To Ms. Esteban, regarding your inquiry, I agrees that PREPARE ME theory can be still apply to any religion. The theory's context is bound to components on how to 'prepare' a patient on maintaining their quality of life and “Birthing” them to External life. Maybe the competency of the nurse to handle patients with different religions should be a "generalized" approached. But basically, what the theory was saying is, spiritual aspect of the patients with cancer should be address in a 'creative way' using the nurse's competency to execute the intervention holistically.

I just add up culture as a factor on patient's preparedness but I do not intentionally interchange it to religion because as what Ms. Esteban was saying, It is indeed a separate entity and context.

To Ms. Mendoza, I agree with your point regarding Leninger's theory, there is no doubt that culture should not affect the nurse-patient relationship. But my main concern is the difference in religion. Culture and religion are two very different aspects. And they have different impact on one's personality. Culture may be learned or acquired but religion is not. It is based on one's belief. And difference in beliefs cannot be resolved by any argument nor confrontation. And it certainly affects the relationship between people. In a study by Alan B. Astrow (2001), he emphasized that for the healthcare team to be able to affect the patient in a spiritual sense, the physician or the nurse must first cultivate his/her own spiritual life. In this context, are you still able to consider that the PREPARE ME theory of Abaquin is still applicable in the Philippine setting?

patients. Through the last decade, palliative care has become organized and was upheld by institutions. It is a comforting intervention for terminally ill patients wherein nurses are actively involved (Masters, 2005). The World Health Organization (WHO) stated that palliative care provides quality of life for terminally ill patients and their families physically, psychosocially and spiritually (2003). All of which were given attention to in “PREPARE ME”.
“PREPARE ME” appears to be impractical if applied on the status quo of the health care system in the Philippines, but I believe this may be resolved. With understaffing being a prevalent problem in health institutions, the onus for them is to improve their standards for recruitment and retraining their staff (Masters, 2005). From my point of view, the seemingly impracticability of “PREPARE ME” cannot be blamed solely on understaffing, but should also be accounted to qualifications by which nurses are hired. In the experience of nurses of our generation, the hospital entrance examinations and trainings are highly procedural and knowledge-based. This does not give equal importance to the nurses’ ability to use their selves therapeutically. It is vital for hospitals to consider what Joyce Travelbee proposed. She said that the spiritual values, ethical values, and philosophical beliefs of a nurse about suffering and illness will affect how he/she will assist patients and families through difficult times (Tomey, Alligood, 2002). These factors should also be examined during hiring. Therefore, even if the number of nurses that an institution can hire is limited, as long as they are selected by their knowledge and also their characteristics necessary to give holistic care, “PREPARE ME” may be applied practically.

According to WHO, palliative care addresses suffering effectively by identification ad assessment of pain and other problems (Masters, 2005). Assessing the patients’ need for “PREPARE ME” involves nurses’ sensitivity to verbal, non-verbal and objective cues. But I believe that this sensitivity should not only be applied at the end-of-life stage. By the onset of a terminal illness, “PREPARE ME” must already be an intervention. This supports Ernestine’s Weidenbechs’s philosophy that nursing deliberative action to help and not just reactionary to what patients manifest. This also embodies Abdellah’s philosophy that nursing anticipates needs and act on them, together with urgent needs. (Tomey, Alligood, 2002).

The interventions in “PREPARE ME” can be generally provided for terminally ill patients provided that they are coherent and the approach used is applicable to their condition and age. Katharine Kolcaba proposed that understanding patients’ comfort needs should be individualized (Tomey, Alligood, 2002). This leads me to say that other than breathing exercises, ways that are soothing for the patient may also be incorporated. For example, an auditory person may find music relaxing; and to a visual patient, videos of nature may be helpful. Whether a patient is auditory, visual, tactile or olfactory may be determined by patient’s request or interviewing the significant others about what they enjoy, or testing to which soothing intervention the patient responds to the most. These extra nursing actions may make “PREPARE ME” more effective.

