Medical Treatment and Healing Process - Concept of Anxiety - Research Paper Example

? Concept Analysis 27th, November Introduction This research paper analyzes the concept of anxiety in relation to medical treatment and healing process. The structure of the paper, including theory development bases on the concept analysis framework of Liehr & Smith (2008). These highly supported the sharing of nursing knowledge and challenges through the theory of story. Background Working as a nurse in the Intensive Care Unit (ICU) gives one diverse knowledge on nursing practice, basing on the various experiences one faces. I work in the ICU, where I am responsible for critically ill patients. Specifically, I am in charge of those who need artificial ventilation. I am to ensure the patients get better, and not contracting more diseases in the course of their admission in the ICU. One of the most dangerous risks that ICU patients on artificial air are exposed to is the Ventilator-Associated Pneumonia (VAP). Its prevention involves a 5-steps process, called the VAP bundle. Of the five steps, interruption of the sedation to introduce extubation to the patient is the most critical step, also called, “weaning from mechanical ventilation.” Previously, the physicians attending to patients in critical situations attempted to reduce the length of time of mechanical ventilation by manipulating ventilator modes and gradually decreasing the ventilator support. Nonetheless, research today has shown that sedation can have a bigger impact on the length of time of mechanical ventilation, and other patient outcomes than can manipulating ventilator modes (Eber, Laximinarayan, Perencevich, Malani, 2010). Patients respond differently to sedation, depending on their ability to cope. One major incidence that comes to my mind when sedation is mentioned is one I experienced with a post renal transplant patient, who was admitted to the ICU for 12 hours’ observation. She was in quite a stable condition as she was alert and conscious, and waited for her transferred to the theatre. However, the patient exhibited high levels of anxiety. She kept questioning about the ICU experience, and her outcome. As a professional, I encouraged her. Unfortunately, an overdose of “FK” is administered to the patient, who collapsed afterwards. After successful surgery, the patient was put on mechanical ventilation and later sedated so that she does not fight the mechanical ventilation equipment. After she stabilized, the weaning process from mechanical ventilation took effect. This is in accordance with the VAP bundle protocol of preventing the occurrence of VAP. On receiving the physician’s order, I adhered by holding the sedation to assess if the patient was ready for extubation. However, after successful extubation, the patient grew violent. She felt this was a mean act as it dehumanized her. My attempts to explain the importance of the process were not welcome by the patient, as she could not understand. The Phenomenon of Interest The phenomenon of interest related to my story and her first action after weaning her from mechanical ventilator, is best described as “Waking up to breath.” This was termed during a discussion with my colleagues while doing our assignment for statistics course. We stopped for a while and discussed our concept development. Thus, each one of us presented her story and then we helped each other the come up with a concept. The phenomenon exhibits the high level of patient’s anxiety. Theoretical Lens for Viewing the Phenomenon The theoretical lens used to view this phenomenon shapes the meaning of this phenomenon. The phenomenon in this research is ‘waking up to breath,” which is accompanied with patient anxiety. This describes reactions of patient after she was weaned from the mechanical ventilator. She reacted rather violently. Various theories can be used to bring this phenomenon into perspective. However, I choose to choose one of the middle range theories. The theory of self-efficacy is one that will bring a deeper meaning and understanding to this phenomenon. In this theory, a person’s self-efficacy is determined by behaviors, environment, and cognitive factors. In addition, objectives are achieved through perseverance and overcoming obstacles and observing others succeed through sustained efforts. In addition, in self-efficacy, it relates to a person’s perception of their ability to reach a goal. According to Bandura (1997), behavior relations and changes are affected by repeated failures, motivation, performance, and frustrations. This theory is applied to this phenomenon since it is widely applied to health behavior change (Lenz, 2002). In this phenomenon, the patient registers low self-efficacy. She lacks motivation that she will get better; instead she is anxious, which is detrimental to the goal of healing process. Related Literature Kas?kc? (2011) also addressed the self –efficacy theory emphasizing how it has its roots from the social theory. He asserts that people are responsible for their own motivation and behavior. Thus there is a relationship between self-perception and individual action. The patient, due to anxiety, had a poor self-perception and so did not attempt to make herself strong. Similarly, Bandura refers to self-efficacy as the level of a person’s confidence in their abilities to successfully execute different tasks (Bandura, 1997). He asserts that behavior is a result of outcome expectations and self-efficacy expectation. The patient therefore had low efficacy and outcome expectations, as she kept pestering the nurse on her outcome. Thus, the goal of healing became slow. Kas?kc? describes outcome expectations as hope that specific behavior will result to positive outcome. He describes efficacy expectations as a person’s assessment of their ability to behave in a particular way (Kas?kc?, 2011). Self-efficacy is crucial in development of health promotion programs in advanced practice, as well as speeding up healing processs. A Reconstructed Story from a Person who has Experienced the Phenomenon The patient I dealt with in my case was a woman aged forty-two, a single mother with an adult daughter and son. She underwent a renal surgery successfully, but admitted for few more days because of her poor coping. When asked about her experience in the ICU, these were her words; I had never been to the ICU before, and so I was afraid. All my life, I believed ICU is for people who had slim chances of living, so when I entered the ICU doors, I did not know what to expect afterwards. I was anxious, as I pestered the attending nurse if I was going to live or die. The whole mechanical ventilation thing was awful. I felt I was not going to get any better. Extubation was irritating, and this compelled me to yell at the nurse and at some point turned violent. Nonetheless, I got better but since I did not cope well, it took me a little longer to totally heal. A Mini-Saga that Captures the Reconstructed Story My operation was terrifying. In the ICU, weak and scared, I almost died of anxiety. I grew violent and let it out on the nurse, despite her encouragement. If only I knew I would survive, I would have acted cool, as that would have gotten me out of hospital faster. The Core Qualities of the Phenomenon The whole phenomenon is characterized by low motivation on the patient’s side, the aspect of despair in healing process is also manifest when the patient fears that death will happen. Finally, the phenomenon is devoid of self-efficacy as the patient does not show any confidence in herself and the entire healing process. A Definition that Integrates the Core Qualities Anxiety is a demotivation factor to a patient, as it results in despair, and makes a patient lose their self-efficacy. This leads patients to experience behavioral changes, which do not support effective and faster healing. A Model that Depicts Relationship between the Core Qualities Despair Anxiety Low Motivation Low Self- efficacy A Mini-Synthesis that Integrates All Phases of the Structure Building Process Anxiety factor is crucial in nursing as it has an impact on the healing process of patients. Anxiety slows the effect of treatment as patients have low motivation, despair, and no self-efficacy. More research needs to be done to show more linkage between patients’ anxiety levels and effectiveness of treatment. References Bandura, A. (1997). “Self-efficacy: The exercise of control.” New York: W.H. Freeman. Eber, M., Laximinarayan, R., Perencevich, E. & Malani, A. (2010). “Clinical and Economic Outcomes Attributed to Health-care-Associated Sepsis and Pneumonia. Arch Intern Med, 2010; 170(4):347-353. Kas?kc?, M. K. (2011). “Using self?efficacy theory to educate a patient with chronic obstructive pulmonary disease: A case study of 1?year follow?up.”.International journal of nursing practice, 17(1), 1-8. Lenz, E. (2002). “Self-Efficacy In Nursing: Research and Measurement Perspectives” Volume 15. New York: Springer Publishing Company. Liehr, P. & Smith, M. (2008 ). “Middle Range Theory for Nursing.” Second Ed. New York: Springer Publishing Company. Read More