
what is required in her plan of study– will make
her a more prepared and most excellent faculty
member when she returns to Thailand.
In an innovative qualitative research project
leading to her future dissertation work and
her future program of research, Ausanee has
conducted a pilot study on experience and
meaning of complementary therapy use by breast
cancer survivors, a study which contributes to our
understanding of this under-researched area. The
manuscript reporting the findings from this pilot
study has been published in the well-respected
oncology nursing journal Oncology Nursing Forum.
Further, Ausanee has completed an extensive
literature review of the research evidence base for
complementary and alternative therapies among
breast cancer survivors which is now in press in
Clinical Journal of Oncology Nursing and which
was selected as a journal club podcast subject by
CJON. Manuscripts reviewing: self care practices
in the area of complementary therapy usage by
breast cancer survivors (applying Orem’s Self
Care Deficit Nursing Theory); nonpharmacologic
strategies to promote quality of life in breast cancer
patients with cancer-related fatigue (a systematic
review); and care practices in complementary
and alternative medicine among breast cancer
survivors (applying the Theory of Culture Care
Diversity and Universality) are now in review. Data
analysis for an additional manuscript examining
psychosocial outcomes among breast cancer
survivors with and without lymphedema is now
well underway. Recently, Ms. Wanchai presented
a research poster at the 4 th national Cancer
Survivorship conference in Washington, D.C.
Ausanee fulfills her educational responsibilities
with the Sinclair School of Nursing and the
University of Missouri, as well as her home
university, with strong dedication, great discipline,
and passion, as she strives to become an
exceptional nurse researcher and educational
leader in Thailand. She is a shining example of
excellence and dedication to the role of nurse
scholar and will well represent our profession as
she moves ahead in her studies and her career.
In summary, I strongly and without reservation
recommend Ausanee Wanchai for the 2010
International Orem Society New Scholar Award.
She is most deserving of this recognition for
her outstanding work and the example she sets
for other doctoral students and her colleagues.
Please feel free to contact me with any questions
you may have regarding her nomination for this
award.
Sincerely,
Jane M. Armer, RN, PhD, FAAN
Professor, Sinclair School of Nursing
Director, Nursing Research,
Ellis Fischel Cancer Center
Director, American Lymphedema
Framework Project
Self-Care Agency Using Complementary and Alternative
Medicine (CAM) Among Breast Cancer Survivors
Ausanee Wanchai, MSN, RN
Jane M. Armer, PhD, RN, FAAN
Bob R. Stewart, EdD
Abstract
Objectives: Meeting self-care requisites, especially health
deviation self-care requisites as posited in Orem’s Self-Care
Deficit Nursing Theory, is challenging for breast cancer
survivors. Even though active treatment such as surgery,
chemotherapy, or radiotherapy is over, self-care agency as
a continuing activity is one part of breast cancer survivors’
lifestyle as they seek to promote their health and well-being.
Many survivors elect to use complementary and alternative
medicine (CAM). However, there is a paucity of research
into its use and effectiveness with this population. Thus, the
purpose of this literature review is to identify and synthesize
research as it relates to self-care agency among breast cancer
survivors using CAM.
Methods: This review examines previous studies on the use
of CAM among breast cancer survivors identified by searching
the following databases from 1990 through October 2009:
Cumulative Index to Nursing and Allied Health Literature
(CINAHL), PsycINFO, and PubMed.
Results: Herbs, vitamins, and dietary therapies were most
frequently used by breast cancer survivors, followed by mindbody medicine, energy medicine, and the traditional medical
system. Family, friends or other breast cancer survivors,
and media are primary information sources about CAM use,
while health care providers are less likely to be a source
of information. Finally, the literature revealed that self-care
operations to promote physical and emotional health and wellbeing and as well as coping with disease and treatment are the
main reasons breast cancer survivors engage in CAM use.
Implication for nursing: Oncology nurses who are
knowledgeable about the use of CAM by breast cancer
survivors will be more able to incorporate CAM into their
supportive-educative nursing system. In addition, there is a
need to evaluate the evidence for efficacy of CAM use by
breast cancer survivors.
Keywords: Breast cancer survivors, self-care agency,
Complementary and alternative medicine
nurses to empower these survivors to achieve
greater self-care agency as they manage the
after-effects of cancer and its treatment (Wendy,
2010).
Once active treatment such as surgery,
chemotherapy, or radiotherapy is completed,
breast cancer patients transition to become breast
cancer survivors (Garofalo, Choppala, Hamann,
& Gjerde, 2009). As a survivor, the role as a selfcare agent now becomes more predominant. In
this role, the breast cancer survivor is empowered
and becomes more able to orchestrate self care
(Orem, 2001). One might believe this is the end
of the role of health care providers in taking
care of these women. In fact, Allen, Savadatti,
and Levy (2009) asserted that the completion of
treatment is a time of great hardship, uncertainty,
and isolation for breast cancer survivors. Studies
suggest that for some survivors, health deviations
such as fatigue, sleep disturbance, uncertainty,
and fear of recurrence persist after completion
of active treatment (Janz et al., 2007; Knobf,
2007; Loudon & Petrek, 2000; Mayer et al.,
2007). As such, breast cancer survivors still
face formidable obstacles in meeting self-care
requisites, especially health deviation self-care
requisites (HDSCR). Thus, the period of cancer
survivorship provides the opportunity for nurses
to move from partially compensatory care to
supportive-educative care to assist the patients in
their return to normalcy. Nurses have a significant
contribution to make at this time (Orem, 2001:
Vivar & McQueen, 2005).
Self-Care Deficit Nursing Theory
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
The Self-Care Deficit Nursing Theory (SCDNT)
is composed of three interrelated theories: the
theory of self-care, the theory of self-care deficit,
and the theory of nursing systems (Orem, 2001).
According to the theory of self-care, individuals
learn and perform actions which help them to
protect human integrity and human functioning.
The goal is for the promotion of normal life and
well-being or for the prevention, control, and
compensation for disease and injuries that affect
the individual’s life. Each individual has ability or
power to engage in self-care which is called “selfcare agency”.
According to Orem (2001), self-care agency can
be affected by basic conditioning factors (i.e. age,
gender, developmental state, health state, sociocultural factors, and health care system factors)
and ten power components, including: ability to
maintain attention and requisite vigilance, ability to
control use of the available physical energy, ability
to control the position of the body, ability to reason
within a self-care frame of reference, motivation or
goal orientation toward self-care, ability to make
decisions about self-care, ability to acquire, retain,
and operate technical knowledge about self-care, a
repertoire of cognitive of skills for self-care, ability
to order discrete self-care actions, and ability to
integrate self-care operations with other aspects
of living, that can develop through the process of
learning (265).
Self-care deficit can occur if the self-care
ability is not adequate to meet self-care demands.
For example, after breast cancer surgery, breast
cancer survivors are required to perform self-care
(i.e. avoiding weight gain and obesity, keeping
affected area free from infection, or reducing the
use of the hand, etc.) in order to minimize the risk
of post-surgery lymphedema. However, because
some breast cancer survivors may lack the ability
to maintain attention and exercise requisite
vigilance, to reason within a self-care frame of
reference, to consistently perform and integrate
self-care operations with relevant aspects of living,
or lack the motivation toward self-care, a self-care
deficit could occur. Nursing is then needed to
assist individuals to accomplish effective self-care
(Armer, et al., 2009). Orem (2001) identified 3
types of deliberate actions nurses perform to help
individuals meet self-care requisites. These are the
3 nursing systems: wholly compensatory nursing
system, partly compensatory nursing system, and
supportive-educative nursing system.
