Applying Theory to a Practical Problem.
In most instances, we do provide care to our patients as operating room nurses and hand them over the back for the post-anesthetic care with a relatively less time spent with the clients compared to other nurses in other units. The case where I applied various theories is when I carried a home visit for a 76-year-old male patient whom I had cared for sometimes back but had undergone eye surgery again in our theatre. Besides the visual problem, the patient was having other condition such as diabetes and hypertension. He was diagnosed with diabetes 11 years ago and had been managed well with the sugars remaining stable. The patient was also nursing stroke that developed from hypertension which resulted in the left side weakness.
The patient was married and had rented an apartment where they were living together with the wife. An incidence occurred at the parking lot of the apartments where unknown individuals shot their daughter to death. This was a big blow to them as they were not only forced to cope with the incident but to take care of her two children, a two-year-old and a six-year-old. Earlier on, the patient was cared for by both the daughter and the wife.
During my visit, the wife stated that from the day their daughter died, the man turned weak in appearance with reduced appetite together with intolerance and rejection to the insulin injections. The wife used to assist him taking the jabs because he had visual problems which had prompted the recent surgery. Apart from the patient, the wife had a feeling of being overwhelmed with care extending from the husband to the grandchildren who also solely depended on her for the care. All these led to stress and burnout.
In tackling the above case and problem, the most appropriate middle-range theory to be applied was Jean Watsons’s theory which is an explanatory middle-range theory (Smith & Liehr, 2013). It is suitable in that the situation encompasses many health concerns for the entire family and there is need to determine the association that exists between these health determinants to provide a solution. It is these theories that that relate various concepts that lead to ill-health.
A borrowed theory that can be used in the situation at hand is the Selye’s General Adaptation Theory that would apply to all the members of this family as in one way or the other, they are undergoing stressful situation and coping and adaptation is vital for healthy living(McCarty, 2016). Han Selye expresses his model of adaptation to stress giving it both a physiological and psychobiological approach that is evident as a general adaptation syndrome. In the model, the stressful situation that interferes with the usual living of the human being leads to three stages of body response including alarm, resistance, and exhaustion.
In the alarm stage, the body labels the stressor making the fight-flight response system to be activated. The stress hormones such as adrenaline, noradrenaline, and cortisol are produced. Under the influence of these hormones, one can engage in unusual activities in trying to accommodate the situation.
At the resistance stage, the body has responded to the stressors with the stress level being eradicated or reduced (McCarty, 2016). Since the body had engaged in the fight-flight activity, it will be exhausted with energy reallocated to repair the tissues which had been damaged by the production of stress hormones lowered. While the body enters this stage, it is also on the standby to keep the continuous check for stressors that persist that require a continuous fight.
In the exhaustion phase, the stress has persisted for a relatively longer period than expected. The body then responds by losing the ability to overcome the stressors and reducing their negative impacts as the adaptive energy is exhausted. This stage is characterized by burnout and stress overload which can lead to health impairment. This theory is appropriate to the scenario presented since the family members are stressed not only by the daughter’s demise but also by the chronic illness of the husband.
Borrowed nursing theories can be related to using of other theories in other disciplines to direct the nursing practice. They form the basis of very, many nursing theory developments. According to Jonson and Webber (2015), they refer to the theories as supporting theories as they form parts of the nursing concepts. The nurses used to borrow from physiology, psychology, medicine, physics, sociology and organizational systems with their concepts and frameworks used in the development of nursing theories that are particular to the nursing practice.
With the relatively little information in the nursing profession, there has been borrowing of theories to enrich the little knowledge from other disciplines to nursing over very many years (Kenworthy & Verbeke, 2015). There exist discipline-specific theories which entail specific knowledge that is unique to the concerned discipline. The borrowed theories were considered to be theoretical or conceptual from other disciplines to influence the nursing practice. The internal frameworks such definition and concepts surrounding the theories were then used to form the basis and influence the development of other theories that are business specific.
For a good time, numerous nursing studies have been conducted with the non-nursing theories taking the lead in use instead of the nursing theories. The researchers use the framework of the non-nursing theories to build their work. Indeed, borrowing theories from other disciplines have been in existence for long, and this had diversified their application in solving various problems. Some of the common theories that have been borrowed in the nursing field encompass the social cognitive theory, general systems theory, stress and coping theory, developmental theories as well as the general adaptation theories.
In the past years, borrowing of the theories allowed the practitioners in different fields to share knowledge that they use to solve issues in their surroundings. In some years ago, Hans Selye came with the general adaption syndrome for stress, but the postulation has been disregarded in the understanding of the diseases. According to the scholars who ventured in stress, the current formulation of stress can be traced back to the work of Hans Selye in 1936 (Jackson, 2014). He wrote an article that concentrated on the pattern of particular physiological responses to injury which led to the syndrome containing the three stages of the stress response, i.e., alarm, resistance and exhaustion stages. It is from these articles that other scholars have deduced their work to determine the body responses to stress as unproblematic as well as progressive.
