Nursing as a practice can be traced far beyond the beliefs of many. While many people tend to solidify the emergence of nursing with Florence Nightingale, the actual practice of nursing was practiced even before Christ. This is in relation to the care and nurturing that was given to sick people at home and the care given to children by their mothers. It is only that Nightingale, due to her compassion of taking care of the sick, become the pioneer of professional nursing after the first nursing school was opened in her courtesy in 1860s (Aliigood &Tomey, 2006).
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From then hence forth, the practice of nursing has reshaped and gained different dimensions. With the emerging new practices in nursing, it has taken the work of nursing theorists co-operate between joining and relating the nursing theory and research to the current nursing. The relationship between theory and research cannot be underestimated. Generally, theory can be described as a product of critical thinking and knowledge. It is a wide abstract of general information that tries to explicit the relationship between a number of existing phenomenons. On the other hand, research can be explained as a process of injury and amendment which proves the theory right or wrong. It is concrete that research cannot be done without a guiding tool which is theory. This is because theory forms a framework of guiding the research process. It is also from the theory proposed that research questions are formulated. Theory is also the ground onto which the final interpretation and analysis pertaining to the research are based on. It is also research that is guided by theories proposed by theorists that scientists in the field of nursing are able to interconnect facts in the nursing practice.
Theory is very important in research as it leads in development of nursing diagnosis, clinical practice protocols and offer applicable approaches in dealing with health problems. While theories are explanatory, predictive and descriptive, research is co-relational and experimental. It is for these intertwine that nursing theorists have to look for researchers to give their theories prove and logicality. Generally in nursing, a theory is like a hypothesis that has to be tested via research. Hence research forms the basis, onto which the proposed theory is developed, improved, changed, nullified or if accepted, put into practice (Bredow & Peterson, 2009). This is because theories are just concepts that portray an interrelationship through which new statements can be derived from through research findings. In many learning systems, the separation in studies between research and theories has led to a great misunderstanding of the relationship between the two. Hence it is important to create coherence between the two in order to make deductive and concrete results of research.
Four types of theoretical models are relevant in the practice of nursing i.e. nursing philosophy, grand theories or conceptual models, other theories closely to nursing practice and middle-range theories. However, two types of these models are commonly used from which research is deducted i.e. middle-range theories and grand theories (Aliigood &Tomey, 2006). In the recent past, the use of middle-range theories has been embraced rather than use of the grand theories in nursing research. The reason for this is that grand theories also called macro theories are considered to be too wide to cover a comprehensive research study. On the other hand, middle- range theories are thought to be better because they tend to be more specific and lack ambiguity. They are more direct to the point and focus on one area of study. Grand theories which are more ancient are general in their scope and mostly have concepts that cover a wide range of psychological behavior. In contrast, middle-range theories are more restricted in the area they cover and usually focus on a slim range. They usually tend to explain complex phenomena relating to stress, self health care and mother to infant attachment. It is important to note that many grand theories form the foundation from which recent middle-range theories are derived. While middle-range theories are specific to nursing, grand theories are widespread in many other disciplines. Raw empiricism precision is used grand theories and other conceptual models whereas the case for middle-range theories have used limited precise data to base research on. Generally middle-range theories are considered to be involving as they contain very precise information about the patients, e.g. their location, age and severity of symptoms. Grand theories due to their wide scope tend be infeasible to prove, while middle-range theories, having a less scope are more precise and are considered to be testable with ease. It is for this testability ability that middle-range theories are said to be more empirical and hence the most widely used in the modern studies of nursing research (Fitzpatrick & Wallace, 2006).
Over the years, from the time of Nightingale, many nursing theories have been emerging. Their core values are to take nursing to higher levels of profession and discipline. These theories do so by prompting research that leads to new inventions. They try to explain why problems arise and possible remedies to counter them. The theorists identify a problem in the field and formulate a set of concepts relating to the problem. A research approach is prompted by the theorist in a bid to prove the concepts of the theory. In other words, theorists are more interested in explaining why things happen the way they do in the practice of nursing.
In this paper, three significant theorists will be discussed and their intuition to developing their theories exemplified. One of the prominent nursing theories is the comfort theory. This theory was put forward by Katharine Kolcaba in 1994. She started with a diploma in nursing and later on practiced in the field of surgery and long term care. Later she enrolled for a degree specializing in gerontology. It is after this degree while working in a dementia department that her interest in the comfort theory came out. When furthering her career at the doctorate level in the University of Akron, she used her students at the University of Akron to develop the comfort theory. Her doctorate coursework also played an important part in strengthening the concepts of the theory. Before she graduated, her foundation of the comfort theory had already been laid (Kolcaba, 2003).
