This is a critical analysis paper about the highly acclaimed film Wit. The film is centered on a middle aged professor who has just been diagnosed with stage four ovarian cancer. She agrees to undergo chemotherapy which is still in the experimental stage. During the film the physician’s focus is on research and there is very little consideration for the patient. This paper will discuss the nursing practices and theories that were used by the nurse in the film while caring for this patient at the end of her life. In our changing society nursing theories are an important guide for nurses to utilize in this dynamic field of medicine.
Introduction Nurses are trusted to care for people at their most vulnerable moments. In today’s modern healthcare system it is imperative that we utilize nursing theories to provide the best care to clients. Since the time of Florence Nightingale, nurses have been following various nursing theories to provide optimum care to their patients. These theories act as a guide to assist nurses in making changes in health care for the benefit of their patient. Nursing theories can also support professional autonomy and credibility within this field. The nursing theories that we utilize help us to provide the highest level of care to our patients.
These nursing theories can also help us to become well rounded as nurses so that we give the most appropriate care to people that need our services. In doing so we assist them to become individuals that can manage their healthcare needs. When individuals are unable to care for themselves, they need to trust that the nurse has the capability to attend to their needs in an effective way. This paper will summarize the film Wit, list the theorists used and explain their concepts. It will analyze how these concepts related to the nursing care provided.
The two theorists that this nurse mainly used to care for her terminally ill patient were the conceptual theories of Hildegard Peplau and Dorothea Orem. Summary of the Film Wit Wit, the movie is a film brought to the screen by Mike Nichols in 2001 to tell the moving tale of a lonely woman just finding out that she has stage four ovarian cancer. Vivian Bearing is a 48 year old College Professor who has lived alone, and has no friends or family. This story is about her valiant struggle to fight to live and ultimately, it ends up to be her struggle to accept her impending demise.
Most of the scenes are that of Vivian alone in her hospital room as she copes with the awful side effects of the drugs being given at full dose. Vivian’s physician and the young intern Jason are both focused on the wonderful research that they will have and therefore show very little concern for their patient and the misery she is going through. The only person to give support is her primary care nurse Susie Monahan RN. Throughout the movie there are many incidents where Susie advocates for her patient. One incident was when Vivian was in terrible pain and Susie fought with the doctors to allow her to have a pump for pain management.
She knew that Vivian wanted to remain in control as long as possible. The physicians didn’t listen to her but this showed that Susie had wonderful insight into what her patient felt. During the course of the film, Vivian through flashbacks does come to realize that maybe she could have been kinder to her students. She also comes to realize that she should have attempted to connect with people, but sadly hadn’t bothered. The viewer realizes during the film that Vivian had preferred her poems by John Donne to human contact. It is not until the end of the film that she finally sees that she had missed out on life.
One of the very last scenes is that of her Professor coming to visit her and finding her almost gone. She attempts to console her by reading her the poems of John Donne, Vivian protests and instead she reads her a simple child’s book which leads to her contentment, and she peacefully drifts off. Theoretical Concepts Dorothea Orem’s Self Care Model Orem’s theory of self care deficit delineates when nursing care is needed and in what situations. It provides that adults should be able to care for themselves and when not able to, nursing care then is needed and given.
Nursing care would be needed to provide services to return patients to optimum levels of health. During illness patients may require knowledge or new skills to deals with an illness or injury. The nursing system designed by the nurse is based on the assessment of an individual’s self care needs and on the assessment of the abilities of the patient to perform self care activities. If there is a difference between what the individual can do and what needs to be done to maintain optimum functioning, nursing is required (George, p. 18). Using Orem’s theory, the nurse uses a three step process to determine the needs of the patient, the plan of care, and the outcomes. Orem’s model allows for ongoing evaluations during the course of the patients illness. Nurse – patient communication is extremely important to determine the effectiveness of the nursing interventions. This of course will determine if further interventions are needed to return the patient to his/her prior state of health. (George, 2011) Hildegard Peplau’s Interpersonal Relationships In Nursing.
According the Peplau (1952/1988) Nursing is therapeutic because it is a healing art, assisting an individual who is sick or in need of health care. Peplau believed that nursing is viewed as an interpersonal process. This interpersonal relationship is established between two individuals during an interaction. Interactions can be with one or more people who are not known to each other. During this opening phase a relationship is started. Peplau believed that all people come with preconceived ideas that need to be discussed in order to move forward into a good working relationship.
It’s during this second phase, the working phase that effective communication skills are a requirement to find out how to best help the patient to solve his/her medical problems. During this phase a plan is worked out together with the patient to achieve optimum results. Very often during this phase the nurses as well as the patients preconceived ideas, customs, and beliefs may still need to be addressed and worked thru. The last phase of Peplau’s theory is the termination phase. At this point, evaluation is needed to determine that all the patient’s needs have been met.
The therapeutic relationship can then be dissolved. The patient and nurse according to Peplau have both grown and benefited due to this interpersonal relationship. (George, 2011) Role Analysis of the Nurse At many points during the movie you can see the nurse, Susie Monahan using the theories of Dorothea Orem and Hildegard Peplau. One of the first scenes that she utilizes Peplau’s theory is when they first encounter each other during her pelvic exam with Jason the research fellow, she is thoroughly humiliated and just with a simple smile from Susie they establish a relationship.
During the course of the movie Susie is her only caregiver and she follows Vivian’s lead on how much care she provides. As Vivian grows weaker and is less able to care for herself she intervenes. This method shows Susie using Orem’s self care deficit. One scene that she uses Peplau’s model is during a discussion they had about end of life issues. This very moving scene really cemented their growing relationship and each learned to trust the other. They were both able to foster a great working relationship and both nurse and patient gained wonderful insight into each other’s values about life and death.
Susie the nurse could than help to be an advocate for her patient when her patient was unable to do that for herself. In my opinion both theorist were utilized to care for this patient as she grew to require more and more care as the disease took her life. Susie went from only just providing minimal support and help to totally caring for all of Vivian’s needs. This would indicate the use of Orem’s theory. The termination phase in this case was to help Vivian deal with her own mortality. At the end of the film Susie had addressed this and all of her patient’s needs.
The patient was at peace with her decision to not prolong her life any longer and to die with dignity. Conclusion In conclusion, it is clear the wonderful profession nursing is. There are many theories as to what nursing is and many frameworks that are used to guide the profession. Orem’s Self Care Theory and Peplau’s Interpersonal Theories are just two of the theories used to set forward the high standards all nurses strive to achieve in the practice of nursing. One of the goals, as a profession, is to help improve the lives of patients and when that is not to be, to help them deal with death, and to die with dignity.