The ability of breast cancer survivors to engage
in self-care depends upon many factors, including
individual self-care requisites, basic conditioning
factors, and personal power components. The
survivors may use options outside mainstream
medicine such as complementary and alternative
medicine (CAM) to increase their self-care
abilities. A previous study by Jacobson, Workman,
and Kronenberg (2000) reported that some
breast cancer survivors seek out CAM after
they suffered from side effects of conventional
cancer treatment (i.e. using acupuncture to
relieve nausea and vomiting associated with
chemotherapy, using massage after mastectomy
to reduce lymphedema, or using mind/body
methods of treatment to reduce pain and stress).
These women used CAM as a way of increasing
their self-care agency when they determined what
to do and how to perform care in order to meet
health deviation self-care requisites associated
with conventional treatment.
Although breast cancer survivors may be
able to perform required measures of externally
- and internally-oriented therapeutic self-care by
themselves, nurses are responsible to help them
develop self-care agency by using a supportiveeducative nursing system (see Figure 1).
Even though there is a lack of rigorous
clinical evidence about the efficacy of CAM to
Figure 1. Nursing system to enhance self-care agency for breast cancer survivors using CAM
alter disease progression of breast cancer, many
survivors choose to use it. According to Astin,
Reilly, Perkins, and Child (2006), the percentage
of women with breast cancer who use CAM
was reported to be as high as 75%. Thus, it
becomes important for nurses to learn about and
understand its use among breast cancer survivors.
This knowledge will provide insight for use in
supportive-educative nursing regulation since it
can enhance an effective communication between
breast cancer survivors and health care providers
about the self-care activities that breast cancer
survivors do for themselves in order to maintain
health and well-being (Balneaves, Kristjanson, &
Tataryn, 1999). Unfortunately, there is a paucity
of research in this particular area and CAM usage
remains poorly understood (Burstein, Gelber,
Guadagnoli, & Weeks, 1999; Owens, 2007;
Patterson et al., 2002). Accordingly, the purpose
of this literature review is to identify and synthesize
the results of research relating to CAM use as a
component of self-care agency among breast
cancer survivors.
Questions
1) Which types of CAM were reported to be
used by breast cancer survivors related to
self-care agency?
2) What were the sources of information about
CAM evaluated by breast cancer survivors
related to self-care agency?
3) What were the reasons given by breast
cancer survivors for their decisions to use
CAM in their self-care?
Methods
Literature Review
Eligible studies were identified by searching
the following databases from 1990 through
October 2009: Cumulative Index to Nursing and
Allied Health Literature (CINAHL), PsycINFO, and
PubMed. The keywords included CAM and breast
cancer survivor, alternative treatment/therapies
and breast cancer survivor, and complementary
therapy and breast cancer survivor.
Criteria
Inclusion criteria required that articles be
original; descriptions of samples and methodology
must be clearly stated; and the abstract must
be available in English. Exclusion criteria were:
studies of non-breast cancer; articles in lay media;
articles not using words “breast cancer survivor”;
and articles not directly relevant to the specific
questions.
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 mind’s
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
Types of CAM use
to enhance selfcare agency
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
Types of CAM use
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
- Mind, body, and
spiritual methods
(e.g. prayer/
spiritual practice,
humor, imagery,
relaxation,
meditation etc.)
90.29%
- Manual healing
and physical touch
(e.g. exercise,
acupuncture,
massage,
chiropractic)
22.52%
- Herbs, vitamins,
minerals 13.41%
- Diet and nutrition
9.11%
- Homeopathy .99%
- 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
- Treat cancer or its
symptom
- Treat non-cancer
illness
-F
or general
wellness
Author(s)
Sample
Method
Types of CAM use
Resources to
enhance self-care
agency related to
CAM use
Ribeiro &
Harrigan
(2006)
n = 42
Asian breast
cancer
survivors
(Hawai’i,
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
CAM products (e.g. Not specified
green tea, vitamin,
flax seeds, special
food/diets, fish oil)
- Practitioners (e.g.
massage therapist,
nutritionist, Reiki
practitioners,
naturopath,
homeopath,
therapeutic touch
practitioner,
herbalist,
chiropractor)
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
- Herbs and herbal
remedies 39%
- Vitamins
and dietary
supplements 32%
- Relaxation
techniques (e.g.
yoga, meditation)
28%
- Body work (e.g.
Chiropractic,
acupuncture) 24%
- Natural anticancer
remedies (e.g.
shark cartilage)
11%
- Diet change (e.g.
vegetarian diet,
soy) 10%
- Address cancerrelated factors
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
Types of CAM use
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
members, friends, and media such as the internet,
magazines, books, newspaper, or journals were
the important information sources about CAM
(Boon et al, 1999, 2000; Canales & Geller, 2003;
Hann et al., 2005; Nagel et al., 2004; Ribeiro &
Harrigan, 2006a). Only three studies reported
physicians or health care providers as sources of
information about CAM for breast cancer survivors
(Boon et al., 1999; Canales & Geller, 2003; Nagel
et al., 2004). In addition, three studies reported
a support group as an information source about
CAM for breast cancer survivors (Boon et al.,
1999; Nagel et al., 2004; Ribeiro & Harrigana,
2006). Thus, it appears that family members,
friends, and media were more likely to affect selfcare agency using CAM among breast cancer
survivors than health care providers.
psychological support, desire for a more holistic
approach, and increased quality of life); and 3)
to deal with disease and manage side-effects of
conventional treatment (e.g. control side-effects of
conventional treatment, reduce risk of recurrence,
treat breast cancer, and react to a bad experience
with conventional treatment) (Boon et al., 1999,
2000, 2007; Buettner et al., 2006; Carpenter et
al., 2009; Canales & Geller, 2003; Hann et al.,
2005; Matthews et al, 2007; Ribeiro & Harrigan,
2006a; Saxe et al., 2008). From the perspective
of Orem’s SCDNT (Orem, 2001), it may be
concluded that the key for CAM use among breast
cancer survivors was the desire to find a way to
increase self-care ability in order to meet self-care
demands resulting from cancer and side-effects
of its treatment.
Reasons for CAM Use
Discussion
The findings of the studies suggest that
the reasons for CAM use by breast cancer
survivors were diverse. However, the reasons
could be grouped into three main categories: 1)
to promote physical health (e.g. boost immune
systems, stabilize current condition, and for
general wellness); 2) to promote emotional
health and well-being (e.g. to manage stress, for
The literature suggests that among the
types of CAM used by breast cancer survivors,
biologically-based practices were most frequently
used, whereas the whole medical system was
used the least. However, there is still a wide
variety in the types of CAM they selected. This
variation may be due to the fact that breast cancer
survivors perceived the range of CAM options as
a smorgasbord of therapies. Indeed, they would
pick and choose what would be the most benefit
for them and the selection depended on the
information they sought out (Boon et al., 1999).
However, caution should be used in generalizing
these findings to other populations. Empirical
research used in this literature review included
only English publications and nearly two-third
of the studies were conducted in the United
States.
According to Orem (2001), basic conditioning
factors (BCFs), such as family system, health
status, or socio-cultural orientation, can affect
the ability of individuals to engage in self-care
or influence the kind and amount of self-care
required. Therefore, the difference in these
basic conditioning factors might contribute to the
variations found among survivors’ use of CAM. As
shown in previous studies, people from different
backgrounds appear to use different types of
CAM. For instance, Chen et al. (2008) reported
that supplements such as Ganoderma lucidum
capsules, vitamins, or gingseng were the most
common type of CAM use by Chinese women
with breast cancer, followed by Chinese herbal
medicine, and physical activities such as qi gong,
Tai Chi, or dancing. In contrast, some studies
showed that black, Latino, and Hispanic women
were more likely to use spiritual healing, followed
by herbal remedies or diet therapies. White women
were more likely to use dietary methods, spiritual
healing, and physical methods such as massage
and acupuncture (Alferi, Antoni, Ironson, Kilbourn,
& Carver, 2001; Owens, Jackson, & Berndt, 2009).