Her liking to developing a nursing theory was a result of a class assignment in her first year of study. The task was to draw a diagram of nursing practice which was to include a concise diagram. The diagram had to show the relationship between all the concepts of nursing learnt in class while comparing the positive and negative aspects of the interrelation of the concepts. During her practice in dementia care, she learned to deal with excess disability (EDs) of patients. The patients who could not talk had to receive a lot of care, especially when the EDs set in and they became very violent. Hence the environment had to be fit to offer comfort and optimum function for them. She noted that when her patients were comfortable, they would do things in an organized manner, were happy, socially interacting and even hummed hymns (Aliigood &Tomey, 2006). In addition, she noted that when in a state of comfort, patients were able to do optimum functions e.g. setting the table or preparing salads. After presenting her first proposal in a nursing conference in Toronto, she got the motivation to go ahead and work on the concepts of her theory.
The comfort theory is a middle-range theory widely used in the field of nursing. It has low level of abstraction, empirical precision and has a few numbers of concepts and proposals. Katharine proposed three steps of utilizing the theory in research i.e. understanding of the origin of comfort and general definition, understanding the concepts of the theory and lastly, trying to relate the concepts in the real field, so as to formulate question to be used in research. Generally she defined the comfort theory in a number of ways. Some of the best definitions of comfort include a life free from worry, making life easy, reducing grief and misery, inspiring and giving hope, relief from distress, a state of enjoyment, cheering and calming. In her context of definitions, comfort could be taken as verb, an adjective, an adverb or even a noun. It also had negative, positive or neutral explanations eg discomfort, cheering and feeling at ease respectively.
Katharine explained comfort in three ways; as being strengthened by having all the necessary human needs for transcendence, ease and relief. She explained relief as a state where earlier discomfort has been removed or curbed, ease as the condition where there is no discomfort and transcendence being the capability to be above the discomfort; in the case where the discomfort cannot be eliminated. She further showed the relationship between the facilitative environments that led to better or optimum performance. In a facilitative environment, a patient could be alleviated off psychological and physical EDS. This alleviation of ED led to comfort that produced optimum function for the dementia patients. In her further development of the comfort theory, while trying to give a holistic view of comfort, four types of experiences, where comfort would be applicable surfaced. The experiences were: physical, psychological, socio cultural and environment experiences. They were closely intertwined with the three types of comforts mentioned above. This formed a grid that she called a taxonomic structure (TS) which tried to justify that any type of comfort would go with a certain type of experience. The cells of this grid formed all the appropriate attributes of comfort. In her view, comfort was one important tool that any pediatric nurse had to have in mind in her quest to bring good care to pediatric patients in the wards. She also showed that any cell of the TS would not apply mutually in bringing holistic care to the patients; all twelve had to work hand in hand. Studies have shown that the places where research has been done using the comfort theory have succeeded. It has led to quicker healing and recovery among patients. It has also led to less violent dementia patients in hospitals, who are easier to take care of. This has given nurses an easy time in their line of career.
Another prominent nursing theorist is Kristine Swanson who came up with the theory of caring. Her theory generally focused on care given to mothers after miscarriage. According to Swanson, caring is the type of nurturing that leads to an individual having a feeling of responsibility and commitment in promoting health. The theory put forward interventions deemed as necessarily in regaining of health status after the loss of a pregnancy. This middle-range theory which is empirically precise has had research being carried out in mothers, families and even groups of patients experiencing health problems. Her theory was considered precise as it only deals with mothers who have had such an experience. She developed her theory when she was a professor at university of Washington medical center. While in her journey in the field of nursing, she counseled families who were affected by the incidences of miscarriage. The theory focuses not only in the physical treatment to regain health after miscarriage but also to handle the socio cultural impact that the family would go through due to a lost pregnancy. Initially, she carried out her studies on three groups that needed perinatal care: Women who had miscarried, mothers at risk and new born in intensive care units. But she later concentrated on the miscarriage issue. Study was done using three processes where the first one led to identification of five caring processes that are up to date used in the caring theory (Aliigood &Tomey, 2006).The second process was aimed at refining and confirming the five processes above while the last step was a solidification of the processes. The five caring processes in the theory are knowing, being with, doing for, enabling and maintaining belief. These are the key concepts of the theory and it is here where the call for people to take care of others originates from. An expounding of the processes is to offer emotional presence, understanding, helping in the transition to reality and give the power and faith to face the future. Apart from the context of miscarriage, the theory is also applicable to each and every nurse-client relationship. This involves application of the above caring processes in helping to cope with health compromise. It is good for other people to be involved in caring processes as a way of easing the burden of suffering in the families involved. Nurses, family and the society should be in the fore front to carry the affected family along the transition of child loss.