To recognize the need for “PREPARE ME”, nurses must be observant. Subjective cues are verbalized by the patient of the family. They may express feelings of anxiety, sadness, or wanting to be ready in anticipation of death. They may also ask questions about death and dying such as “Do you think there is a heaven?”. Aetient may also verbalize that he/she is experiencing blurred vision, increased sensitivity of taste and smell. Obejctve cues have many physiologic manifestations. Respirations may change to rapid, slow shallow and irregular, noisy and rattling, or Cheyne-Stokes. The heart rate may slow down. The blood pressure progressively drops. The skin is cool to touch. The extremities become pale, mottled and cyanotic. Urinary output decreases gradually and incontinence may occur. Peristalsis decreases characterized by decrease in Borborygmi sounds, leading to constipation and gas accumulation. There may be sudden bowel movement before death. The patient slowly loses the ability to move, has difficulty swallowing and speaking, and gaga reflex. (Saunders, 2008)

“PREPARE ME” is socially and morally sound for all cultures. Palliative care for terminal illness allows the patient to die with dignity by alleviating pain and suffering (Masters, 2005). Generally, we believe that valuing people should not only happen when they are alive and healthy, but also during their dying days. “PREPARE ME” addresses this belief.

As a human being, “PREPARE ME” gave me a new perspective about valuing people. As a person, at every chance I would get, i should make my loved ones feel my presence in times of need, recall good past experiences with them, pray and be an avenue for them to re-evaluate and refurbish their values in their everyday lives. I can also apply “PREPARE ME” techniques when I am personally going through difficulties, not necessarily death.
As a nurse, I should seek to provide comfort and care to all my patients, not just to the terminally ill. “PREPARE ME” made me realize that if the dying deserve to be cared for with dignity, what more do the other patients. Every person deserves holistic care that would address their physical, emotional, social and spiritual suffering. ? I should treat all m patients with equal respect and dedication, regardless of their social status and the severity of their condition.
“PREPARE ME” does not only provide a framework for treating the terminally ill. With introspection, one can say that it suggests that nursing is about caring holistically for all patients and people, surviving and dying alike.

To Ms.Esteban. I fully agrees with you in your reflection especially on the moral and social implication brought about by the theory. But Mam Abaquin generalize the spiritual needs of a terminally ill/cancer patient on her PREPARE ME, setting aside the religion preference of each patient.

Cultural considerations should also be address in the theory as what Madeleine Leininger's Cultural Care proposing. A basic tenet of Leininger’s theory is that human beings are inseparable from their cultural background and the society to which they belong. So culture plays a special role in handling patients. We need to consider their beliefs and values. Nurses must also be culturally incline on caring for this patients.

But generally, the theory makes us feel that nursing is not just an ordinary profession but indeed makes us feel extraordinary by touching lives of each and every patients we had.

The way that I understand the PREPARE ME intervention by Abaquin is that the nurse must have compassion to be with the patient, sympathy to understand what the patient is going through, competence to give palliative care to the terminally ill patient, therapeutic skills to deal with the emotional and psychospiritual aspect of the patient’s life, and dedication to serve the patient during his last few days. I think that doing all the aspects of the PREPARE ME intervention would not take much time when dealing with patient. So, it is not the issue of understaffing that I am concerned of.

The PREPARE ME intervention will not take much time for, the way that I understand it, those are just guidelines of how a nurse would treat not just only the terminally ill patients, but also to any patient that he / she will interact to. According to theory by Jean Watson (1999), the human care process in nursing is a significant humanitarian and epistemic act that contributes to the preservation of humanity. This means that caring is the essence of nursing. And showing compassion, dedication, sympathy and being responsible to gain the necessary skills and competence are ways of expressing one’s care to another.

The PREPARE ME model of Abaquin is not a process, but it is a way of approaching the patient. It is not a process, so it is not necessary to allot much time in performing it. This means, the issue of understaffing is not the issue that we should be focusing on. I think that we should be focusing on the moral and social implications of this theory. Is it possible that the difference of culture and religion to affect this theory? I think it would. In the Philippines alone, many different religions are prevalent. According to the Philippine Census (2000), the percent of the different religions in the Philippines are as follows: Roman Catholic 80.9%, Muslim 5%, Evangelical 2.8%, Iglesia ni Kristo 2.3%, Aglipayan 2%, other Christian 4.5%, other 1.8%, unspecified 0.6%, none 0.1%. The difference in religion may affect the impact of the nurse-patient relationship. According study by C.G. Ellison(1998), a direct relationship between religion and the health care service was identified. If there is a difference between the nurses’ and the patients’ religion, how would the nurse give psychospiritual support to the patient? The patient may think that the nurse is not credible enough and attainment of holistic intervention may not be possible.

