ASSUMPTIONS

The study assumes that

1. The oncology patients before surgery will experience preoperative anxiety.

2. Music is a non invasive method to reduce anxiety and has no ill effects on patients.

CONCEPTUAL FRAMEWORK

Conceptualization refers to the process of developing and refining abstract ideas (Polit and Hungler, 1993). A conceptual model
provides for logical thinking, of systemic observation and interpreting the observed data. They also give direction for relevant
questions on phenomenon and point out solutions to practical problems.

The framework for this study based on Theory of Goal Attainment by Imogene King.

This theory focuses on the patient as an individual. Each person in each situation is different.

Nursing is concerned with individual, who suffer or anticipate a sense of helplessness.

According to Goal Attainment Theory the patient behavior stimulates a nurse's reaction, which marks the beginning of the nursing
process discipline. This reaction is composed of five sequential parts of how a nurse react to a given situation, in which the oncology
patient

has developed preoperative anxiety, is charted next in schematic representation.

It is represented by a situation in which both the nurse and the patient perform care

It measures or other actions involving manipulative tasks or ambulation.

Here, either the patient or the nurse may have the major role.
The person is able to perform and leam to perform required measures of externally or internally oriented therapeutie self-care but
cannot do so without assistance.

The patient is doing all of the self-care and requires help in the areas of making decisions, controlling behavior, gaining knowledge
and skills.

the nurse's role is to promote the patient as a self care agent.

Theoretical framework

This study will adopt King’s theory of goal attainment as a theoretical framework. According to nursing theory, (2016), this nursing
theory focuses on dynamic Interaction between two or more persons to meet specific goal in specific time. It consists of three
systems which include:

Personal system-the individual

- Interpersonal system -individuals interacting with one another

- Social system-groups of people in a community or society sharing common goals, interests and values.

The series of actions, reactions and interactions that take place between the nurse and client based on mutual perception and
judgment of both are described in (FIGURE 1).

clinical-practice-goal-attainment

Figure 1: King’s theory of goal attainment.

The ultimate result is the shard goal attainment.

King’s theory will be applied to meet the goal of providing patients after (AHSCT) with health information needed to become ready to
discharge from the hospital (FIGURE 2). It is done through the application of the following concepts postulated by King’s theory
include growth and development, communication, stress, time, and satisfaction:

clinical-practice-current-study

Figure 2: Adaptation of King’s theory of goal attainment in the current study.

Growth and development

Assessing the patients’ age, gender, their expectation and goals from educational sessions.

Communication

Patient and researcher will communicate to set a mutual goal and collaborate to meet this goal.

Stress
Hospital discharge after (AHSCT) can be stressful event for the patients and may cause anxiety and depression for them, so the
researcher will assess anxiety level and depression for these patients and provide complete information using proper communication
channels to reduce anxiety and depression.

Time

Patients after stem cells transplantation complain from long time of hospital isolation, it can cause psychological upset. So the
researcher will fill part of this time by interacting with the patients, providing them with educational sessions, determine time to
perform different types of activities intended to be gained to help them deal properly with their own needs after discharge.

Satisfaction

Researcher will assess patients’ satisfaction by asking them to respond to questions at least two times at the end of sessions, then;
modification in the session will be done if needed.

Experimental method

One group pre-post-test quasi-experimental design was used to achieve the aim of the current study.

Procedure
An official permission was obtained from the hospital director, and director of stem cells transplantation unit for conducting the
study. Measures were taken to protect the patients’ ethical rights. Each patient was pre informed and asked to sign a written consent
after clarifying the purpose and the nature of the study. The study was conducted on four phases; assessment, planning,
implementation, and evaluation phase.

Assessment or initial phase

It involves collecting data through reviewing the literature dating back for at least 5 years using scientific data base. Besides ensuring
the accessibility of subjects, the environment as well as facilities needed to perform the proposed study. Also, the researcher was
selecting the study design, sample size and the appropriate tools to collect pertinent data of the study.