The studies by Ribeiro and Harrigan (2006b) and
Simpson (2003) showed that factors such as
family system or culture and belief system could
affect breast cancer survivors’ use of CAM.
The literature in this review indicated that
family, friends or other breast cancer survivors, and
the media are the primary sources of information
about CAM use by breast cancer survivors, while
health care providers are less likely to be a source
of such information. This result might reflect the
reluctance of both breast cancer survivors and
health care providers to communicate about CAM
because its efficacy has not been established.
Reasons why breast cancer patients hesitate to
disclose CAM use to their physicians include the
fear of a negative response and uncertainty about
whether or not CAM would be effective (Adler
& Fosket, 1999; Astin, Reilly, Perkins, & Child,
2006; Wong-Kim & Merighi, 2007). However,
Verhoef, Mulkins, Carlson, Hilsden, & Kania
(2007) reported that patients want this guidance
from the health care provider because they feel
frustrated and overwhelmed by the amount of
available information and find it difficult to identify
those sources that are reliable. Therefore, future
research aimed at interventions to develop positive
communication between health care providers and
breast cancer survivors is needed.
With regard to the attitudes toward CAM use
in professional care providers, a previous study
showed that two-thirds of health care providers
were willing to combine CAM with conventional
treatment for a curable disease. However,
inadequate knowledge about CAM was reported
as a barrier for providers (Lee, Hlubocky, Hu,
Stafford, & Daugherty, 2008). Although many
physicians may advocate a holistic approach,
inconclusive and conflicting evidence about the
benefits of CAM may make them reluctant to
prescribe them (O’Beirne, Verhoef, Paluck, &
Herbert, 2004). Previous studies showed that
most physicians questioned the efficacy of CAM
due to lack of solid research evidence on CAM’s
effectiveness (Salmenpera, Suominen, & Vertio,
2003; Samano et al., 2005). Therefore, future
research to develop a reliable evidence-base for
CAM is needed.
The literature revealed a variety of reasons
that breast cancer survivors use CAM, with the
main reasons being: to promote their physical
and emotional health and well-being, and to deal
with the effects of the disease and the treatment.
Reasons for CAM use in breast cancer survivors
might be explained by the fact that, although
they can gain the benefits from conventional
treatments, these treatments may cause them to
suffer from substantial adverse effects (i.e. hair
loss, fatigue, lymphedema, etc.) (Morrell et al,
2005). Supportive-educative nursing operations
that provide informational resources continue
to be needed as these survivors struggle to
increase self care abilities. As shown in the study
by Yap et al. (2004), women with breast cancer
who used CAM were those who had experienced
symptoms (e.g. stiffness, pain, numbness,
or swelling) in shoulder/arm than non-users.
Similarly, the study by Carpenter et al. (2009)
showed that women with breast cancer who had
poorer emotional functioning and more medical
problems were more likely to use CAM than those
who had better emotional functioning and who
did not have medical problems. This suggests
that the need for supportive-educative nursing
is greatest among those breast cancer survivors
who have already faced greater increases in
self-care demands.
Implications for Nursing
This literature review has focused on studies
exploring the use of CAM among breast cancer
survivors with the goal of enhancing self-care
agency for these patients. Survivors report family,
friends, and media as the main resources for
information about CAM use. As a result, nurses
who work with breast cancer survivors, especially
oncology nurses, need to learn more about
each type of CAM in order to improve nursing
care for them (Lengacher, Bennett, Kip, Keller,
LaVance, et al., 2002; Lengacher, Bennett, Kip,
Gonzalez, Jacobson, et al., 2006). The provision
of supportive-educative nursing in relationship to
various CAM will help survivors make informed
decisions about their self-care practices. Using the
SCDNT, nurses can help survivors learn to access
information about CAM, weigh their self-care
demands, identify self-care deficits, and consider
the influence of basic conditioning factors, thus
empowering them to select those interventions
most helpful to them. Furthermore, since family
members were seen as the primary source of
information about CAM by breast cancer survivors,
involvement of family members as dependent care
agents would also enhance self-care agency for
The challenge remains that reputable sources
of evidenced-base information on CAM available
to both breast cancer survivors and health care
providers are not adequate. Bott (2007) reported
that sources of information on CAM in relation
to breast cancer remain limited. Accordingly,
research in this particular area is needed,
especially studies to determine the efficacy of
CAM use as components of self-care agency for
This literature review also revealed that
health care providers are the least used source
of information about CAM for breast cancer
survivors when compared to other groups such
as family, friends, or media. This finding suggests
that there is a need to develop a communication
process between health care providers and breast
cancer survivors. Even though evidence about
the efficacy of CAM use in breast cancer is scant
or incomplete, Velicer and Ulrich (2008) posited
that discussion between health care providers and
patients is still important. Additional information
about why breast cancer survivors do not disclose
or use health care providers as their sources of
information is also needed.
In addition, this literature review showed that
the reasons for CAM use among breast cancer
survivors are associated with both physical and
psychological problems related to the disease
and treatments. As such, health care providers
should not discourage patients who use CAM
in a safe manner (Alferi et al., 2001). Qualitative
studies exploring the perspectives of individuals
who use CAM are needed (Adler, 1999; Verhoef,
Balneaves, Boon, & Vroegindewey, 2005).
Finally, some limitations of this review should
be noted. This review was based on original
studies that were conducted predominately in
the United States. Readers should be cautious in
inferring these results about CAM use by breast
cancer survivors to CAM use in other countries.
Consequently, further research in areas such as
Asia and Africa would provide additional information
about CAM use by breast cancer survivors. 
Acknowledgement
The authors gratefully acknowledge the
contribution of Dr. Constance W. Brooks, PhD,
APRN, BC – associate professor at Sinclair School
of Nursing, University of Missouri, in the review of
this manuscript.
References
Adler, S. R. (1999). Complementary and alternative
medicine use among women with breast cancer.
Medical Anthropology Quarterly, 13(2), 214-222.
Adler, S. R., & Fosket, J. R. (1999). Disclosing
complementary and alternative medicine use in the
medical encounter: A qualitative study in women
with breast cancer. The Journal of Family Practice,
48(6), 453-458.
Alferi, S. M., Antoni, M. H., Ironson, G., Kilbourn, K. M.,
& Carver, C. S. (2001). Factors predicting the use of
complementary therapies in a multi-ethnic sample
of early-stage breast cancer patients. Journal of
the American Medical Women’s Association, 56(3),
120-123.
Allen, J. D., Savadatti, S., & Levy, A. G. (2009). The
transition from breast cancer ‘patient’ to ‘survivor’.
Psycho-Oncology, 18(1), 71-78.
American Cancer Society. (2010) Cancer facts &
figures 2010. Retrieved September 6, 2010, From
http://www.cancer.org/acs/groups/content/@
epidemiologysurveilance/documents/document/
acspc-026238.pdf
Armer, J. M., Shook, R. P., Schneider, M. K., Brooks, C.
W., Peterson, J., & Stewart, B. R. (2009). Enhancing
supportive-educative nursing systems to reduce
risk of post-breast cancer lymphedema. Self-Care,
Dependent-Care & Nursing, 17(1), 6-15.
Astin, J. A., Reilly, C., Perkins, C., & Child, W. L. (2006).
Breast cancer patients’ perspectives on and use of
complementary and alternative medicine: A study
by the Susan G. Komen
Breast Cancer Foundation. Journal of the Society for
Integrative Oncology, 4(4), 157–169.
Balneaves, L. G., Kristanson, L. J., & Tataryn, D. (1999).