Caring for terminally ill patients and palliative care is very close to my heart. In my almost 1 year of practice as a nurse in a tertiary government hospital, I’ve seen and empathized with patients who are suffering from end stage illness like cancer. Dealing with terminal illness is obviously not a walk in the park. Not only is it taxing to the patient, it also is an emotional and financial obscurity to the patient’s relative or support system. Palliative care not only involves the patient who has terminal illness, it also includes the patient’s family, community and people taking care of him (Silveria, 2006). Nurses should have a deeper understanding and appreciation for caring for terminally ill clients more than just alleviating the pain with pharmacologic interventions because caring is the essence of nursing (Watson, 1979). The costs are also high in caring for patients with terminal illness or palliative care but its core caring aspect cannot be quantified to any amount of money. (Silveria, 2006)

Prepare Me interventions of Carmencita Abaquin is helpful in a lot of ways but mainly in providing a holistic approach in caring for terminally ill patients. Using these interventions or techniques do not need the use of machines or other equipment but ony the most basic function of a nurse which is to provide care by means of communication to say the least. It involves spending more time with the patient and “preparing” him for the culmination of his life. The contemporary issues hospitals are facing right now include understaffing, especially here in the Philippines which, ironically, produces more nurses than its hospitals can employ. Understaffing is an issue that must be addressed because a right amount of staff in nursing units caring for terminally ill patients is essential to the success of a palliative care plan and, subsequently, an empirical evidence of Carmencita Abaquin’s theory.
I believe that this theory would benefit a lot of terminally ill patients and it would have a positive effect on the perception of nurses in their profession. We, as nurses, should not concentrate on the medical aspect of end of life care and we should be reminded of our own identity which according to Lydia Hall (1963) is primary care that includes hands on bodily care and that is exclusive to nursing.

Furthermore, I also believe that we should have a more strong foundation regarding caring for terminally ill patient. Nurses who render end of life care should be spiritually and emotionally ready. Nurse educators should re-emphasize the importance of end of life care in order for their students to have a better understanding and appreciation of it so that we can have more nurses who are ready to face the challenges of this special and heartwarming part of nursing.

I applaud Carmencita Abaquin for doing a study on an area most nurses are not so much interested about. It reminds us of what our mission as nurses which is to care for our patients from birth till death and that we should give the patient the dignity that he deserves.

Nursing workload definitely affects the time that a nurse can allot to various tasks. Under a heavy workload, nurses may not have sufficient time to perform tasks that can have a direct effect on patient safety (Grifith, 1997). I think the PREPARE ME of Carmencita Abaquin will not be practical to use anymore when understaffed, because it takes time for a nurse to assess and establish a relationship with the patient. How could one nurse assess and establish a relationship with 50 patients all at the same time for example? Assessment is the initial part of he nursing process, forms the basis of the nurse interventions. A heavy workload can lead to poor nurse-patient communication (Davis, 2003). I think prioritizing the patients involves making sure extra time is found for patients that are more critical.


Assessment forms the basis of the nursing interventions. The essential requirement of accurate assessment is to view patients holistically and thus identify their real needs. Assessing the need for PREPARE ME is an implied nursing intervention a nurse should do on terminally patients like cancer. It can only be done if the PREPARE ME theory of Abaquin was known to a lot of nurses.

The PREPARE ME theory may not cure the disease of the patient, but it can treat the whole person, mind, body and spirit because of the Holistic approach. Using the holistic approach will change nursing from a draining job to a fulfilling profession. Nurses who build up trusting relationships prove a holistic approach to caring, show their understanding of patients’ suffering, are aware of their unvoiced needs, give comfort without actually being asked, and are consistent, proficient, and dedicated in their care.


Theoretical work of Peplau (1952) was critical to the development of the idea that the cover of the nursing practice is more than physical care. According to Spross (1996), primary interventions are interpersonal and the subjective status is given even greater priority in palliative care. So it will be the nurse’s responsibility to take note of the subjective cues of the patients that will also became the basis for the interventions.

PREPARE ME theory can improve the caring values of the nurses by means of the nursing interventions that can improve the quality of life of the patients. On terminally ill patients, the nurses usually feel the necessity to relieve the suffering, as time was short. The feeling that each nurse could achieve something and their hearts would be at ease.

The participants in this study were primarily cancer patients. It will be an opportunity to study the patients suffering from other illnesses where in it might find out different aspects of the phenomena that were explored on PREPARE ME theory.


Refrences:

Davis S, Kristjanson LJ, Blight J. Communicating with families of patients in an acute hospital with advanced cancer: problems and strategies identified by nurses. Cancer Nurs 2003;26:337-45.

