Part II. Theory reflection in research

Group Theory Presentation

Part II. Theory reflection in researchResearch purposeExamine relationship of stress, severity, uncertainty, coping, and adaptation in families of children undergoing liver transplantationResearch questionThree main questions looking at variables over the pre and post-transplantation time periodsResearch methodsDescriptive, longitudinal study of 15 mothers whose children were at least 5 years post-transplantationInstruments used: FILE, POMS, CHIP, FAD, PPUS

(Lobiondo-Wood, 2003; Lobiondo-Wood, Williams, & McGhee, 2004)

Theoretical frameworkNursing theories offer a framework for nurses to apply to their practice. The framework is the knowledge that guides nursing actions when caring for patients (Cody, 2013).Lobiondo-Woods theoryBased on Double ABCX Model by McCubbinUsed in 2000 by Van Riper to study family stress in families with a sibling with Downs syndrome (Smith & Liehr, 2003)

Theoretical framework contdRelevant today with transplant patientsEssential to teach, assess early intercessions, and provide support to families during all phases of the transplant courseWithout the framework, it would be difficult to assess family stress during transplantation

Theory in practiceNurses often care for patients and families who are faced with a stressful situation such as:SicknessDeathFinancial hardshipsStrained RelationshipsSurgeryNurses can alter patients and families perception of the stressorEducation is the key to avoid crisis and to help families cope when dealing with a crisisNurses can introduce new resources and facilitate coping and adaptation

Theory in practice contdPractice example: Patient is preparing for a complex surgeryComplex surgery is the stressorThe nurse alters the familys perception of the surgery through education and open conversationThe education that continues through the post-operative period and prior to discharge facilitates coping and adaptationThe nurse introduces new resources such as home care and physical therapy to aide in the adaptation process

Tie between theory and practiceTheory provides framework for how nurses can help families through an extended period of the liver transplantation process (Lobiondo-Wood et al., 2004)Acknowledge stress and uncertaintyEarly information dispersal and teachingAllow mother time to recognize issues in order to build rapportImportance of nursing knowledge (Lobiondo-Wood, et al., 2004)Nurses are involved for an extended periodRapport is essential to identify needs and provide interventionsHolistic approach to help patient and familyHelp families with long term aspects of care during times of uncertainty

Contributions to nursingContributions (Lobiondo-Wood et al., 2004)Maternal stress, coping, and uncertainty had significant changes over timeFamily stress did not have significant changesSupports the need for testing nursing interventions focused on education and supportEarly and long term support as needs changeFirst step towards investigation of short and long term family implications of having a child that received a transplantSet the state for further development of research based nursing interventions for children and their families

ConclusionThis presentation was designed to provide a better understanding of a middle range nursing theory, and its implications for nursing practice. We hope these findings can be a benefit to your own personal practice as you assist patients and families during stressful situations

ReferencesCody, W. (2013). Philosophical and theoretical perspectives for advanced nursing practice (5th ed.). Burlington, MA: Jones & Bartlett Learning.Fawcett, J. (2005). Contemporary nursing knowledge: Analysis and evaluation nursing models and theories (2nd ed.). Philadelphia, PA: F. A. Davis. Lobiondo-Wood, G. (2003). Theory of family stress and adaptation. In Goosby, B. J., Caldwell, C. H., Bellatorre, A., & Jackson, J. S. (2011). Ethnic differences in family stress processes among African-American and black caribbeans. Journal of African American Studies 16(3), 406-422.Lobiondo-Wood, G., Williams, L., & McGhee, C. (2004). Liver transplantation in children: Maternal and family stress, coping, and adaptation. Journal for Specialists in Pediatric Nursing 9(2), 59-66.

References contdLoBiondo-Wood, G. (2008). Theory of family stress and adaptation. InP. R. Liehr & M. J. Smith (Eds.),Middle Range Theory for Nursing (2nd ed.).(pp. 225-240). New York, NY: Springer Publishing Company.Peterson, S., & Bredow, T. (2009). Middle range theories: Application to nursing research. (2nd ed.). Philadelphia, PA: Lippincott, Williams, and Wilkins.Smith, M., & Liehr, P. (2003). Middle range theory fornursing. New York, NY: Springer Publishing Company.