Beyond convention: Describing complementary
therapy use by women living with breast cancer.
Patient Education and Counseling, 38(2), 143-153.
Boon, H., Brown, J. B., Gavin, A., Kennard, M. A.,
& Stewart, M. (1999). Breast cancer survivors’
perceptions of complementary/alternative medicine
(CAM): Making the decision to use or not to use.
Qualitative Health Research, 9(5), 639-653.
Boon, H. S., Olatunde, F., & Zick, S. M. (2007). Trends in
complementary/alternative medicine use by breast
cancer survivors: Comparing survey data from 1998
and 2005. BMC Women’s Health, 7(4). Retrieved
January 30, 2009, from http://www.biomedcentral.
com/I472-6874/7/4.
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 Women’s
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.
Matthews, A. K., Sellergren, S. A., Huo, D., List, M., &
Fleming, G. (2007). Complementary and alternative
medicine use among breast cancer survivors. The
Journal of Alternative and Complementary Medicine,
13(5), 555-562.
Mayer, D.K., Terrin, N.C., Menon, U., Kreps, G.L.,
McCance, K., & Parsons, S.K., et al. (2007). Health
behaviors in cancer survivors. Oncology Nursing
Forum, 34(3), 643-651.
Morrell, R. M., Halyard, M. Y., Schild, S. E., Ali, M.
S., Gunderson, L. L., & Pockaj, B. A. (2005).
Breast cancerrelated lymphedema. Mayo Clinic
Proceeding, 80(11), 1480-1484.
Nagel, G., Hoyer, H., & Katenkamp, D. (2004). Use
of complementary and alternative medicine by
patients with breast cancer: Observations from a
health-care survey. Supportive Care in Cancer,
12(11), 789-796.
National Center for Complementary and Alternative
Medicine. (2009). The use of complementary and
alternative medicine in the United States. Retrieved
November 1, 2009, from http://nccam.nih.gov/news/
camstats/2007/camsurvey_fs1.htm
O’Beirne, M., Verhoef, M., Paluck, E., & Herbert, C.
(2004). Complementary therapy use by cancer
patients: Physicians’ perceptions, attitudes, and
ideas. Canadian Family Physician, 50, 882-888.
Orem, D. E. (2001). Nursing concepst of practice (6th).
St. Louis, MO: Mosby.
Owens, B. (2007). A test of the self-help model and use
of complementary and alternative medicine among
Hispanic women during treatment for breast cancer.
Oncology Nursing Forum, 34(4), E42-E50.
Owens, B., Jackson, M., & Berndt, A. (2009).
Complementary therapy used by Hispanic women
during treatment for breast cancer. Journal of
Holistic Nursing. 27(3), 167-176.
Patterson, R. E., Neuhouser, M. L., Hedderson, M. M.,
Schwartz, S. M., Standish, L. J., & Bowen, D. J.,
et al. (2002). Types of alternative medicine used
by patients with breast, colon, or prostate cancer:
Predictors, motives, and costs. The Journal of
Alternative and Complementary Medicine, 8(4),
477-485.
Ribeiro, M. A., & Harrigan, R. C. (2006a). The use of
complementary and alternative medicine by Asian
women of Hawai’i in the treatment of breast cancer.
Hawai’i Medical Journal, 65(7), 198-205.
Ribeiro, M. A., & Harrigan, R. C. (2006b). A literature
review on complementary and alternative medicine
for the treatment of breast cancer: Hawai’i. Hawai’i
Medical Journal, 65(7), 190-197.
Salmenpera, L., Suominen, T., & Vertio, H. (2003).
Physicians’ attitudes towards the use of
complementary therapies (CTs) by cancer patients
in Finland. European Journal of Cancer Care, 12(4),
358-364.
Samano, E. S. T., Riberio, L. M., Campos, A. S., Lewin,
F., Filho, E. S. V., Goldenstein, P. T., et al. (2005).
Use of complementary and alternative medicine by
Brazilian oncologists. European Journal of Cancer
Care, 14(2), 143-148.
Saxe, G. A., Madlensky, L., Kealey, S., Wu, D. P. H.,
Freeman, K. L., & Pierce, J. P. (2008). Disclosure
to physicians of CAM use by breast cancer patients:
Findings from the women’s healthy eating and
living study. Integrative Cancer Therapies, 7(3),
122-129.
Simpson, P. B. (2003). Family beliefs about diet and
traditional Chinese medicine for Hong Kong women
with breast cancer. Oncology Nursing Forum, 30(5),
834-840.
Velicer, C. M., & Ulrich, C. M. (2008). Vitamin and mineral
supplement use among US adults after cancer
diagnosis: A systemic review. Journal of Clinical
Oncology, 26(4), 665-673.
Verhoef, M. J., Balneaves, L. G., Boon, H. S., &
Vroegindewey, A. (2005). Reasons for and
characteristics associated with complementary
and alternative medicine use among adult cancer
patients: A systematic review. Integrative Cancer
Therapies, 4(4), 274-286.
Verhoef, M. J., Mulkins, A., Carlson, L. E., Hilsden, R. J.,
& Kania, A. (2007). Assessing the role of evidence
in patients’ evaluation of complementary therapies:
A qualitative study. Integrative Cancer Therapies,
6(4), 345-353.
Vivar, C. G., & McQueen, A. (2005). Informational and
emotional needs of long-term survivors of breast
cancer. Journal of Advanced Nursing, 51(5), 520528.
Wendy, W. (2010). Building cancer survivorship care.
American Journal of Nursing, 110(4), 17-18.
Wong-Kim, E., & Merighi, J. R. (2007). Complementary
and alternative medicine for pain management in
U.S.- and foreign-born Chinese women with breast
cancer. Journal of Health Care for the Poor and
Underserved, 18(suppl.4), 118–129.
Yap, K. P. L., McCready, D. R., Fyles, A., Manchul, L.,
Trudeau, M., & Narod, S. (2004). Use of alternative
therapy in postmenopausal breast cancer patients
treated with tamoxifen after surgery. The Breast
Journal, 10(6), 481-486.
Self-Care Deficit Nursing Theory in
Ingolstadt – An Approach to Practice
Development in Nursing Care
Monika Hohdorf, RN; M.Sc
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. Orem’s 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
Introduction: Context of Proposed Change
The Diagnostic Related Groups (DRG)
system was introduced into the German health
care system in 2004. This was done in response
to exploding expenditures for social welfare
and healthcare due to chronic illness, an aging
society, and the complexity of treating patients
with multi-system health care problems. The
goals of this initiative were to reduce the length of
patient stay in acute care hospitals and to lessen
the consumption of costly inpatient resources.
This new payment system represented a radical
shift from traditional reimbursement and led to
increased pressure to meet the needs of medically
complex patient situations. Consequently, the role
of the nurse in the health care system needs to
be reorganized with the focus shifted to the health
care demands of patients from the moment they
enter the health care system, throughout the
hospital stay, and continued care at home.
With this shift, German health care consumers
became the ‘third party’ in the national health care
system. As such, they were expected to assume
more responsibility for their own health situation,
on the premise that they best understand their own
health needs and thus are competent to decide
what resources they need. The consumers of
health care services are now expected to actively
participate in health care decisions; and, as a
result, contribute to direct cost control of national
health care resources. In order to facilitate this,
German health care policy now mandates health
care professionals to strengthen the consumers’
competency to participate in planning and
determining their health care. Consequently,
the nursing profession is challenged to change
traditional nursing care delivery systems. Nurses
are now asked to take over responsibility for the
quality of care provided, to justify the need for
nursing actions targeted to individual needs, and
to quantify nursing services in order to clarify
nursing’s contribution to the nation’s health.
