Community Health Nursing: Caring in Action - Essay Example

?Introduction Nursing theory is a general term which is given to the body of knowledge which is used to define and explain nursing. This comprehensive set of theories provides a way to understand and explore the professional nursing and how it should be conducted. It is however, important to understand that nursing theory is divided into three important categories i.e. Grand Nursing Theories, Mid-Range Theories and Nursing Practice Theories. Middle range nursing theories are considered to be helpful to both the nurses as well as the student nurses to carry out their research and accomplish their goals relatively easily. If properly analysed and explored within a systematic framework, mid-range nursing theories can actually proper guidance as well as direction in terms of what research goals to be pursued. The serious development of mid-range nursing theory started during 1960’s and 1970s when serious efforts were put in place to actually drift away from the existing models being followed in Nursing. (McEwen & Wills, 2007) Community empowerment requires a continual shift in the power relationships between individuals and groups. It is also considered as an outcome which varies with different distribution of resources within the society. The community psychology suggests a positive link between community empowerment and overall health outcomes. When it comes to self care, community empowerment and motivation can play an important role. This paper will actually discuss the issue of community empowerment and motivation with regards to self-care and discuss is it from the perspective of mid-range theories of nursing and how they can solve this problem. Brief Description of the Problem Literature on community psychology indicates that empowerment can actually increase the overall self-esteem and competence of individuals which improves the perception of control and which invariably results into better health outcomes. Empowerment is generally related with an individual’s actions and subsequent development of small groups, community partnerships and organizations which can further lead to the ultimate political action required to bring in the desired change in the public health. It is however critical to understand that concrete efforts have not been put in place in order to ensure self-care, community empowerment has not been viewed as one of the critical tools to ensure positive health outcomes. The overall domain of community empowerment as well as self-care has been mostly focused upon the environmental changes and how it can affect the overall health outcomes for the patients. Individuals can have better chance to ensure their self-care and better health outcomes if individuals can participate into the communities and empower themselves. (Lundy & Janes, 2009) From the perspective of nursing, community empowerment is relatively important however, given the overall complexity involved, nurses need to take greater care in understanding the overall dynamics and how they can develop an effective link between community empowerment and self-care. It is critical for nurses therefore to understand the individual circumstances of their patients and attempt to deliver an overall experience which can improve the overall health outcome for the students. Nurses therefore face difficult and complex challenges in this regard. (Janice E. Hitchcock, Schubert, & Thomas, 2003) Comfort Theory Word comfort is considered as complex and diverse in nature and has remained one of the intriguing aspects of nursing. Comfort has been defined as “the immediate state of being strengthened through having the human needs for relief, ease, and transcendence addressed in four contexts of experience”. The comfort therefore is considered as the desirable and positive outcome which is required to bring patients and their families to engage into the positive health outcomes. Comfort theory was developed in 1990s by Katharine Kolcaba and is considered as middle range theory for nursing practice, education and research. This theory is considered as powerful enough to actually put comfort on the forefront of the healthcare once again because it focuses on the relief as one of the basic activities for nursing. This theory defines nursing as a process of assessing patient comfort needs and outlines as to how to develop and implement the patient comfort following the nursing intervention. Nurses need to complete intentional assessment of the comfort needs of the customers, design and development of the comfort measures as well as the reassessment of the comfort measures after implementation. Comfort theory therefore outlines the need to have self-care and how community including the family of the patient can actually contribute towards the development of positive health outcomes for the patients. (Kolcaba, 2002) What is also critical to understand that this theory outlines the role of environment including patient’s family and society as a whole which can be manipulated by the nurse or loved ones to actually improve the comfort level? The Theory of Family Stress and Adaptation This theory outlines that an individual family’s experiences of stress as well as crises is a dynamic process. It also includes as to how the family subsequently adapt to the situations and prepare adequate response to such experiences and crises. What is important to note however is the assumption that the response of family towards such stressful events is dependent upon family’s resources and presence as well as absence of the overall coping mechanisms? Level of adaptation varies from positive adaptation to maladaptation and this also results into increased or decreased family functioning. The original family stress theory was developed during 1949 when it was developed from the perspective of how families can actually cope with the events which happened during World War-II. ABCX Model was developed to understand the interaction of stressor event, the overall perception of the family about the stressor as well as the existing resources of the firm in determining the overall likelihood of the event resulting into crises. (Liehr, 2009) This theory was further modified based upon the input from sociologists and included post-crises ability of family to cope with the crisis. This was also based upon the research done on the families and prisoners of war during Vietnam War. The overall focus of this addition to the study was to understand the dynamics of how families actually design the coping mechanisms to deal with the stress and discomfort created due to stress related events. (McCubbin, 1983) Evaluation of Theories Comfort Theory It is critical to note that this theory is significant from both the social as well as theoretical perspectives at it outline important social issues of importance. Further, this study also offers