Nursing Theory Comparisons - Assignment Example

NURS 4343 NURSING THEORY AND RESEARCH COMPARISON OF NURSE THEORISTS Nursing Theory Comparisons: Human Becoming Theory, Theory of Illness Trajectoryand Theory of Comfort Introduction Nursing theory has been used to categorize an array of perspectives in the wide domain of knowledge in nursing. These theories are perceived as well articulated systems of distinct concepts and propositions grounded on the philosophy of nursing and can be used to guide research and practice in nursing. In this assignment, three theories, namely, "Human Becoming Theory", "Theory of Illness Trajectory" and "Theory of Comfort" will be compared on different parameters, and findings from this analysis would be used to examine whether these can guide practice. Relationship between nursing research and theory Practicing nurses and nurse theorists are consistently developing conceptual models of nursing and nursing theory. In recent years, clarification of the relationship between conceptual models of nursing and theories of nursing has made it possible to use nursing processes as research techniques that combine both inductive and hypothetico-deductive commitments. Therefore it opens the perspectives that systemic use of the nursing process may identify a set of research methods that may facilitate development of nursing theory involving use of insights from both the direct experience of practicing nurses and conceptual models of nursing. Like any knowledge, nursing knowledge is also a blend of knowledge from nursing and other disciplines. Nursing knowledge needs to be unique to be regarded as professional body of knowledge. The nursing research needs to develop and confirm nursing knowledge, and to be able to do this, nursing research needs to be linked to nursing theories. Thus nursing theory can form a conceptual framework for research studies, can be tested by research, and can be built by development of theory from research into practice. In this way, nursing research is closely related to nursing theory and hence to nursing practices (LoBiondo-Wood & Harber, 2006). Grand Theories and Middle Range Theories Types of nursing theories generally include grand theory, middle-range theory, and practice theory. Grand theories have the broadest scope and present general concepts and propositions. Theories at this level may both reflect and provide insights useful for practice but are not designed for empirical testing. Therefore their scopes are limited in terms of directing, explaining, and predicting nursing in specific situations, and they are wide in the sense that they can be pertinent to all instances of nursing. Development of grand theories resulted from the deliberate effort of committed scholars who have engaged in thoughtful reflection on nursing practice and knowledge and the many contexts of nursing over time. Middle-range theory was proposed in the field of sociology to provide theories that are both broad enough to be useful in complex situations and appropriate for empirical testing. Nursing scholars proposed using this level of theory because of the difficulty in testing grand theory. Middle-range theories are narrower in scope than grand theories and offer an effective bridge between grand theories and nursing practice. They present concepts and propositions at a lower level of abstraction and hold great promise for increasing theory-based research and nursing practice strategies (Tomey & Alligood, 2006). Theorists Dr. Parse is a graduate of Duquesne University in Pittsburgh and received her master's and doctorate from the University of Pittsburgh. She was on the faculty of the University of Pittsburgh, was dean of the Nursing School at Duquesne University, and from 1983 to 1993 was professor and coordinator of the Center for Nursing Research at Hunter College of the City University of New York. She is founder and editor of Nursing Science Quarterly; president of Discovery International, Inc., which sponsors international nursing theory conferences; and founder of the Institute of Human Becoming. Her area of research includes the ontological, epistemological, and methodological aspects of the human becoming school of thought (Tomey & Alligood, 2006). The illness trajectory model was proposed by Juliette Corbin and Anselm Strauss. Strauss was internationally known as a medical sociologist for his pioneering and ground-breaking attention to chronic illness and dying. He was the developer of grounded theory, which is an innovative method of qualitative analysis that is now widely used in various fields of science such as sociology, nursing, education, social work, and organizational studies. This theory proposes that nursing care should differ along a trajectory of eight phases to meet the needs of the patients and the families. When he died, he was Professor Emeritus of Sociology in the Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco (Tomey & Alligood, 2006). Juliet Corbin is regarded as a highly respected and prominent figure on grounded theory. She has a background in nursing. She is a lecturer at San Jose State University, School of Nursing USA with interests in the areas of chronic illness, pain, maternity care, aging, and sociology of