Nurses must focus on health care problems
involving multi-system disorders, co-morbidity,
case complexity, and duration of health care
needs which impact the clients’ ability to care
for themselves. Nurses are also called upon to
actively control the length of stay in hospitals and
ensure that health deviation self-care requisites
are met by the patients and their dependent care
agents when they are discharged from hospital.
Unfortunately, the German nursing force is ill
prepared to respond to the national demand for the
increased scope of nursing care required. There is
a need for more advanced educational preparation
to meet the new challenges facing nurses.
In addition, the issues of professional versus
technical status of nurses, the lack of professional
autonomy, domination by a strong medical model,
and the absence of a clear statement of the scope
of nursing practice remain unresolved.
In 1992, nursing education in Germany
became available in the university setting. With
this move, studies in nursing science, nursing
research, and professional role development were
recognized as crucial components of nursing.
However, there is no history of a nursing theory
component in Germany compared to some
other countries. Indeed, attempts to establish a
scientific infrastructure based on nursing theory
has been met with resistance from the nursing
professional organizations (Brandenburg et al.,
2003). Thus, there remains a lack of awareness
about the specific perspective of nursing – what
it is, what it should be and what impact nursing
has on the person’s state of health. It seems
more and more obvious that without a nursing
perspective on health related issues, nursing
is only a superficial and subordinate activity
that cannot be named or measured. If nursing
is to justify itself as a profession with actions
separate from that of medicine, it must be able to
articulate its overall relevance to the health care
system and to the health outcomes of patients.
Nursing knowledge needs to be made explicit,
meaning that what nurses think and how they
finally decide to act must be set in the context of
patient needs. Therefore, nurses must be able to
relate nursing actions to the actual care needs
of people when those people are not able to
provide continuously for themselves because of
the amount and quality of self-care they require
(Orem, 1997). Thus, practitioners of nursing must
develop nursing knowledge that provides “in depth
nursing knowledge and experience based on a
theoretical nursing framework, which continues to
explore, explicate and develop nursing knowledge
and technologies based on the concepts of that
theory” (Nickle, 1998).
In addition, nursing education in Germany
does not adequately address nursing diagnosis.
There is no common understanding about
the structure, the process and the relevance
of nursing diagnosis to nursing practice. The
process of care is defined as a process of
systematically gathering information that justifies
health care assistance, health care support, or
complete delivery of health care actions. Nurses
often fail to collect information in a systematic
manner and fail to communicate their findings
effectively with other health care professionals.
As a result, their information does not provide
a clear understanding of the patients’ deficits.
Consequently, while the pathophysiology of the
patient’s condition may be understood, other
factors that impinge on overall health are not
analyzed. Often those assessments nurses
consider relevant for nursing care are not
addressed. Thus, a nursing theoretical structure
that systematizes the process of data collection,
relates the information gathered to the individual
patient’s self-care needs, and guides the
interventions and action considered necessary to
adequately respond to them might prove helpful
to structuring nursing care.
Conceptualizing the Program
In 2005, the nurse management team at
one hospital in Germany decided to implement a
program for the nursing work force. The goals of
the program were to improve the quality of nursing
care provided and to adequately respond to the
needs of future health care development. This
decision was based on the belief that the “future
nurse” would have to work in increasingly complex
situations and would have to manage increasingly
complex care. To meet this challenge, the role of a
clinical nurse case manager was introduced. In this
role, nurses would be asked to identify patients’
health care demands on admission to the hospital,
to devise nursing strategies to address these
demands during the hospital stay, and to develop
ways to meet these demands as patients segue
from the hospital environment to the home. The
team selected Orem’s Self-Care Deficit Nursing
Theory (SCDNT) to provide the organizational
framework for the new program and for the
new nursing system. This decision provided a
theoretical approach to shape the decision-making
process and describe the operational process of
nursing (Orem Study Group, 2004, Taylor, 1998).
Use of a nursing theory “...suggests appropriate
facts to be gathered and the relatedness of data
and provides the structure for the reasoning
process” (Taylor, 1998 p.112).
Orem (1997) postulated that people can and
want to learn self-care. In order to meet what she
defined as self-care requisites, they use their
self-care abilities (or access help in the form of a
dependent-care agent) to meet the demands they
face. As long as self-care abilities equal or exceed
self-care demands, they (or their dependent care
agents) have no need for nursing. When the
demands exceed the abilities, a self-care deficit
occurs. Orem defines self-care deficit as the
relationship between the existing self-care agency
and self-care demand of persons, when self-care
competencies are inadequate to satisfy self-care
demand. Within this theoretical framework, nurses
can identify self-care problems and plan care
based on case complexity and health related risks,
select the related demand for case coordination
during hospital stay, and plan for the acquired
need of information and education for patients.
Information can also be organized quantitatively
and qualitatively and be classified according to
nursing interventions.
According to Taylor (1998) “...the way the
individual nurse conceptualizes nursing is
reflected in the process of information gathering,
diagnostic reasoning, and clinical decision
making as well as in the selection of methods
of assisting and designs for action that produce
nursing results” (p.112). The SCDNT provides the
basis for nurses to systematically collect data and
appraise the individual demand for nursing care,
shape communication, select nursing objectives
appropriate to meet patient’s self-care demands
and guides the development of instruments and
technologies. Adopting the view that the need
for nursing exists the moment self-care demand
exceeds self-care agency supports the change
toward a patient centered approach of care.
Selecting a communication tool
In order to improve and coordinate patient care,
decisions made by nurses must be individualized
to the patient situation, information collected by
nurses must be clearly communicated to other
health care providers and nurses must actively
intervene and support the therapeutic selfcare demands of patients. Orem stated, “The
conclusions or judgements made by nurses must
be labelled in order to communicate what is known
about the situations and what has been done and
should be done” (Orem Study Group, 2004, p.13).
Nursing diagnosis helps achieve a systematic
process for organizing and communicating nursing
judgements. Thus, nursing diagnosis as “...a
means of communication became the term used
to refer to a series of judgements about
• a therapeutic self-care demand present at
a point in time,
• self-care capabilities and limitations and
a judgement about potential for change,
and
• the relationship between the two” (Orem
Study Group, 2004, 14).
Applying Orem’s theory to practice provides
a guide to predict, describe and explain the
phenomena of nursing and helps nurses to
discover why patients need nursing care. The
introduction of the SCDNT focuses nursing care
on the determination of patients’ abilities to provide
self-care in order to strengthen their self-care
competency. Coupled with nursing diagnosis,
nurses can finally come to a statement where
they describe these phenomena that indicate
that patients or their dependent-care agents
show deficiencies of competencies to maintain
self-care.
Initiating the program
Initially, there was resistance to this program.
Traditional hospital structures, work load and work
environment did not favour organizational change.
Indeed, the nurses themselves considered the
proposed changes as painful and unnecessary.
They did not consider nursing diagnosis as a
change that was necessary nor did they value
a nursing theory based nursing service. There
were three major obstacles in the attempt to move
forward with the changes:
• “Nurses in practice settings do not accept
theoretical concepts which in their view are
a contrast to their practice fields.
• Nurses in practice settings are critical of
theories, often viewing theory as something
that is incompatible with practice.
• Nurses’ efforts in practice mostly relate to
human behaviours, even if no scientific or
nursing specific system of explanation for
a course of nursing actions exist” (Bekel,
1998 p.7).
Within this atmosphere, strategies had to be
developed to successfully implement a theoretical
approach to guide daily nursing practice. Hence the
team decided on measures which hopefully would
impact practice development quickly, result in
short term success to satisfy hospital management
concerns, and demonstrate positive results to the
nurses in order to change their personal beliefs
and knowledge about the effectiveness of using
nursing theory to guide practice. The long range
goal was to stabilize practice development and
introduce a model of patient-centered care in
which the patients’ health care needs would
stimulate organizational development. The
hospital management team set the following goals
for implementing the program:
• “Decrease in discontinuity of nursing
processes related to patient treatment.