Griffith CH, Wilson JF, Desai NS, et al. Housestaff workload and procedure frequency in the neonatal
intensive care unit. Crit Care Med 1999;27:815-20

Peplau H. (1952) Interpersonal Relations in Nursing: A Conceptual
Frame of Reference. G.P. Putnam, New York.

Spross J. (1996) Coaching and suffering: the role of the nurse in helping people face illness. In Suffering (Ferrell B., ed.), Jones and Bartlett, Boston, pp. 173–208

According to Stanton and Rutherford (2004), understaffing has a significant association to poorer health outcomes. Although it is the function of the nurse to offer a holistic approach, it is not practical to provide all of these interventions as part of their care plan of their patients due to factors such as understaffing. But it doesn’t mean that they can’t implement any of these. For instance, presence of the nurse and values clarification can already be imposed as the nurse is taking the vital signs or providing bedside care. Clustering of care plan for these patients can provide nurses more time in exploring clients’ needs thus, implementing PREPARE ME interventions as entailed by Carmelita Abaquin.

Assessment is based on the nurses’ clarification and exploration of the patients’ perception of their specific needs. However, assessments may vary depending upon how the nurses perceive the needs of the patients. Peruselli et al. (2004) concluded that nurses’ assessments were more congruent to the somatic symptoms by the terminally ill cancer patients rather than the psychological aspect. In assessing these patients, nurses are required to have a good therapeutic nurse-patient relationship to further explore what the client is trying to articulate on their psychological needs. Subjective and objective cues are part of the nurses’ knowledge and it is a patient-based that we could find certain indicators.

Nursing interventions that could improve Abaquin’s theory is the hospice care in which aside from the psychological aspect and spiritual guidance, it is necessary to provide coping strategies or approaches in terminally ill patient issues. Counseling to family members is significant intervention that could help patients to cope with their specific needs.

The implication of using this theory can be reviewed in a study by Rehse and Pukrop (2002) that psychosocial interventions can improve quality of life among adult cancer patients. It can improve our life as a human being as it give us a deeper understanding of our inner self, on how we view ourself as a unique person specially on the psychological perspective. It can improve our caring values as a nurse as we learn to appreciate patients’ views.

References:
Hospital Nurse Staffing and Quality of Care. Stanton, M.W., Issue 14. AHRQ, March 2004. Agency for Healthcare Research and Quality, Rockville, MD.

Peruselli, C, et al. "Nursing care planning for terminally ill cancer patients receiving home care." Journal Of Palliative Care 8.4 (1992): 4-7. MEDLINE with Full Text. EBSCO. Web. 27 June 2010.

Rehse B., Pukrop, R. Effects of psychosocial interventions on quality of life in adult cancer patients: meta analysis of 37 published controlled outcome studies. Patient Education and Counseling 50 (2003) 179–186

I would like to give emphasis to these 2 lines right here that Mr. Enrile and Ms. Reyes said, "the PREPARE ME theory serves as a wake up call to society to be more aware, understanding and empathic towards...patients" and "PREPARE ME is already an innate behavior as a nurse".

"the PREPARE ME theory serves as a wake up call to society to be more aware, understanding and empathic towards...patients" This line caught my eye and psyche because it made me think about the situation of cancer patients here in the Philippines. Does society do enough for them? do they get justice from us? It made me realize that a lot of things can do much better regarding cancer care especially here in our country; from assessment to dealing with death.

"PREPARE ME is already an innate behavior as a nurse". I am a firm believer that this line is true, Nurses have a natural affinity towards caring regardless what his/her motivations are towards caring. It just called being more humane and human, humane because you are acknowledging their need for caring and comfort. Being human is acknowledging their need for help and addressing their need.

Please continue to post your ideas and opinions regarding the manner.

Hope to see your posts soon.

It’s already been a year since I became a nurse. I have worked as a private duty nurse for the past 11 months now; I have been caring for different patients with terminal cases but I haven’t been reflecting too much on how my caring behavior is affecting my patients. Caring, I believe is the reason why God gave me my life so I have always been happy to serve my patients. I only appreciate my caring behaviors if a patient would tell me, “Salamat, dahil sa iyo mas mabilis akong gumaling.” Only with those words can I conclude and reflect that my nursing behavior towards my patient definitely made my patient better. Perceptions made by my patients really help me in improving my caring behaviors. Through reading the theory, it made me reflect the experiences I had and made me realize how important it is to care for patients holistically.