They are also supposed to show acceptance of the family back into the society rather than separate them in a cocoon. The five concepts of the theory have hence been incorporated in many health institutions. It has also been used in the counseling units of numerous hospitals all over the world. Concern and commitment which drives the motive to providing care to an individual is promoted in the medical institutions. As a result of the tremendous success that the theory gets as a result of research based upon it, it has been integrated in the teaching curriculum of many nursing training institutions as part of the course work. This has further led to the expansion of the theory to include care provision to all other fields of nursing.
In addition to the above two theories, the theory of uncertainty in illness was proposed in 1990 by Mishel Merle. It is another widely used theory in the practice of nursing. Mishel described it as the situation where one is unable to say justifiably that an illness exists or to determine the meaning of events closely related to illness. This is an outcome of lack of insufficient cues to let the patient know that they are in an acute health problem. The theory tries to explain how the uncertainty in illness patients develops and especially those who have acute health challenges. It also gives proposal of how patients who suffer uncertainty in illness should cope about it. Initially, the theory was directed to uncertainty in illness for patients with who exhibited a downward trajectory response to treatment phases (Aliigood &Tomey, 2006). Later on it was expanded to also include patients with chronic suffering. Identifying it as the force with the highest magnitude of causing stress to chronically ailing patients, Michel was determined to let known that such a phenomena existed which she took as her doctoral study. This theory is encompassed in three themes of study i.e. antecedents, appraisal and coping. It displays how patients due to panic interpret uncertainty in illness, the outcomes and the treatment. Mishel formulated the theories in a bid to display uncertainty in research and nursing practice. With the two conditions i.e. chronic illness and downward trajectory condition, the theories tend to take two approaches. In the chronic illness approach, self management is encouraged as the primary method of treatment while in the other diagnostic, pre-diagnostic and treatment patterns are applied. Studies from other scholars work led to the distinction between cognitive states as opposed to emotional response in relation to lack of certainty in illness.
From the external studies, she was able to come up with the measurement model in uncertainty that led to the formulation of the uncertainty in illness scales. Uncertainty is seen to expand from the illness condition of an individual to other aspects of their lives. It leads to deterioration of the general functioning of the person and disruption of daily life patterns. A feed back mechanism in uncertainty leads to extra magnitude of uncertainty. Unluckily it is observed that if uncertainty in a patient stays too long, it becomes unbearable to the patient and their level of tolerance is exceeded, disorganization becomes evident. This later leads to instability on the persons capabilities and coherence is lost. Reorganization comes as the last step where a gradual transition occurs into a new dimension of life where multiple incidences are displayed. Uncertainty is most explicit while a patient is awaiting diagnosis. The theory is built on two major concepts i.e. uncertainty and cognitive schema. Cognitive schema described the individual's view of illness-related events (Aliigood &Tomey, 2006).
After many research findings, social support from family has been noted to be the best remedy in reducing uncertainties in illness. The theory which explains that uncertainty is the first stance in a cognitive condition portrays the inability of chronic or acute patients to interpret the outcome of events that relates to their health state. Hence immediate interventions by nurses in practice must be applied in order to help this type of patients cope. They are taught not to ignore it but to integrate it as part of their lives with an aim of improving their living state.
In all the above theories is evident that any patient in a hospital setting or receiving home care or long tern care should be provided with ground information concerning their conditions of illness. The nurses should try and employ the use of theory related research in order to get best results or solutions of how to deal with patients of different kinds. This will eventually lead to the accomplishment of the quests of nursing as a discipline and a professional. Nursing having evolved from an art to a science, should highly embrace the practice of research which is the only way that leads to development in sciences (Smith & Liehr, 2008).
In my opinion, the caring theory discussed above is the most appealing to me. This is because, after one feels the need for commitment and concern, automatically, all the others will follow. It is only when one has a sense of commitment that you will have the heart of helping other in the capacity of coping uncertainty and comforting can occur. This theory as compared to the three forms a wrap that ties the other two. From the experience in the practice of nursing, care has been the sole agenda of nurses and it is for this reason that it seems to en-campus all the rest. Despite any other form of research based treatment being applied, at the end of the day, a person needs to be taken care of until they regain their full beam of health condition. Hence Swanson can be considered in my view to be a very rounded theorist whose work is applicable in the day to day practice of nursing. It is therefore inevitable to consider it a nursing theory that is intelligent and a stronghold to realize the dreams of all nurses.
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