Also in the application of the theory, practitioners concentrated on the engagement of their clients on the training exercises that enabled them to prevent crossing over into the exhaustion stage. The practitioners have employed the periodization which entails the different training cycles that works to vary the volume and intensity of training. The training goals dictate the forms of periodization which in the end varies the training stress and relieves one of the stressful events.
Moreover, the Selye’s General Adaptation Theory has also guided the self-assessment of the body response to various situations both at the diagnostic level as well as the management level (Fink, 2017). The theory has been used by individuals to listen to their bodies in recognizing and respecting the signs enumerated by the body response which has enabled determination of instances requiring intervention and those requiring one to back down.
Despite the focus of Selye on hormones responding to nonathletic stress, the theory was used by the Russian sport training theories in explaining the performance of athletes that was observed to improve with the application of correct training stress (Hoover, VanWye, & Judge, 2016). The volume and intensity of exposure to the training stress which is controlled and body allowed to sustain it would lead to adaptation and allow accommodation of a relatively raised stressful exercise activities.
In handling the problem that was facing my client as well as his family, the Selye’s General Adaptation Theory guide my understanding of the entire situation. From the history provided by the wife as well as the assessment, I carried out, both the client and the family members were in the exhaustion stage of the Selye’s General Adaptation Theory. This was evident from the fact that the stressors were too much for the family and had prolonged for a good period hence they could not tolerate and efficiently cope (Fink, 2017). Besides this, the stress did not end since the coping mechanisms did not take effect due to lack of support system.
The situation kicked off with the existence of chronic illness by the man who was a stressor to the family but could be handled as the family members could share the care provision. The stress increased with the death of their daughter with the response worsening from the nature of the death. With the wife remaining as the sole care provider, the work tends to be too much, and she verbalizes the overwhelming situation which is throwing her to burn out.
Through the theory, I can determine the effect of the continuously escalating level of stress to the family of the client. This leads to depletion of the adaptation of energy leading to exhaustion stage which can easily plunge the members into other health problems. With this in mind, managed to explain to the wife the relationship of issues that could lead to the strange behaviors of her husband as he was not only stressed by the death of the daughter but also his ailing status leading to the rejection of treatment and being weak. I advised the wife to embrace the use of the care services to the disabled and the elderly that exist in the community that will relieve her of the care provision and reduce her stressors.
In addition to the above intervention, there was a need to involve psychotherapy services to keep the family healthy in terms of mental health following the traumatic demise that claimed the life of their daughter. It was also essential to involve physiotherapists as well as social workers to visit and talk to the patient. All these would provide a holistic care and relieve the patient of his stressor. In the long haul, the patient will cope with the stressors and regain the initial energy to live a near-normal life.
Both Selye’s General Adaptation Theory and Jean Watson can be combined to apply to the stressful situation that the client was undergoing. As Jean Watson model explains the relationship among concepts such as the deteriorating health of the client which might be connected to the events such having a chronic illness, having visual problems and then the loss of the daughter (Smith & Liehr, 2013). In line with this, the Selye’s General Adaptation Theory brings about the aspect of the persistence of stressful events which leads to the exhaustion stage of stress response which is risky for maintenance of a healthy life. This prompted my intervention which was then directed at the events leading to the entire unhealthy situation.
Conclusion.
Certainly, the borrowed theories build on the nursing theories to ensure there are proper assessment and interventions to address nursing concerns. The borrowed theories do not only allow diverse assessment of patients but give an avenue through which comprehensive care nursing can be achieved in the nursing profession. On the other hand, the middle range theories give explanation on occurrences of various concerns in the health bracket of a patient. This guides the intervention of the healthcare providers. When both the borrowed and middle-range theories that fit situations are put together, a concrete intervention erupts to provide a solution to patients’ problems.
References:
Chinn, P. L., & Kramer, M. K. (2013). Integrated Theory & Knowledge Development in
Nursing-E-Book. Elsevier Health Sciences.
Fink, G. (2017). Selye’s general adaptation syndrome: stress-induced gastro-duodenal ulceration
and inflammatory bowel disease. Journal of Endocrinology, 232(3), F1-F5.
Hoover, D. L., VanWye, W. R., & Judge, L. W. (2016). Periodization and physical therapy:
Bridging the gap between training and rehabilitation. Physical Therapy in Sport, 18, 1-
20.
Jackson, M. (2014). Evaluating the Role of Hans Selye in the Modern History of Stress. Boydell
& Brewer/University of Rochester Press.
Kenworthy, T. P., & Verbeke, A. (2015). The future of strategic management research:
Assessing the quality of theory borrowing. European Management Journal, 33(3), 179-
190.
McCarty, R. (2016). The alarm phase and the general adaptation syndrome: two aspects of
Selye’s inconsistent legacy. In Stress: Concepts, Cognition, Emotion, and Behavior(pp.
13-19).
Smith, M. J., & Liehr, P. R. (Eds.). (2013). Middle range theory for nursing. Springer Publishing
Company.