Planning phase

Based on the outcome of the previous phase, final decision about time, frequency, of patients’ educational sessions and its content
was taken. Final format of the study tools and the patients discharge guide were developed.

Implementation phase

Firstly, the researcher was communicated with the head nurse of stem cells transplantation unit to identify the newly admitted
patients and immediate post-transplant patients, then; the researcher was conduct an initial meeting with each patient individually
in his/her room (before or immediate after stem cells transplantation) for 10 minutes, in this first patient contact, the researcher was
introduced herself to the patient, explain the nature of the study and take the initial agreement from the patient to participate in the
study. Then the patients who were meet the initial inclusion criteria for the study was approached individually for 1 hour by the
researcher (after one week from date of transplantation). Pre assessment was done for each patient by using (PFS), (HADS) and pre-
post patients’ knowledge assessment test to select which patients were included in the study (final inclusion criteria). Pre assessment
was field by the researcher because all communication between the researcher and each patient through glass or rubber
transparency screen.

In the same session, an individualized interview was conducted with each patient to collect the related personal and medical data;
patients were also asked about their expectation and goals regarding their readiness to discharge. Four educational sessions were
started from second week after transplantation (two session per week) each session was last from 30 to 45 minutes with the aim of
training the patients on how to perform pursued lips breathing exercise and active (ROM) exercise, also, to instruct the patients and
their available caregivers about follow-up dietary instructions, medication regimen, precautions about hygienic care, instructions
about home environment, follow up of medical care, signs of complications may developed at home and how they deal with them.

During each session, the researcher was give break time according to patients’ needs and used teaching (pictures and audio-visual
materials) to facilitate the information given for the patients. Also, the researcher was taking an immediate feedback from them and
assesses patients’ satisfaction two times at the end of sessions; no modification in the way of explanation was needed. Each patient
was handed in a copy of the instructional guide to assist their understanding of the learned material.

Evaluation phase
After finishing all sessions, one postassessment was carried within one week before patients’ hospital discharge by the researcher
using the study tools adapted (PFS), adapted (HADS) and pre-post patients’ knowledge tool. The collected post-assessment scores
were analyzed and compared statistically to evaluate the effect of discharge plan on patients’ readiness to discharge after stem cells
transplantation.
 Major Concepts

PERSONAL SYSTEM

Perception

Self

Growth and Development

Body Image

Time

Personal Space

Learning

INTERPERSONAL SYSTEM

Interaction

Communication

Verbal Communication

Nonverbal Communication

Transaction
Role

Stress

Coping

SOCIAL SYSTEM

Organization

Authority

Power

Status

Decision Making

Control

INTERNAL ENVIRONMENT

EXTERNAL ENVIRONMENT

HEALTH

ILLNESS

NURSING PROCESS
Perception

Judgment

Action

Reaction

Disturbance

Mutual Goal Setting

Exploration of Means to Achieve Goals

Agreement on Means to Achieve Goals

Transaction

Attainment of Goals

Typology

Conceptual model of nursing

Brief Description

King’s Conceptual System, which also has been called the Open Systems Model, the Interacting Systems Framework, the General
Systems Framework, “focuses on the continuing ability of individuals to meet their basic needs so that they may function in their
socially defined roles, as well as on individuals’ interactions within three open, dynamic, interacting systems.” (Fawcett, J., &
DeSanto-Madeya, S. (2013). Contemporay nursing knowledge: Analysis and evaluation of nursing models and theories (3rd ed., p.
81). Philadelphia, PA: F. A. Davis.)
The Theory of Goal Attainment was developed by Imogene King in the early 1960s. It describes a dynamic, interpersonal relationship
in which a patient grows and develops to attain certain life goals. The theory explains that factors which can affect the attainment of
goals are roles, stress, space, and time.

The model has three interacting systems: personal, interpersonal, and social. Each of these systems has its own set of concepts. The
concepts for the personal system are perception, self, growth and development, body image, space, and time. The concepts for the
interpersonal system are interaction, communication, transaction, role, and stress. The concepts for the social system are
organization, authority, power, status, and decision-making.