• Decreasing discontinuity of interdisciplinary
treatment processes of patients.
• Development and utilization of nursing
specific language related to nursing theory”
(Bekel 1998 p.7).
Implementing the Program
Between the years 2005 to 2007, the nurse
management team developed an educational
program introducing the SCDNT for all nurses
who had completed three years of basic nursing
education. To encourage and strengthen the use
of theory in practice, the nurses were taught the
method of case analysis as a way of gathering and
synthesizing data. Case analysis is an approach
to problem solving where nurses develop their
ability to conceptualize and develop creative
nursing care in actual clinical practice. This relates
theoretical concepts to clinical reality, enabling
nurses to relate their implicit knowledge to what
they perceive when they look at an individual
patient’s health care situation (Andrews, 1996).
The SCDNT provides a frame of reference that
sets data into context enabling nurses to ‘frame
the problem’ and reduce case complexity, thus
providing nurses with a cognitive structure which
they internalize as a ‘cognitive map on demand’ in
order to guide their reasoning process. By focusing
on issues that impinge on a patient’s health care,
nurses develop strategies and actions specific to
nursing to help the patient achieve the necessary
self-care abilities to regulate therapeutic self-care
demand. To this end, an Orem based instrument
for systematic data collection was created (Bekel,
2004). This instrument helped guide nurses to
look at data they had not previously considered
as relevant prior to implementing the plan of care.
(see Table 1)
Nurses were also taught to use Orem’s basic
conditioning factors (BCFs) in their assessments.
The BCFs influence an individual’s ability to
take part in self-care. BCFs include age, sex,
developmental stage, socio-cultural orientation,
dynamics of health care system, dynamics of
family system, patterns of living, environmental
factors and resource adequacy and resource
accessibility (Orem, 2001, p. 167). For example,
a patient’s age, health state, the existing family
system, existing access to the general practitioner,
and access to the health care system are
characteristics that influence an individual’s selfcare agency and affect whether patients are able
to meet their therapeutic self-care demands.
Indeed, therapeutic self-care demand exceeding
self-care capability is a contributory cause of
hospital admission. Using the foundations of
Orem’s theory enables nurses to identify factors of
self-care demand that exceed self-care abilities.
Selecting and Educating the Participant
Nurses
A human resource program designed to
sustain the integration of nursing theory based
practice and to provide the basis for organizational
change was implemented. Specifically selected
nurses participated in this 2 year training program.
Nurses were chosen based on two criteria: first,
for their potential for leadership in health care and
second, for their ability to deal with controversial
change issues, such as the demand for change
in the processes of care, the structure of hospital
organization and the provision of health care
services. Since university programs designed to
help nurse practitioners acquire the necessary
skills were either non- existent, or the nursing
staff did not have the entrance qualifications
for enrolment, it became necessary to develop
a hospital based program. While this program
was supported and recognized by the hospital,
no academic credits were awarded at the end of
the course.
In this program, emphasis was placed on
the development of a deep understanding of
the concept of self-care. Nurses were taught
to systematically analyze health deviations
and their impact on self-care abilities versus
Table 1: Orem-based instrument for systematic data collection (Bekel, 2004).
1. Issues of degree of severity of patient needs:
a. Primary medical issues like symptoms of the disease which caused admission
b. Medical procedures to be considered during hospitalization
c. Medical prognosis as predicted by the medical doctor
2. Issues of the existing care system before admission
a. b. c. d. Impact of disease on present self-care abilities
Recent changes in self-care demand or self-care abilities
Relevant basic conditioning factors and patient power components
Ongoing needs for dependent-care agent or a professional nurse
3. Issues relevant to coordination of care while in hospital
a. Case complexity
b. Nursing systems applicable in relation to patients self-care deficits
c. Health care professionals involved
demand, self-care deficits and the identification of
therapeutic self-care demands. They were taught
to isolate a health care phenomenon perceived
within their daily practice, aggregate knowledge
available by literature research as through data
collection from different sources (including
patients or relatives), synchronize with existing
information and develop solutions and strategies
to improve patient care or provide educational
programs for patients to strengthen self-care.
Nurses were introduced to aspects of evidence
based strategies of research. There was a strong
focus on the patient’s perspective as an essential
part of all aspects of nursing care provided in order
to effectively strengthen autonomy, to enhance
participation, and strengthen self-care abilities in
order to improve the quality of care provided.
In addition, the program covered aspects
of knowledge development including literature
reviews, ways and methods to collect and process
patient information, nursing diagnoses and nursing
classifications, aspects of diagnostic reasoning
and decision making, aspects of nursing science
and research and issues of leadership. Nurses
demonstrated knowledge development through a
written final report following standards for a thesis
with a formal defense of their projects. Reports
were presented publically to the hospital’s nursing
community and are archived in the hospital’s
library. Nurses who participate in the program also
present the results of their work internally at an
annual conference open to the hospital staff. This
program has now been in effect since 2005.
Results
Although, to date, there has been no empirical
evaluation of the educational program and
its impact on professional and organizational
change, anecdotal results can be reported (see
Box 1). Nurses who participated in the training
initiative were positioned at points where patients
enter the hospital, such as in the emergency
department. They identify risks related to unmet
self-care demands and demands of increasingly
dependent patients (for instance, patients who
have increased self-care or dependent-care
needs due to beginning dementia, or missing
or unstable support systems. They assess the
potential therapeutic demands and self-care
abilities needed when the patient is first admitted
to the hospital, develop a plan of care for the
period spent in hospital, and plan for continued
care after the patient has been discharged.
The results of this program indicate improved
communication with other health care professionals
as noticed by such colleagues as physicians,
physiotherapists and social workers. The work
relationship between nurses and doctors has
improved considerably due to the fact that nurses
now contribute specific information related to
changes in patients’ self-care demands or selfcare abilities that affect self-care agency. This
information has proved to be relevant to medical
decisions made.
Positive effects have been seen in the delivery
of care and in individual nursing competence and
nurse agency. Nurses develop an understanding
of patients’ health situations and gain an insight
that enables them to understand how these
situations developed, sometimes over a long
period of time. They look more closely at factors
that impinge on an individuals’ health status,
determining individual demand for nursing and
increasingly setting immediate or long term health
targets with individuals and their families. Nurses
manage to develop a more comprehensive view
of health demands as well as the facts that directly
affect individual care situations. Results are:
• improvement of communication between
nurses and patients/ family members
concerning quantity and quality of care
• consideration of self/dependent care needs
beyond hospital discharge – a phenomenon
nurses never perceived before
• early referral to other health care agencies
and social care experts
• earlier application for rehabilitation following
discharge
• improved quantity and quality of docu
mentation.
Hospital management proposed a catalogue of
measures where qualified nurses who underwent
the 2 years academic training are now considered
jointly responsible when generating protocols and
codes relevant for reimbursement (as requested
by the DRG-System). Measured results show a
slight decline in length of hospital stay in complex
care situations, specifically linked to nurse
assisted case management.
A percentage distribution of care systems in
a group of patients screened by case managers
between February 2006 and November 2008
is presented in Figure 1.The “rate screening”
refers to the overall number of 18,175 patients
being screened by nurse case managers. The
“rate CM” refers to these patients within this
group, who show a need of nurse assisted case
management.