PREPARE ME interventions by Carmencita Abaquin can improve quality of life of patients especially with patients who are terminally-ill. These behaviors primarily will help the patients cope with their grieving process. But, I think that PREPARE ME is already an innate behavior as a nurse. As a private duty nurse, these behaviors included in the PREPARE ME are already reflecting as I care for my patients. Having only one patient in a home environment, I definitely have time to interact with my patient. In a typical setting during my day shift, we reminisce events in her life to help her in divert pain symptoms. As a therapy, reminiscence uses the recollection of the past to bring meaning and understanding to the present and resolve current conflicts. (Potter and Perry, 2005) It really helps the patient in all aspects. “Being with” the patient or Presence for example is an innate behavior as a nurse. According to Potter and Perry (2005), nursing behaviors include providing presence. Through presence, the nurse will be able to connect with the patient thus in return helps the patient understand himself/herself and identify solutions and making choices. Prayer, meditation and values clarification are all included in spiritual care. Spiritual health is achieved when a person finds a balance between his or her own life values, goals and belief systems and those of others. (Potter and Perry, 2005) As a Roman Catholic and a Filipino, I value spirituality myself and as a nurse I encourage my patients to pray and reflect. PREPARE ME is a set of interventions that is needed to be improved and enhanced especially that nurses tend to ignore or forget these aspects of care.

PREPARE ME interventions are needed in different clinical setting. It should be applied and demonstrated by a nurse. I also agree with Ms. Mosquera and Mr. Enrile in saying that understaffing is not a reason for not rendering these behaviors to patients. These behaviors should be innate in us, as caregivers, and should be reflected upon when caring for patients. Understaffing delineates the main problem which is lack of time. According to Carayon and Gurses (2008), under a heavy workload, nurses may not have sufficient time to perform tasks that can have a direct effect on patient safety. Although it really affects the nurse patient communication, we can still adjust to it like while preparing medications we can talk to our patient.

Through the PREPARE ME intervention, I realized how important caring for the patient holistically is. It also taught me how these behaviors are important in the quality of life of our patients. Effective palliative care requires a broad multidisciplinary approach that includes the family.(WHO, n.d.) Lastly, palliative care is not limited of caring for the patient alone but also caring for his/her family.

Understaffing is one of the problems in the hospital in giving holistic care here in the Philippines. The theory of Carmencita Abaquin is a good application to the nursing interventions. PREPARE ME in terminally ill patient is one of the good interventions a nurse can give to patient for them to meet peaceful death. But understaffing can somehow be one of the reasons for a patient who is dying will not meet a peaceful death. Due to this, a time for giving bedside care is very limited, but we can do about this by having another intervention. And I agree with Ms. Mosquera that this is not an excuse to give holistic care. "Patients don’t care how much you know until they know how much you care" (Dr. Sanjeev Singh), for patient who know that you care for them can give them satisfaction. In giving palliative care to the terminally & chronically ill patients & patients who cannot afford to come to the hospital for treatment or follow up are managed by Home care team. Team is manned by Palliative care doctor, Nurse, MSW, Health educator and daily visits 10 patient in an around 35 km of the hospital campus (Dr. Sanjeev Singh). By this, let us also remember that in giving care to our patient there is a collaboration to meet their satisfactions. Because as a nurse, we cannot do everything, we also seek help to others in the health team to fill the needs of our patients. In addition, palliative care is now considered an essential part of end-of-life care, yet little research examines the efficacy of interventions addressing the psychological treatment of dying patients. Forgiveness therapy has been shown to be effective in improving psychological well-being and may provide a valuable addition to a terminal cancer patient's overall treatment plan. Participants were given instruments in measuring forgiveness, hope, quality of life, and anger at pre-test, post-test 1, and post-test 2. After receiving forgiveness therapy, participants in both forgiveness treatment conditions demonstrated significant improvements on all measures. The aggregated effect size was large. The four-week forgiveness therapy demonstrated psychological benefits for elderly terminally ill cancer patients and thus may be an appropriate addition to the treatment plan for terminal cancer patients (Hansen MJ, et al, 2009).