The following propositions are made in the Theory of Goal Attainment:

If perceptual interaction accuracy is present in nurse-patient interactions, transaction will occur.

If the nurse and patient make transaction, the goal or goals will be achieved.

If the goal or goals are achieved, satisfaction will occur.

If transactions are made in nurse-patient interactions, growth and development will be enhanced.

If role expectations and role performance as perceived by the nurse and patient are congruent, transaction will occur.

If role conflict is experienced by either the nurse or the patient (or both), stress in the nurse-patient interaction will occur.
If a nurse with special knowledge communicates appropriate information to the patient, mutual goal-setting and goal achievement
will occur.

There are also assumptions made in the model. They are:

The focus of nursing is the care of the human being (patient).

The goal of nursing is the health care of both individuals and groups.

Human beings are open systems interacting with their environments constantly.

The nurse and patient communicate information, set goals mutually, and then act to achieve those goals. This is also the basic
assumption of the nursing process.

Patients perceive the world as a complete person making transactions with individuals and things in the environment.

Transaction represents a life situation in which the perceiver and the thing being perceived are encountered. It also represents a life
situation in which a person enters the situation as an active participant. Each is changed in the process of these experiences.

According to King, a human being refers to a social being who is rational and sentient. He or she has the ability to perceive, think,
feel, choose, set goals, select means to achieve goals, and make decisions. He or she has three fundamental needs: the need for
health information when it is needed and can be used; the need for care that seeks to prevent illness; and the need for care when he
or she is unable to help him or herself.
Health involves dynamic life experiences of a human being, which implies continuous adjustment to stressors in the internal and
external environment through optimum use of resources to achieve maximum potential for daily living. Environment is the
background for human interaction. It involves the internal and external environments. The internal environment transforms energy
to enable a person to adjust to continuous external environment changes. The external environment involves formal and informal
organizations. In this model, the nurse is part of the patient’s environment.

The Theory of Goal Attainment defines nursing as “a process of action, reaction and interaction by which nurse and client share
information about their perception in a nursing situation” and “a process of human interactions between nurse and client whereby
each perceives the other and the situation, and through communication, they set goals, explore means, and agree on means to
achieve goals.” In this definition, action is a sequence of behaviors involving mental and physical action, and reaction is included in
the sequence of behaviors described in action. King states that the goal of a nurse is to help individuals to maintain their health so
they can function in their roles. The domain of the nurse “includes promoting, maintaining, and restoring health, and caring for the
sick, injured and dying.” The function of a professional nurse is “to interpret information in the nursing process to plan, implement,
and evaluate nursing care.”

King gives detailed information about the nursing process in her model of nursing. The steps of the nursing process are: assessment,
nursing diagnosis, planning, implementations, and evaluation.

The theory explains that assessment occurs during interaction. The nurse brings special knowledge and skills whereas the patient
brings knowledge of him or her self, as well as the perception of problems of concern to the interaction. During the assessment, the
nurse collects data regarding the patient including his or her growth and development, the perception of self, and current health
status. Perception is the base for the collection and interpretation of data. Communication is required to verify the accuracy of the
perception, as well as for interaction and translation.
The nursing diagnosis is developed using the data collected in the assessment. In the process of attaining goals, the nurse identifies
problems, concerns, and disturbances about which the patient is seeking help.

After the diagnosis, the nurse and other health care team members create a care plan of interventions to solve the problems
identified. The planning is represented by setting goals and making decisions about the means to achieve those goals. This part of
transaction and the patient’s participation is encouraged in making decisions on the means to achieve the goals.

The implementation phase of the nursing process is the actual activities done to achieve the goals. In this model of nursing, it is the
continuation of transaction.

Evaluation involves determining whether or not goals were achieved. The explanation of evaluation in King’s theory addresses
meeting goals and the effectiveness of nursing care.

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