At present, specially trained nurses can
compensate for about half of the patients
who would need special attention due to their
therapeutic self-care demand and their existing
self-care system. Anecdotal information suggests
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
investment in a program designed to provide a
foundation for its nursing work force that enhanced
the professional skills of the nurses and enabled
them to play a key role in the provision of patient
care. This project resulted in an improvement in
nursing practice with a focus on the development
of the diagnostic reasoning process used by
nurses through the use of the SCDNT. The goals
to improve nursing language, strengthen the
process of care and emphasize clinical decisions
that are specific to nursing were met. Nurses now
assume responsibility and determine the demand
for nursing care of patients on admission, identify
Box 1: Anecdotal Information about the Success of this Program
Characteristics of patients showing a need for a nurse case manager include
•
•
•
•
•
age > 70 years,
mean age 74.3 years, 50% of patients are between 68 and 83 years old
in general make use of professional nursing care services, like home care services or reside in a nursing home
show existing demand for wholly or partially compensatory nursing care when admitted
show existing self-care demand due to
- cognitive imbalance
- liquid imbalance
- nutrition imbalance
- altered respiration
- altered communication
- problems with medication
risks related to an imbalance between self-care
demands and self-care abilities and the need
for a dependent-care agent and then effectively
coordinate patient care during a hospital stay. The
SCDNT remains a strong foundation for practice
at this hospital. 
Acknowledgements
My acknowledgements to Gerd Bekel, who
with much patience continuously guided practice
development in Ingolstadt Hospital. He served
as consultant in the development of this program
and continues to provide consultation in its
implementation.
My acknowledgements also to hospital
management for providing continuous support
and assistance in the program development and
evaluation.
References
Andrews M., Jones P.R. (1996). Problem based learning
in an undergraduate nursing Programme: A case
study. Journal of Advanced Nursing. Vol 23, pp
357-365.
Bekel G. (1998) Theory-Based Nursing Practice
in Germany. The International Orem Society.
Newsletter. Vol 6 (2), pp 6-7.
Bekel G. (2004) Erfassung der Fallproblematik.
Fallmanagement Übungsbogen. Version 5.5. 20042008. gbconcept.
Brandenburg H., Dorschner S. (2003) Pflegewissenschaft
1. Lehr- und Arbeitsbuch zur Einfuehrung in die
Pflegewissenschaften. Verlag Hans Huber Bern.
Nickle L. (1998) Some Thoughts About Advanced
Nursing Practice. The International Orem Society.
Newsletter. Vol 6(2), 1-6.
Orem D.E. (1971) Nursing Concepts of Practice. New
York: McGraw-Hill.
Orem D.E. (1997) Strukturkonzepte der Pflegepraxis.
Deutsche Ausgabe von Gerd Bekel. Verlag Ullstein/
Mosby Berlin/Wiesbaden.
Orem D.E. (2001) Nursing Concepts of Practice (6th
Edition). St. Louis: Mosby.
Taylor S.G (1998) Clinical Decision-Making from The
Perspective of Self-Care Deficit Nursing Theory. The
International Orem Society Newsletter. Vol. 6(1).
The Orem Study Group (2004) Publication on the Occasion
of the 8th World Congress S-CDNT, Sept.29-Oct.3,
2004 Ulm Germany. Diagnostische Schriften.
Institut für Pflegediagnostik und Praxisforschung.
Cloppenburg. Germany.
Spotlight on Vietnam
Interim Report on Project Funded by the Sarah E. Allison
Foundation, Inc: Advancing the Introduction of the SelfCare Deficit Nursing Theory into Vietnam by Supporting
the Scholarly Productivity of Vietnamese MSN Graduates
of the University of Medicine and Pharmacy Ho Chi Minh
City and Teaching an Introduction to Nursing Theory to
BSN Students
Dr. Violeta A. Berbiglia
Purpose
The specific aim of this ongoing project is
to support an ongoing nursing research and
scholarship initiative utilizing the Self-Care
Deficit Nursing Theory (SCDNT) framework in
Vietnam. The initiative is two-pronged: one, the
fostering of SCDNT-framed nursing research in
Vietnam, and two, the mentoring of Vietnamese
BSN students in the understanding and use of
the SCDNT. The overall goal is the improvement
of nursing practice and nursing education in
Vietnam through the theoretical guidance of the
SCDNT. The project will be completed Spring,
2011.
Funding
This project was funded by the SEA Foundation,
Inc, the Friendship Bridge Nurses Group, and
Madison Square Presbyterian Church of San
Antonio, TX. Elsevier Publishers contributed
selected textbooks.
Background
A base for this initiative was established by
my introducing post graduate and MSN students
to the SCDNT in all nursing courses I taught in
Vietnam for the Friendship Bridge Nurses Group
( Jarret, Hummel. & Whitney, 2005 http://www.
friendshipbridgenursesgroup.com/mission.html),
2000 through 2009. Subsequently, the SCDNT
was incorporated into MSN level theses research.
The first two SCDNT-framed MSN theses were
completed at the University of Medicine and
Pharmacy Ho Chi Minh City in 2009. A third
SCDNT-framed MSN thesis was completed in
Fall of 2010. I was appointed to advise 4 theses
students and attended their thesis defense in
September. One of the four chose the SCDNT
for the theoretical framework for her thesis. While
in Ho Chi Minh City, I offered a 4 hour class on
Introduction to Nursing Theory to the BSN third
year students of the University of Medicine and
Pharmacy. The Theory of Dependent-Care was
featured.
Two of the MSN graduates will join me in
Bangkok to present their SCDNT guided research
at the 11th World Congress SCDNT. And, many of
the MSN graduates are considering attending.
Significance
This initiative clearly supports the
introduction of a beginning foundation for
SCDNT-based practice, research and education
in Vietnam. The University of Medicine and
Pharmacy Ho Chi Minh City MSN program
(http://en.moet.gov.vn/?page=2.4&view=4201)
was established through the efforts of the
Vietnam Ministry of Health and the Friendship
Bridge Nurses Group to advance nursing in
Vietnam. It is the first MSN program in the
country. It is expected that the MSN program
will produce professionals who will continue into
nursing doctoral programs and subsequently
become the administrators and faculty for
graduate nursing education in Vietnam. The
SCDNT foundation that they master will be a
significant contribution to nursing education and
practice in Vietnam.
The MSN Class of 2010 defended their
theses in September. During the past year, I have
been a thesis advisor to four MSN students. It
was my privilege to be a member of the Theses
Defense Committee, to hear 17 MSN candidates
defend. and to celebrate their success with
them.
BSN Introduction to Nursing Theory class
members who won educational games are shown
below. Forty seven 3rd year BSN students at the
University of Medicine and Pharmacy Ho Chi Minh
City participated. I would like to acknowledge the
invaluable assistance I received from Minh Khanh
Lu ( Hong Bang University faculty) and Ha Thi
Nhu Xuan (University of Medicine and Pharmacy
faculty) who translated class documents and
presentation for me.
University of Pharmacy and Medicine
Ho Chi Minh City MSN class of 2010
thesis advisees of Dr. Berbiglia
(Left to right: Ly Thi Phuong Hoa, Tran Thi Nhuy,
Dr. Vi, Vu Thi La, Nguyen Thi Minh Hang)
Vu Thi La’s thesis utilized the SCDNT as its
theoretical framework. She will present her
research at the 11th World Congress SCDNT 
Ho Chi Minh City BSN student winners of
SCDNT – Tell me about It game. The prize
was complimentary IOS memberships.
(Left to right. 1st row) Trinh Thi Yen, Kieu Thi Thuy Ngan, Dr.
Vi, Ha Thi Nhu Xuan (faculty translator), Nguyen Ngọc Thanh
Tuyen , Pham Thi Kieu Trinh
(Left to right. 2nd row) Vu Thi Thuy Nhai, Nguyen Hien Trang,
Nguyen Thi Thu Trang, Ka Transe Sor Lueng B.K, Nguyen Thi
Cam Nhung, Nguyen Quoc Vu
Ho Chi Minh City BSN student winners of
Nursing Theory Jeopardy. Elsevier publishers
contributed a theory text for their prize.