nursing profession. She had been associated with Anselm Strauss for over 15 years and proposed jointly the theory of chronic illness trajectory (Tomey & Alligood, 2006). The comfort theory has been proposed by Dr. Kathy Kolcaba. She is now the associate Emeritus professor of the University Of Akron College Of Nursing. Her special area of interest is nursing care of the older people. She has been instrumental in designing, updating, and teaching nursing care of the older adults based on her comfort theory. Moreover, her area of interest received greater expanse due to her speciality in Gerontology, end of life and long-term care interventions, comfort studies. She is on the Board of Elderlife, a community outreach and support network for elders in the larger community (Tomey & Alligood, 2006). How the Theory Defines Nurses are people educated according to nationally regulated, defined, and monitored standards. The standards and regulations are to preserve the safety of health care for members of the society. Nursing is a discipline and a profession. The goal of the discipline is to expand knowledge about human experiences through creative conceptualization and research. This knowledge is the scientific guide to living the art of nursing. Nursing as a profession is responsible for regulation of standards of practice and education based on disciplinary knowledge that reflects safe health service to society in all settings. Parse claims that her theory is a human science theory, with the principal orientation to the concept of "human becoming" as "a unitary construct referring to the human being's living health." Thus in this theory, nursing has been defined as a discipline that encompasses at least two paradigmatic perspectives related to the human-universe-health process. The person has been defined as human who is coexisting while co-constituting rhythmical patterns with the universe at the same plane and in the same time frame. The human is open, freely choosing meaning in situation, bearing responsibility for decisions. The human in this theory has been defined from two views. The totality paradigm where human is a conglomeration of body, mind, and spirit. The other is simultaneity paradigm, where human is unitary. The body-mind-spirit perspective is particulate in the sense that it focuses on the bio-psycho-social-spiritual parts of the whole human as the human interacts with and adapts to the environment. Health thus is defined as a state of biological, psychological, social, and spiritual well-being. This ontology leads to research and practice on phenomena related to preventing disease and maintaining and promoting health according to societal norms. In contrast, the unitary perspective is a view of the human as irreducible in mutual process with the universe. Health is considered a process of changing value priorities. It is not a static state but, rather, ever-changing as the human chooses ways of living. This ontology leads to research and practice on patterns synthesized from lived experiences, quality of life. Health thus is a manifestation and expression of these interactions between the person and his universe which includes his environment (Tomey & Alligood, 2006). The goal of the discipline from the human becoming perspective is quality of life. The goal of the nurse living the human becoming beliefs is true presence in bearing witness and being with others in their changing health patterns. True presence is lived through the human becoming dimensions and processes: illuminating meaning, synchronizing rhythms, and mobilizing transcendence.. The nurses need to practice true presence, which is a free-flowing attentiveness that arises from the belief that the human in mutual process with the universe is unitary, freely chooses in situation, structures personal meaning, lives paradoxical rhythms, and moves beyond with changing diversity. True presence is a powerful human-universe connection experienced in all realms of the universe. It is lived in face-to-face discussions, silent immersions, and lingering presence. Nurses have opportunities to fortify their unique contributions to the healthcare of the society through the use of nursing knowledge based on unitary perspectives of human being in mutual process with the universe leading to a concept of health which is a process based on a set of values (Tomey & Alligood, 2006). Corbin and Strauss' chronic illness trajectory framework uses qualitative research in a focused area of practice, and it is widely used in everyday nursing practice. This concept sprang from the major study of death and dying. The term trajectory indicates that dying takes time, and professionals and family may use many strategies that may shape and manage the course of dying. In chronic illnesses for adults, uncertainty has been described as a universal experience. Some of these are related to the severity of illness, erratic symptomatology, and ambiguous symptoms. Psychologically, concern about unknown future is another component. The person suffers from the impact of chronic illness and its effects on daily routine. Thus the changes that it begets on concept of self and identity are considerable to start with. Moreover, chronic illness in a