Using the theory, me being a nurse will improve my values as I can see that giving holistic care to terminally ill patient or in all kind of patients will satisfy them and have them a meaningful life experiences through establishing a good relationship. Base on my experiences, building a good relationship to the patient and to the relatives will improve the sufferings of the patient, they recover faster and I can see that they want to live more to experience life. According to Kolcaba theory of comfort, it is the immediate and holistic experience of being strengthen through having the needs met for the three types of comfort ( relief, ease, and transcendence) in four context of experience (physical, psychospiritual, social, and environmental). Nurses’ comfort is often enhanced when we know we have comforted patients effectively. Giving comfort will have the patient a relaxed, peaceful and meaningful life even they face an end-to-life stage. This can be an addition to the theory of PREPARE ME.

I believe that PREPARE ME theory is very applicable to all patients not only to terminally ill cancer patient because all who needs our care is disserving to have a holistic care rendered by us.

I would like to commend Ms. Mosquera's reflection to our critique. She answered the guide questions that we included. I would like to suggest the other members to do so as well.

If you have any other opinions or thoughts about the theory, don't be afraid to mention it, so that we can lead to a discussion of some sort.

Hope to read your posts soon.

Understaffing of nurses is a complex problem that results to decrease in the quality of care rendered to the patients. Studies over the past several decades have shown an association between nurse staffing and patient outcomes. Because of understaffing, nurses are unable to spend adequate time with each patient, which reduces attention to the needs of the patient. Having said that, this problem can be solved through appropriate nursing staffing (Daleen, AP 2010). In the context of practicality to use PREPARE ME intervention in the understaffing situation, it is hard to justify such notion given that the problem lies in the lack of time of nurses. But that doesn’t mean that this theory is not applicable to the situation. As there are other means by which understaffing are being solved by the management like cross-training of nurses from other units and having them as floaters. As Nurse Manage said “understaffing isn’t an excuse for delivering poor nursing care (2002)”.

I believe that PREPARE ME theory elucidates the care needed by terminally ill patients. It defines what behaviors of a nurse are needed in providing emotional and spiritual support to the clients facing a difficult situation of accepting the realism of life-- that death is inevitable when the time comes. However, the concepts of PREPARE ME should also have included intervention that involves family members of the patients since they are also affected in coping with impending death. There are also cases that patient may only want the presence of the loved ones in the process, therefore, a concept of personal space should also be emphasized.

Since this theory was applied only to adult terminally ill patients, one recommendation to be added is the consideration of age-appropriate care like in case of pediatric patients. Adult and children have some commonalities in palliative care but children have different approach thus, extension of existing adult services into the pediatric world is needed (Summer, 2003)

Overall, Carmencita Abaquin’s theory of PREPARE ME, had achieved the vital things to be considered in giving care to a terminally ill patient. It has helped me realize that giving care encompasses the physical aspect, but also emotional and spiritual needs as well. I’ve also learned from her theory the importance of reminisce therapy. This is my first time to encounter an intervention that uses past experience of a patient in search for the meaning of his/her life in striving for emotional resolution. And I definitely agree in its importance to help the patient understand one’s self and to “find new meaning in the face of impending death (Butler, 1974).

References:
1.Daleen , A.P. (2010). Nurse staffing and patient outcomes in critical care: A concise review. Critical Care Medicine: Volume 38 - Issue 7 - pp 1521-1528

2.http://www.cancer.net/patient/Coping/End-of-Life+Care/

3.Lewis MI, Butler, RN. Life-review therapy: putting memories to work in individual and group psychotherapy. Geriatrics. 1974;29: 165-173.

4.Sumner, L. (2006).Pediatric care:The hospice perspective. In B. Ferrell
& N. Coyle, Textbook of palliative nursing (2nd ed.) ( pp. 909- 924).
Oxford, United Kingdom: Oxford University Press.

In response to Carlo's argument, I think it is impossible for a health care provider not to improve his/her life as a human being while caring for patients. Although the theory's main objective is to prescribe systematized care, covertly, the health care provider is also benefited from learning something (new) from the "caring" experience with the patient. All conditions, circumstances and influences that surround, affect the development and behaviour of the person (Andrews & Roy, 1991). A nurse who also has a social environment (and not just the patient), affects her development not just as "being nurse" but as a human being as a whole.

Learning theory and research have consistently concluded that learning opportunities provides a chance to "do" or experience the educational input, result in higher learning gains and retention (Richardson, 1994).

All principles (including this theory) are abstract. They become concrete only in the consequences which result from their application (Dewey, 1938). Aristotle once said, "For the things we have to learn before we can do them, we learn by doing them." Experiential learning is the process of making meaning from direct experience (Itin, 1999).