a relatively fresh perspective on the comfort as one of the key aspects of how to manage the self-care from the perspective society and self-care. This theory is critically important because it’s philosophically oriented towards fulfilling the human needs. It considers comfort as one of the basic human needs in situations where patients require help. (Fawcett & Garity, 2009) One of the key aspects of this theory is that it is consistent internally and put forward plausible arguments. It has been able to outline one of the major concepts of middle range theories and critically discussed the core concept of Comfort and how community can actually contribute towards the improvement of individual comfort and self-care. Besides, inductive reasoning is also presented in the theory and is derived from the literature as well as existing models. This theory has been inductively driven from the theory originator’s individual experiences while dealing with the patients having higher level of disabilities. It is also important to note that the theory is parsimony i.e. theory is relatively concisely stated and it has been able to outline important concepts in really concise manner. Most important thing about the theory is that it has been able to put forward the concept of comfort as one of the core concepts. A good theory always focuses on defining what is important and how it can be empirically tested. It is critical to note however that this theory may not be empirically testable because it focuses on the issue which has relatively different and multiple perspectives to deal with. This theory therefore may not be testable with good empirical results The Theory of Family Stress and Adaptation This theory has completely defined the concept of the role of family in managing stress and allowing individuals to develop better self-care. From the perspective of the internal consistency, this theory has been able to critically outline the important concept and provided reasonable reasoning. This theory is based upon deductive reasoning and outlines as to how different combinations of family and self-care can interact to provide valid solutions for coping with the stress. Deductive reasoning is also evident from the fact that theory has outlined the empirical results about the families involved in the self-care and management of stress. This theory has also highlighted important concepts of the mid-range theory and discussed the coping mechanism adapted by the families and how the support from community can actually result into better management of the same. This theory is parsimonious too because it has been able to outline few concepts in really concise and effective manner. Theory has focused on defining the role of family, their resources and how they combine both to actually cope with the stress. This theory has been derived based upon the empirical studies derived from the interviews and extensive study of the families affected by the World War II and Vietnam War. This theory has been empirically described with few concepts defined in really important manner. This theory is based upon the empirical research therefore it is also testable and can be empirically proven with the available data. Which theory is appropriate? From the perspective of current problem discussed in this paper, it is more appropriate to consider the family stress and adaptation theory. This theory involves family as the unit which is also considered as the basic part of the community and therefore can help understand the dynamics of how community empowerment can actually result into better health outcomes. More importantly, this theory is focused upon understanding the empirical links between the issue and how families actually coped with the stress created by such traumatic events as World War-II and Vietnam War. As such the overall empirical validity of theory is relative higher as compared to the Comfort theory. It is also important to note that this theory has also been viewed from the perspective of the sociology also. The later modifications in the theory are based upon the research done by the sociologists in understand the impact of family and community and the overall resources available to design, develop, execute and implement the coping mechanisms to deal with the overall level of stress. This theory is based upon three components i.e. the stressor events, existing resources as well as the perceptions of the family. The overall perceptions of the family are mostly defined and shaped by the society and the community at large. This therefore has a significant impact in terms of understanding the role of community in empowering the families and individuals to actually design the coping mechanisms. Better the perceptions of family about the stressor event, more family will be able to cope with the stress and improve the self-care of the patients in family. Nurses therefore have to play an important role in terms of improving those perceptions of the families and individuals. By actively participating with the community, nurses can play an important role in improving the resources of the individuals, families as well as the community as a whole. Further, community participation requires empowerment and this theory, by discussing about the available resources to the family, has actually been able to outline as to how such resources can be actually used to improve the response towards self-care. Conclusion Mid-range theories offer a fresh and alternative perspective on nursing and provide a diversified range of tools which can be used to critically evaluate and understand the nursing and nursing research. This paper discussed comfort theory and family stress and adaptation theory and focused on exploring and evaluating them from the perspective of criteria defined under Fawcett, J., & Garity, J for the clinical problem of community empowerment and motivation for self-care. The family stress and adaptation is more suitable theory to properly address the clinical issue discussed in this paper. Bibliography Fawcett, J., & Garity, J. (2009). Evaluating Research for Evidence-Based Nursing Practice. New York: Medicus Media. Janice E. Hitchcock, Schubert, P., & Thomas, S. (2003). Community Health Nursing: Caring in Action. London: Cengage Learning. Kolcaba, K. (2002). Comfort Theory and Practice: A Vision for Holistic Health Care and Research. New York: Springer Publishing Company. Liehr, P. R. (2009). Middle Range Theory for Nursing. New York: Springer Publishing Company. Lundy, K. S., & Janes, S. (2009). Community Health Nursing: Caring for the Public's Health. New York: Jones & Bartlett Learning. McCubbin, H. I. (1983). Social Stress and the Family: Advances and Developments in Family Stress Theory and Research, Volume 6. London: Routledge. McEwen, M., & Wills, E. (2007). Theoretical Basis for Nursing. New York: Lippincott Williams & Wilkins. Read More