person needs lifelong management by the person experiencing it. Adequate knowledge and understanding about the illness do not come quickly and easily to the most. Therefore, the effective management strategies should cover these concerns and illness trajectories, so the uncertainties at various points during the illness are addressed. The disease may be something at the initiation; however, with time during this trajectory change, there would be a new diagnosis, initiation of a new treatment, new complications, and with the possibility of recurrence and exacerbations. The illness trajectory has been defined as the path or progression of illness as it relates to all persons involved. These include the person suffering, family, ethnic group, community, and care provider fit. The dimensions of the illness trajectory include knowledge component dealing with the patient's perception and understanding about the illness; emotional component involving patient's feelings and coping styles related to his or her illness; the role behaviors of person involved leading to expected responsibilities of patients and nurses. The nurses are defined as caregivers who are in a caregiving dynamics through interacting processes of commitment, expectation management, and role negotiation supported by self-care, new insight, and role support that move the caregiving relationship along an illness trajectory. Health would thus be the resultants of relationship of the caregiver and the care recipient in the past, present, and future. The present relationship would be prominent, but not fragmented from past and future. Commitment, expectation management, and role negotiation would connect the caregiver and the patient and would provide the force to move the caregiving relationship through time. Health has been defined implicitly by a dynamic feeling of confidence by the persons in order to make order of the variability associated with instability of the chronic illness trajectory in order to accomplish trajectory shaping work. Health will be demonstration of motivation necessary to initiate come-back phase, ability of the person to accommodate to an unstable or stable-but-diminished trajectory. Health would also involve family which is an important part of the environment that the person belongs to, and therefore, the nurse would be able to minimize the impact of chronic disease on the family across the trajectory, and the person would be able to engage in meaningful activities around the chronic illness experience (Tomey & Alligood, 2006). Commitment, expectation management, and role negotiation connect the caregiver and the patient, and through this all the concepts of the framework for illness trajectory are connected. Self-care, new insights, and role support ground the concepts of commitment, expectation management, and role negotiation respectively. Through self-care, the nurses can maintain their commitment to the person through a trajectory, and this is possible since when physically and emotionally healthy, the nurses can continue to focus attention on the persons' needs. New insights come with support for managing expectations. New understandings and ways of framing the caregiving experience help nurses make sense of illness outcomes. Role support offers nurses tools to fulfill successfully the care demands for the care recipient. In this way, the illness trajectory overlays the nursing relationships, moves forward through time with the relationship, and influences the relationship (Tomey & Alligood, 2006). Nurses are traditionally associated with provision of comfort to patients and their families through comfort measures. Nurses take intentional comforting measures that strengthen patients and families. Persons are defined as members of the community who have health seeking behaviors which are related positively to institutional integrity. The Theory of Comfort relates these concepts through the proposition that when patients and families are strengthened by actions of the nurses, they can better engage in health-seeking behaviors. According to this theory, enhanced comfort is an immediate desirable outcome of care provided by the nurses. When comfort interventions delivered by nurses over time, it leads to a trend toward increased comfort levels leading to desired health seeking behaviors. Health is a direct correlate of health seeking behavior which can be internal, such as, healing, immune function or external such as health related activities, functional outcomes, or even peaceful death (Tomey & Alligood, 2006). The Theory of Comfort defines these elements in the conceptual framework for Comfort Theory. It has been proposed that healthcare needs and nursing interventions over time that cover all the possible intervening variables would lead to enhanced comfort in the person over time. Since disease leads to alteration of health seeking behaviors, comfort care interventions in illness will lead to alterations in health seeking behaviors, which would encompass internal behaviors, peaceful death, and external behaviors. Moreover this can lead to a modification of institutional integrity when it is extended to nurses' comfort in caring, thereby fostering best practices and best policies (Tomey & Alligood, 2006). Type of Research Studies Directed by Theory Doucet and Bournes published a survey of research guided by Human Becoming Theory, and they have identified 93 human-becoming guided research studies, which have used either a phenomenological or a qualitative descriptive research method. Perse herself suggested research method that is a phenomenological-hermeneutic method consistent with the ontology of human becoming. Some examples are dealt in here (Doucet and Bournes, 2007). Pilkington and Kilpatrick (2006) studied suffering in 12 persons in a long-term care. The question was whether suffering is lingering desolation which with human becoming intervention changes to a situation of emerging with resolute acquiescence with benevolent affiliations. Empowerment of these persons through valuing and connecting separating led to reduction in suffering imaging (Pilkington & Kilpatrick, 2006). On the qualitative front, a descriptive study by Pilkington & Mitchell (2004) done on quality of life of 14 women with gynecological cancer identified that quality of life is a treasuring loving expression while affirming personal worth. Consoling immersions emerge with expanding fortitude for enduring (Pilkington & Mitchell, 2004). Kirkevold (2002) described the characteristics of the illness trajectory of stroke during the first year in 9 mild to moderately affected stroke patients through a qualitative, prospective case study design with repeated in-depth semi-structured 63 interviews using hermeneutic approach. The application of theory of illness trajectory indicated that the adjustment process is gradually evolving and prolonged that involves 4 phases and with characteristic tasks and focal points. This involves hard physical and psychosocial work on the part of the patient, which takes time and experience to achieve, and the care may involve creation of realistic conception of the illness and its implications (Kirkevold, 2002). Novak and coworkers (2001) tested several formats of end-of-life comfort instruments for patients and closely involved caregivers using theoretical framework of Comfort Theory of Kolcaba. Data were collected from both members of 38 patient caregiver dyads from hospice patients in two phases with the use of end of life comfort questionnaires and horizontal and vertical visual analogue scales through total comfort lines. This study revealed that through this framework, evidence may be available for practice that highlights the goal of care in this population, which is comfort (Novak, Kolcaba, Steiner, and Dowd, 2001). Dowd and coworkers (2002) utilized Comfort Theory assessed the psychometric properties and relationships among 8 measures of comfort, status of urinary frequency and incontinence, and quality of lives of 45 women and 2 men through a convenience sampling of ages 25 to 92. Relationships among variables were reliable and valid, and recommendations were made (Dowd, Kolcaba, and Steiner, 2002). Nursing Theory most Congruent with my Belief In my view, I feel that across all areas of chronic illness care in nursing, there is a need for mid-range theories, and this theory of illness trajectory can be aptly congruent with practice. It may be argued why the other theories are not congruent with my beliefs. The human becoming theory is very strong one, essential for researches, but difficult to apply in practice easily. Comfort theory is also an established one, but it is not widely accepted. In contrast, the illness trajectory theory very easily is applicable in practice and is necessary and relevant in carrying nursing knowledge forward. Chronic illness focused multidisciplinary ways of care can be related to each other, and in my practice I have seen this theory can provide a better understanding of the disease processes through many common phenomena. This theory combines biological and behavioral methods that would fit better nursing's holistic perspectives on the many aspects of person's life that is affected in chronic illness. Finally, there is a huge body of literature that can be used easily to extract evidence for use in practice. Reference List Doucet, TJ. and Bournes, DA., (2007). Review of Research Related to Parse's Theory of Human Becoming. Nursing Science Quarterly; 20: 16 - 32. Dowd, T., Kolcaba, K., and Steiner, R., (2002). Correlations among measures of bladder function and comfort. Journal of Nursing Measurement; 10(1): 27-38. Kirkevold, M., (2002). The unfolding illness trajectory of stroke. Disability Rehabilitation; 24(17): 887-98 LoBiondo-Wood, G. & Harber, J. (2006). Nursing research (6th ed.). St Louis: Mosby. Novak, B., Kolcaba, K., Steiner, R., and Dowd, T., (2001). Measuring comfort in caregivers and patients during late end-of-life care. American Journal of Hospice and Palliative Medicine; 18: 170 - 180 Pilkington, F. B., & Kilpatrick, D. (2006). The lived experience of suffering: A human becoming perspective. Manuscript submitted for publication in Nursing Science Quarterly. Pilkington, F. B., & Mitchell, G. J. (2004). Quality of life for women living with a gynecologic cancer. Nursing Science Quarterly, 17, 147-155. Tomey, A.M., & Alligood, M.R.. (2006). Nursing Theorists and Their Work. (6th ed.).St Louis: Mosby Read More