(Left to right. 1st row) Pham Thi Thanh Hoa, Thai Thi Hong
Phuc, Dr.Vi, Ha Thi Nhu Xuan (faculty translator), Nguyen Thi
Phuong Tien, Bui Thi Kieu Oanh
(Left to right. 2nd row) Pham Thi Nhu Sen , Ngo Le Thanh, Tran
Huynh Phat, Hoang Ngoc A, Tran Thi Thu Ha 
IOS Scholarship Research
Grant
The International Orem Society is pleased to offer
funding to support projects for the Advancement
of Nursing Science and Scholarship.
Purpose
The purpose of this funding opportunity is to
promote the advancement of nursing science and
scholarship in the area of Orem’s Theory of SelfCare Deficit Nursing. Priority is given to projects
that will lead to further advancement of knowledge
for the discipline of nursing.
Eligibility Criteria
• Applicants must be members of the
International Orem Society (IOS)
• Applicants must be ready to implement
research project when funding is received
and agree to publisha the results.
Grants available: One per year
Amount: $2,500
Deadline: October 1 of each year
Date of notice of the grant: November 15
Because funds are limited, they may not be
used for salary for grant applicants or institutional
overhead. They may, however, be used to hire
research assistants. Funds may also be used for
consultants, essential equipment and supplies,
telephone, necessary travel, and other relevant
costs. All budget items should be justified with
brief, clear rationale.
How to apply?
• Applicants must submit a completed
research proposal, signed research
agreement, and CV to:
Barbara Banfield, 34010 Ramble Hills
Drive , Farmington Hills , MI 48331 E-Mail:
[email protected] 
The Sarah E. Allison Foundation, Inc is a small
private foundation established in December 2000
for the purpose of promoting and supporting the
continuing development and formalization of the
practical science of nursing based on Dorothea E.
Orem’s conceptualizations about nursing. Small
grants will be given to encourage and promote
scholarly activities and studies in nursing for
the advancement of nursing knowledge and
improvement of nursing practice and nursing
education based on Orem’s general theory of
nursing, the Self-Care Deficit Nursing Theory, and
the associated foundational nursing sciences.
Areas of Interest: The Foundation seeks to:
1. Give priority to interpretive integrative review
and synthesis of what is known in relation to
conceptualizations associated with the selfcare deficit theory of nursing, for example, a
specific self-care requisite, bringing together
disparate pieces of knowledge that create a
new whole.
2. Support a new nursing research initiative within
the framework or related theoretical frameworks
of the self-care deficit nursing theory and the
foundational nursing sciences.
3. Support the development of working groups
seeking to advance the theory and produce
working papers suitable for publication; for
example, facilitate the formation of groups
of young scholars in establishing networks
working toward further development of the
theory.
4. Encourage writing of nursing textbooks for
undergraduate nursing students based on
the self-care deficit nursing theory and its
associated theories.
5. Provide seed money for pilot work of those
seeking larger grants or partially support work
in cooperation with other funding agencies,
such as the International Orem Society for
Nursing Science and Nursing Scholarship.
Grants Available
One or more grants may be provided per year
ranging in amount from $ 1000 to $ 5000
dependent on available monies and the merit of
the project in relation to the areas of interest of
the Foundation.
Criteria for Awards
Grants will be made to individuals demonstrating
apparent scholarly merit in terms of the
following:
1. Knowledge of the Self-Care Deficit Nursing
Theory, its conceptual components, and their
relationship(s) to other bodies of knowledge
and/or Orem’s other conceptualizations
2. Sound methodology
3. Potential contribution to further development
of the theory and nursing knowledge
4. Proposed project can be carried out within
a reasonable time limit in relations to funds
requested for the project
5. The findings and results of the work will be
published within a reasonable length of time as
determined by the Grants Award Committee.
6. Eligible recipients are professional nurses
or nursing students who meet the foregoing
criteria. However, the Foundation will place
greater priority on persons who are members
of the International Orem Society.
7. No restrictions or limitations on awarding
grants will be based on race, ethnicity, gender,
sexual orientation, religion, and employment
status of a prospective recipient.
8. If the proposal involves human subjects,
documentation of the proposal’s acceptance by
the appropriate institutional review body must
be submitted prior to receipt of the award.
9. A report of the project’s progress, findings and/
or accomplishments must be submitted to the
Foundation at the end of the award year.
10.Any subsequent publication of the work and
results emanating from the funded project
must acknowledge support from The Sarah
E. Allison Foundation, Inc.
expected date of funding. Foundation grants given
in association with other accepted funding sources
will be provided only when the applicant submits
a receipt of the award notification from the other
funding source(s).
Application
The applicant should submit a brief biographical
sketch of the principal investigator indicating
knowledge and experience and, in particular,
qualifications in relation to study of and application
of the self-care deficit theory of nursing and related
theories.
Give the title and briefly describe the specific
aim, background and significance of the project,
methods/procedures proposed, plan of work/
time line and budget. Any references cited in the
proposal must use the American Psychological
Association format.
Applications should be submitted in Microsoft
Word as an e-mail attachment to the address
given below:
The Sarah E. Allison Foundation, Inc.
260 Eastbrooke II
Jackson, MS 39216-4716
Email: FOUNDATION SEA @aol.com 
Time Frame
Grants are awarded on a yearly basis only. If a
project requires more than one year, reapplication
must be made each year.
The deadline for submission is April 1st of
each year. Grant award notification will be made
in July followed by funding in August.
Funding Limitations
A budget for the project must be submitted.
Note: The Foundation does not provide any
indirect cost reimbursement, such as for salaries,
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
Call for Papers
Self-Care, Dependent-Care, & Nursing (SCDCN)
is the official journal of the International Orem
Society for Nursing Science and Scholarship.
The editor welcomes manuscripts that address
the mission of the Journal.
Mission:
To disseminate information related to the
development of nursing science and its
articulation with the science of self-care.
Vision:
To be the venue of choice for interdisciplinary
scholarship regarding self-care.
the intention of the editor to facilitate the flow of
information and ideas. Authors are responsible for
checking the accuracy of the final draft.
Submission
Manuscripts are to be submitted in MS Word
format as an eMail attachment to the co-editor,
Dr. Violeta Berbiglia at violetaberbiglia@
hotmail.com. Submissions will be immediately
acknowledged. It is assumed that a manuscript is
sent for consideration solely by SCDCN until the
editor sends a decision to the lead author. 
Values:
We value scholarly debate, the exchange of
ideas, knowledge utilization, and development
of health policy that supports self- care and
dependent-care.
Author Guidelines
Manuscript Preparation
Use Standard English. The cover page must
include the author’s full name, title, mailing
address, telephone number, and eMail address.
So that we may use masked peer review, no
identifying information is to be found on subsequent
pages. Include a brief abstract (purpose, methods,
results, discussion) followed by MeSH key words
to facilitate indexing. The use of metric and
International Units is encouraged. Titles should
be descriptive but short. Full-length articles should
not exceed 15 double-spaced pages. Use of the
Publication Manual of the American Psychological
Association (5th ed.) is strongly encouraged but
not mandatory. When required by national legal or
ethical regulations, research-based manuscripts
should contain a statement regarding protection
of human subjects.
Review Process
Manuscripts are reviewed anonymously. One
author must be clearly identified as the lead, or
contact author, who must have eMail access. The
lead author will be notified by eMail of the editor’s
decision regarding publication.
Intellectual Property
Authors submit manuscripts for consideration
solely by SCDCN. Accepted manuscripts become
the property of SCDCN, which retains exclusive
rights to articles, their reproduction, and sale. It is

Self-Care Dependent-Care Nursing

Transcription

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